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Potential discolouration of silver diamine fluoride versus silver diamine fluoride/potassium iodide in primary teeth: a randomised clinical study

British Dental Journal (2022)Cite this article

Abstract

Aim This study aimed to evaluate the potential discolouration and carious lesion arresting effect of silver diamine fluoride (SDF) and silver diamine fluoride/potassium iodide (SDF/KI) in the treatment of carious primary teeth.

Materials and method A total of 30 carious primary canines were randomly assigned to treatment groups where Group I was treated with SDF while Group II was treated with SDF/KI. Caries arrest was assessed based on consistency and stability of lesion size while the discolouration of treated lesions was assessed digitally using a VITA Easyshade spectrophotometer.

Results Both treatments demonstrated 100% efficacy in arresting active caries lesions. Regarding discolouration, the total colour difference represented by delta E (ΔE) was 16.45 ± 5.69 for Group I compared to 9.54 ± 3.09 for Group II immediately post-operative, with a statistically significant difference (p = 0.003). Both groups showed similar values at 1, 3, 6 and 12 months after the treatment, with no statistically significant difference. No incidence of serious adverse effects related to either treatment and the majority of parents/guardians were satisfied with both treatments compromising their child's aesthetic appearance.

Conclusions Both SDF and SDF/KI are effective in arresting carious lesions in primary teeth but in terms of the discolouration potential, the use of KI significantly reduced the discolouration caused by SDF immediately post-operatively. Unfortunately, marked discolouration was recorded in the subsequent follow-up visits, compromising the aesthetic outcome.

Key points

  • Based on the results of our study, both silver diamine fluoride and silver diamine fluoride/potassium iodide were effective in arresting carious lesions in primary anterior teeth, but the application of potassium iodide didn't prevent the discolouration caused by silver diamine fluoride application.

  • No adverse events were reported with either materials.

  • Although parents/guardians perceived discolouration, they were open to compromise aesthetics in favour of using a less invasive approach.

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References

  1. Abdellatif H M, Ali A M, Baghdady S I, ElKateb M A. Caries arrest effectiveness of silver diamine fluoride compared to alternative restorative technique: randomized clinical trial. Eur Arch Paediatr Dent 2021; 22: 575-585.

  2. Garg S, Sadr S, Chan D. Potassium Iodide Reversal of Silver Diamine Fluoride Staining: A Case Report. Oper Dent 2019; 44: 221-226.

  3. Crystal Y O, Janal M N, Hamilton D S, Niederman R. Parental perceptions and acceptance of silver diamine fluoride staining. J Am Dent Assoc 2017; 148: 510-518.

  4. Gao S S, Amarquaye G, Arrow P et al. Global Oral Health Policies and Guidelines: Using Silver Diamine Fluoride for Caries Control. Front Oral Heal 2021; DOI: 10.3389/froh.2021.685557.

  5. Roberts A, Bradley J, Merkley S, Pachal T, Gopal J V, Sharma D. Does potassium iodide application following silver diamine fluoride reduce staining of tooth? A systematic review. Aust Dent J 2020; 65: 109-117.

  6. Sabbagh H, Othman M, Khogeer L, Al-Harbi H, Al Harthi A, Abdulgader Yaseen Abdulgader A. Parental acceptance of silver Diamine fluoride application on primary dentition: a systematic review and meta-analysis. BMC Oral Health 2020; 20: 227.

  7. Fröhlich T T, Gindri L D O, Pedrotti D, Cavalheiro C P, Soares F Z M, de Oliverira Rocha R. Evaluation of the Use of Potassium Iodide Application on Stained Demineralized Dentin Under Resin Composite Following Silver Diamine Fluoride Application. Paediatr Dent 2021; 43: 57-61.

  8. Sarkis-Onofre R, Poletto-Neto V, Cenci M S, Moher D, Pereira-Cenci T. CONSORT endorsement improves the quality of reports of randomized clinical trials in dentistry. J Clin Epidemiol 2020; 122: 20-26.

  9. Sealed Envelope Ltd. Power calculator for continuous outcome superiority trial. 2012. Available at https://www.sealedenvelope.com/power/continuous-superiority/ (accessed November 2022).

  10. Nguyen V, Neill C, Felsenfeld J, Primus C. Potassium Iodide. The Solution to Silver Diamine Fluoride Discoloration? Adv Dent Oral Heal 2017; 5: 1-6.

  11. World Medical Association Inc. Declaration of Helsinki. Ethical principles for medical research involving human subjects. J Indian Med Assoc 2009; 107: 403-405.

  12. Pitts N B, Ekstrand K, ICDAS Foundation. International Caries Detection and Assessment System (ICDAS) and its International Caries Classification and Management System (ICCMS) - methods for staging of the caries process and enabling dentists to manage caries. Community Dent Oral Epidemiol 2013; DOI: 10.1111/cdoe.12025.

  13. Clemens J, Gold J, Chaffin J. Effect and acceptance of silver diamine fluoride treatment on dental caries in primary teeth. J Public Health Dent 2018; 78: 63-68.

  14. Oliveira B H, Rajendra A, Veitz-Keenan A, Niederman R. The Effect of Silver Diamine Fluoride in Preventing Caries in the Primary Dentition: A Systematic Review and Meta-Analysis. Caries Res 2019; 53: 24-32.

  15. Haiat A, Ngo H C, Samaranayake L P, Fakhruddin K S. The effect of the combined use of silver diamine fluoride and potassium iodide in disrupting the plaque biofilm microbiome and alleviating tooth discoloration: A systematic review. PLoS One 2021; DOI: 10.1371/journal.pone.0252734.

  16. Li R, Lo E C M, Liu B Y, Wong M C M, Chu C H. Randomized clinical trial on arresting dental root caries through silver diammine fluoride applications in community-dwelling elders. J Dent 2016; 51: 15-20.

  17. Turton B, Horn R, Durward C. Caries arrest and lesion appearance using two different silver fluoride therapies with and without potassium iodide: 6-month results. Heliyon 2020; DOI: 10.1016/j.heliyon.2020.e04287.

  18. Vollú A, Rodrigues G, Rougemount Teixeira R et al. Efficacy of 30% silver diamine fluoride compared to atraumatic restorative treatment on dentine caries arrestment in primary molars of preschool children: A 12-months parallel randomized controlled clinical trial. J Dent 2019; 88: 103165.

  19. Gao S S, Zhao I S, Hiraishi N et al. Clinical Trials of Silver Diamine Fluoride in Arresting Caries among Children: A Systematic Review. JDR Clin Trans Res 2016; 1: 201-210.

  20. Rosenblatt A, Stamford T C M, Niederman R. Silver diamine fluoride: A caries 'silver-fluoride bullet'. J Dent Res 2009; 88: 116-125.

  21. Fung M H T, Duangthip D, Wong M C M, Lo E C M, Chu C H. Arresting Dentine Caries with Different Concentration and Periodicity of Silver Diamine Fluoride. JDR Clin Trans Res 2016; 1: 143-152.

  22. Mei M L, Lo E C M, Chu C H. Arresting Dentine Caries with Silver Diamine Fluoride: What's Behind It? J Dent Res 2018; 97: 751-758.

  23. Thanatvarakorn O, Islam S, Nakashima S, Sadr A, Nikaido T, Tagami J. Effects of zinc fluoride on inhibiting dentin demineralization and collagen degradation in vitro: A comparison of various topical fluoride agents. Dent Mater J 2016; 35: 769-775.

  24. Sayed M, Matsui N, Hiraishi N, Nikaido T, Burrow M F, Tagami J. Effect of Glutathione Bio-Molecule on Tooth Discoloration Associated with Silver Diammine Fluoride. Int J Mol Sci 2018; 19: 1322.

  25. AlGhazali N, Burnside G, Smith R W, Preston A J, Jarad F D. Performance assessment of Vita Easy Shade spectrophotometer on colour measurement of aesthetic dental materials. Eur J Prosthodont Restor Dent 2011; 19: 168-174.

  26. Zhao I S, Mei M L, Burrow M F, Lo E C-M, Chu C-H. Effect of Silver Diamine Fluoride and Potassium Iodide Treatment on Secondary Caries Prevention and Tooth Discolouration in Cervical Glass Ionomer Cement Restoration. Int J Mol Sci 2017; 18: 340.

  27. Gupte M, Saraf T, Jawdekar A M, Khare D S, Tiku A. A comparative analysis of staining propensity of SDF, SDF with potassium iodide and SDF with glutathione biomolecule on demineralized enamel: An in vitro study. Int J Appl Dent Sci 2021; 7: 297-301.

  28. Vennela E, Sharada J, Hasanuddin S, Suhasini K, Haemachandrika I, Singh I. Comparison of staining potential of silver diamine fluoride versus silver diamine fluoride and potassium iodide under tooth-coloured restorations: An in vitro study. J Indian Soc Pedod Prev Dent 2021; 39: 47-52.

  29. Zhao I S, Chu S, Yu O Y, Mei M L, Chu C H, Lo E C M. Effect of silver diamine fluoride and potassium iodide on shear bond strength of glass ionomer cements to caries-affected dentine. Int Dent J 2019; 69: 341-347.

  30. Miller M B, López L A, Quock R L. Silver diamine fluoride, potassium iodide, and esthetic perception: An in vitro pilot study. Am J Dent 2016; 29: 248-250.

  31. Duangthip D, Jiang M, Chu C H, Lo E C M. Non-surgical treatment of dentin caries in preschool children - systematic review. BMC Oral Health 2015; 15: 44.

  32. Duangthip D, Fung M H T, Wong M C M, Chu C H, Lo E C M. Adverse Effects of Silver Diamine Fluoride Treatment among Preschool Children. J Dent Res 2018; 97: 395-401.

  33. Chaurasiya A, Gojanur S. Evaluation of the clinical efficacy of 38% silver diamine fluoride in arresting dental caries in primary teeth and its parental acceptance. J Indian Soc Pedod Prev Dent 2021; 39: 85-89.

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Acknowledgements

The authors acknowledge the children and their parents/guardians for their co-operation in accomplishing this work.

Funding

No funding was received for conducting this study.

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Authors and Affiliations

  1. Lecturer of Paediatric Dentistry and Dental Public Health, Faculty of Dentistry, Cairo University, Egypt

    Mariam M. Aly & Yasmin M. Yousry

Authors
  1. Mariam M. Aly
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  2. Yasmin M. Yousry
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Contributions

Mariam M. Mohsen and Yasmin M. Yousry contributed to the study's conception and design, material preparation, data collection and analysis. The first draft of the manuscript was written by Mariam Mohsen and Yasmin Yousry contributed. Both authors read and approved the final manuscript.

Corresponding author

Correspondence to Mariam M. Aly.

Ethics declarations

This study was approved by the Ethics Committee of Scientific Research, Faculty of Dentistry, Cairo University with approval number 19-12-23. The research was carried out in accordance with the Declaration of Helsinki. Written informed consent to participate was obtained from the children's parents/guardians.

The authors have no relevant financial or non-financial interests to disclose.

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Aly, ., Yousry, Y. Potential discolouration of silver diamine fluoride versus silver diamine fluoride/potassium iodide in primary teeth: a randomised clinical study. Br Dent J (2022). https://doi.org/10.1038/s41415-022-5272-9

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