Nanosilver fluoride as a caries arresting agent: A narrative review

Mohammed Zameer1Orcid, Sameen Badiujjama Birajdar2Orcid, Syed Nahid Basheer3Orcid, Syed Wali Peeran4Orcid, Syed Ali Peeran5Orcid, Arun Reddy6Orcid


The current paper foregrounds the effectiveness of a non-invasive treatment approach for dental caries using caries arresting agents.
The newer nanotechnology-based caries arresting agent presents effective antibacterial properties against cariogenic bacteria and modulation of the demineralization-remineralization balance for teeth.
The silver nanoparticle-based preparations present to overcome the limitations of using silver ion-based solutions for caries arrest.


Dental caries is the most prevalent oral disease that continues to affect almost every country in the world. The contemporary management of dental caries focuses on non-restorative, non-invasive, and micro-invasive treatment approaches that arrest or reverse the caries process at a lesion level and reduce the loss of sound tooth structure. One of these approaches is the employment of caries arresting agents that possess antibacterial and remineralizing properties. Silver diamine fluoride (SDF) has drawn significant attention as an efficient caries arresting agent in children and adults. The major limitation with the use of SDF is the dark black staining of the carious tissue that compromises the esthetics. Silver ions are known for their antimicrobial effects, and silver nanoparticles (AgNPs) have the added advantage that it increases the surface area for exposure to the microbes. Literature reports that AgNPs have antimicrobial potential against predominant cariogenic flora. It has led to the development of nanosilver fluoride (NSF), a new colloid based on AgNPs, chitosan, and fluoride. It has shown to overcome the clinical limitations of SDF as it does not cause carious lesion staining. However, the current scientific literature lacks a comprehensive review of the benefits of using NSF for caries prevention and arrest. Thus, the purpose of this paper was to review the studies and clinical trials on NSF as a caries arresting agent, including antibacterial actions and modulation of the demineralization-remineralization balance.

Keywords: Dental Caries; Fluoride; Tooth Demineralization

Author Affiliations

  1. M.D.S (Pediatric Dentistry), Registrar Pedodontist, Armed Forces Hospital, Jazan, KSA (✉ Correspondence:
  2. General Dentist, Sanjeevani Dental Clinic, Raichur, India
  3. S Assistant Professor, Department of Restorative Dental Sciences, Jazan University, Jazan, KSA
  4. Senior Registrar periodontist, Armed Forces Hospital, Jazan, KSA
  5. Registrar Prosthodontist, Armed Forces Hospital, Jazan, KSA
  6. Associate Professor, Department of Oral & Maxillofacial Orthodontics, Navodaya Dental College, Raichur, India
  1. Bernabe E, Marcenes W, Hernandez CR, Bailey J, Abreu LG, et al. Global, regional, and national levels and trends in burden of oral conditions from 1990 to 2017: A Systematic Analysis for the Global Burden of Disease 2017 Study. J Dent Res 2020;99:362–373
  2. Urquhart O, Tampi MP, Pilcher L, Slayton RL, Araujo MWB, Fontana M, et al. Nonrestorative treatments for caries: systematic review and network meta-analysis. J Dent Res 2019;98:14–26
  3. Slayton RL, Urquhart O, Araujo MWB, Fontana M, Guzmán-Armstrong S, Nascimento MM, et al. Evidence-based clinical practice guideline on nonrestorative treatments for carious lesions: A report from the American Dental Association. J Am Dent Assoc 2018;149:837–849
  4. Dorri M, Dunne SM, Walsh T, Schwendicke F. Micro-invasive interventions for managing proximal dental decay in primary and permanent teeth. Cochrane Database Syst Rev 2015;5:CD010431
  5. Hendre AD, Taylor GW, Chávez EM, Hyde S. A systematic review of silver diamine fluoride: Effectiveness and application in older adults. Gerodontology 2017;34:411–419
  6. Llodra JC, Rodriguez A, Ferrer B, Menardia V, Ramos T, Morato M. Efficacy of silver diamine fluoride for caries reduction in primary teeth and first permanent molars of schoolchildren: 36-month clinical trial. J Dent Res 2005;84:721–734
  7. Oliveira BH, 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
  8. Subbiah GK, Gopinathan NM. Is silver diamine fluoride effective in preventing and arresting caries in elderly adults? A systematic review. J Int Soc Prev Community Dent 2018;8:191–199
  9. Fakhruddin KS, Egusa H, Ngo HC, Panduwawala C, Pesee S, Venkatachalam T, et al. Silver diamine fluoride (SDF) used in childhood caries management has potent antifungal activity against oral Candida species. BMC Microbiol 2020;20;95-105
  10. Karched M, Ali D, Ngo H. In vivo antimicrobial activity of silver diammine fluoride on carious lesions in dentin. J Oral Sci 2019;61:19–24
  11. Mei ML, Li Q-L, Chu C-H, Lo EC-M, Samaranayake LP. Antibacterial effects of silver diamine fluoride on multi-species cariogenic biofilm on caries. Ann Clin Microbiol Antimicrob 2013;26;12:4
  12. Fakhruddin KS, Egusa H, Ngo HC, Panduwawala C, Pesee S, Samaranayake LP. Clinical efficacy and the antimicrobial potential of silver formulations in arresting dental caries: a systematic review. BMC Oral Health 2020;20:160-170
  13. Zhao IS, Gao SS, Hiraishi N, Burrow MF, Duangthip D, Mei ML, et al. Mechanisms of silver diamine fluoride on arresting caries: a literature review. Int Dent J 2018;68:67–76
  14. Punyanirun K, Yospiboonwong T, Kunapinun T, Thanyasrisung P, Trairatvorakul C. Silver diamine fluoride remineralized artificial incipient caries in permanent teeth after bacterial pH-cycling in-vitro. J Dent 2018;69:55–59
  15. Yu OY, Zhao IS, Mei ML, Lo ECM, Chu CH. Caries-arresting effects of silver diamine fluoride and sodium fluoride on dentine caries lesions. J Dent 2018;78:65–71
  16. Mei ML, Ito L, Cao Y, Li QL, Lo ECM, Chu CH. Inhibitory effect of silver diamine fluoride on dentine demineralisation and collagen degradation. J Dent 2013;41:809–817
  17. Primus C. Potassium Iodide. The Solution to Silver Diamine Fluoride Discoloration? Adv Dent Oral Health 2017;5:555655
  18. Patel J, Anthonappa RP, King NM. Evaluation of the staining potential of silver diamine fluoride: in vitro. Int J Paediatr Dent 2018;28;514-522
  19. Crystal YO, Kreider B, Raveis VH. Parental expressed concerns about silver diamine fluoride (sdf) treatment. J Clin Pediatr Dent 2019 ;43:155–160
  20. Crystal YO, Janal MN, Hamilton DS, Niederman R. Parental perceptions and acceptance of silver diamine fluoride staining. J Am Dent Assoc 2017;148:510–518
  21. Alshammari AF, Almuqrin AA, Aldakhil AM, Alshammari BH, Lopez JNJ. Parental perceptions and acceptance of silver diamine fluoride treatment in Kingdom of Saudi Arabia. Int J Health Sci 2019;13:25–29
  22. Horst JA, Ellenikiotis H, Milgrom PM. UCSF Protocol for caries arrest using silver diamine fluoride: rationale, ındications and consent. Pedia Dent 2017;84:16–26
  23. Rosenblatt A, Stamford TCM, Niederman R. Silver diamine fluoride: a caries “silver-fluoride bullet.” J Dent Res 2009;88:116–125
  24. Zhao IS, Mei ML, Burrow MF, Lo EC-M, Chu C-H. Effect of silver diamine fluoride and potassium ıodide treatment on secondary caries prevention and tooth discolouration in cervical glass ıonomer cement restoration. Int J Mol Sci 2017;18:340-345
  25. Sayed M, Matsui N, Hiraishi N, Nikaido T, Burrow MF, Tagami J. Effect of glutathione bio-molecule on tooth discoloration associated with silver diammine fluoride. Int J Mol Sci 2018;9:1322-1330
  26. Roberts A, Bradley J, Merkley S, Pachal T, Gopal JV, Sharma D. Does potassium iodide application following silver diamine fluoride reduce staining of tooth? A systematic review. Aust Dent J 2020;65:109–117.
  27. 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;6:e04287
  28. Turton B, Horn R, Durward C. Caries arrest and lesion appearance using two different silver fluoride therapies on primary teeth with and without potassium iodide: 12-month results. Clin Exp Dent Res 2020 Dec 02. Doi:10.1002/cre2.367
  29. Espíndola-Castro LF, Rosenblatt A, Galembeck A, Monteiro G. Dentin staining caused by nano-silver fluoride: A comparative study. Oper Dent 2020;45:435–441
  30. Sayed M, Hiraishi N, Matin K, Abdou A, Burrow MF, Tagami J. Effect of silver-containing agents on the ultra-structural morphology of dentinal collagen. Dent Mater 2020;36:936–944
  31. Javan Bakht Dalir S, Djahaniani H, Nabati F, Hekmati M. Characterization and the evaluation of antimicrobial activities of silver nanoparticles biosynthesized from leaf extract. Heliyon 2020;6:e03624
  32. Mikhailov OV, Mikhailova EO. Elemental silver nanoparticles: Biosynthesis and bio applications. Materials 2019;12:3177
  33. Yin IX, Zhao IS, Mei ML, Li Q, Yu OY, Chu CH. Use of silver nanomaterials for caries prevention: A concise review. Int J Nanomedicine 2020;15:3181–3191
  34. Yin IX, Yu OY, Zhao IS, Mei ML, Li Q-L, Tang J, et al. Developing biocompatible silver nanoparticles using epigallocatechin gallate for dental use. Arch Oral Biol 2019;102:106–112
  35. Yin IX, Zhao IS, Mei ML, Lo ECM, Tang J, Li Q, et al. Synthesis and characterization of fluoridated silver nanoparticles and their potential as a non-staining anti-caries agent. Int J Nanomedicine 2020;15:3207–3215
  36. Tirupathi S, Svsg N, Rajasekhar S, Nuvvula S. Comparative cariostatic efficacy of a novel Nano-silver fluoride varnish with 38% silver diamine fluoride varnish a double-blind randomized clinical trial. J Clin Exp Dent 2019;11:105–112
  37. Burns J, Hollands K. Nano silver fluoride for preventing caries. Evid Based Dent 2015;16:8–9
  38. Santos VE dos Jr, Vasconcelos Filho A, Targino AGR, Flores MAP, Galembeck A, Caldas AF Jr, et al. A new “silver-bullet” to treat caries in children–nano silver fluoride: a randomised clinical trial. J Dent 2014;42:945–951
  39. Baker C, Pradhan A, Pakstis L, Pochan DJ, Shah SI. Synthesis and antibacterial properties of silver nanoparticles. J Nanosci Nanotechnol 2005;5:244–249
  40. Morones JR, Elechiguerra JL, Camacho A, Holt K, Kouri JB, Ramírez JT, et al. The bactericidal effect of silver nanoparticles. Nanotechnology 2005;16:2346–2353
  41. Targino AGR, Flores MAP, dos Santos Junior VE, de Godoy Bené Bezerra F, de Luna Freire H, Galembeck A, et al. An innovative approach to treating dental decay in children. A new anti-caries agent J Mater Sci Mater Med 2014;10: 2041–2047
  42. Teixeira JA, Silva AVCE, Dos Santos Júnior VE, de Melo Júnior PC, Arnaud M, Lima MG, et al. Effects of a new nano-silver fluoride-containing dentifrice on demineralization of enamel and adhesion and acidogenicity. Int J Dent 2018;2018:1351925
  43. Silva AVC, Amitis Vieira Costa, Teixeira JA, Cláudia C B, Emery Clayton Cabral, de Melo Júnior PC, et al. In Vitro morphological, optical and microbiological evaluation of nanosilver fluoride in the remineralization of deciduous teeth enamel Nanotechnol Rev 2018;7:509–520
  44. Freire PLL, Albuquerque AJR, Sampaio FC, Galembeck A, Flores MAP, Stamford TCM, et al. AgNPs: The new allies against s. mutans biofilm – a pilot clinical trial and microbiological assay. Braz Dent J 2017;28:417–422
  45. Silva AVC, Amitis Vieira Costa, de Araújo Teixeira J, de Melo Júnior PC, de Souza Lima MG, de Oliveira Mota CCB, et al. Remineralizing potential of nano-silver-fluoride for tooth enamel: An optical coherence tomography analysis. Pesqui Bras Odontopediatria Clin Integr 2019;19: 1–13
  46. Nozari A, Ajami S, Rafiei A, Niazi E. Impact of nano hydroxyapatite, nano silver fluoride and sodium fluoride varnish on primary teeth enamel remineralization: An ın vitro study. J Clin Diagn Res 2017;11:97–100
  47. Akyildiz M, Sönmez IS. Comparison of remineralising potential of nano silver fluoride, silver diamine fluoride and sodium fluoride varnish on artificial caries: an ın vitro study. Oral Health Prev Dent 2019;17:469–477
  48. Zhao IS, Yin IX, Mei ML, Lo ECM, Tang J, Li Q, et al. Remineralising dentine caries using sodium fluoride with silver nanoparticles: An ın vitro study. Int J Nanomedicine 2020;15:2829–2839
  49. Chu CH, Lo ECM, Lin HC. Effectiveness of silver diamine fluoride and sodium fluoride varnish in arresting dentin caries in Chinese pre-school children. J Dent Res 2002;81:767–770
  50. Nagireddy VR, Reddy D, Kondamadugu S, Puppala N, Mareddy A, Chris A. Nanosilver fluoride-A paradigm shift for arrest in dental caries in primary teeth of schoolchildren: A randomized controlled clinical trial. Int J Clin Pediatr Dent 2019;12:484–490
  51. Westland S, Luo W, Li Y, Pan Q, Joiner A. Investigation of the perceptual thresholds of tooth whiteness. J Dent 2017;67:11–14
  52. Zander HA. use of silver nitrate in the treatment of caries. J Am Dent Assoc 1941;28:1260–1267
  53. Crystal YO, Niederman R. Evidence-based dentistry update on silver diamine fluoride. Dent Clin North Am 2019;63:45–68
  54. Köhler W. WD Miller. The micro-organisms of the human mouth 1974;14:84–84
  55. Muntz JA, Dorfman A, Stephan RM. In vitro studies on sterilization of carious dentin. Evaluation of germicides. J Am Dent Assoc 1943;30:1893–900
  56. Gao SS, Zhao IS, Duffin S, Duangthip D, Lo ECM, Chu CH. Revitalising silver nitrate for caries management. Int J Environ Res Public Health 2018;15:80-85
  57. Yamaga R, Nishino M, Yoshida S, Yokomizo I. Diammine silver fluoride and its clinical application. J Osaka Univ Dent Sch 1972;12:1–20
  58. Thibodeau EA, Handelman SL, Marquis RE. Inhibition and killing of oral bacteria by silver ıons generated with low ıntensity direct current. J Dent Res 1978;57:922–926
  59. Craig GG, Powell KR, Cooper MH. Caries progression in primary molars: 24-month results from a minimal treatment programme. Community Dent Oral Epidemiol 1981;9:260–265
  60. Craig GG, Powell KR, Cooper MH. Clinical appearance of permanent successors after nonextraction treatment of grossly carious primary molars in highly anxious children. ASDC J Dent Child 1987;54:170–175
  61. Green E. A clinical evaluation of two methods of caries prevention in newly-erupted first permanent molars. Aust Dent J 1989;34: 407–419
  62. Yee R, Holmgren C, Mulder J, Lama D, Walker D, van Palenstein Helderman W. Efficacy of silver diamine fluoride for arresting caries treatment. J Dent Res 2009;88:644–657
  63. Zhi QH, Lo ECM, Lin HC. Randomized clinical trial on effectiveness of silver diamine fluoride and glass ionomer in arresting dentine caries in preschool children. J Dent 2012;40:962–967
  64. Zhang W, McGrath C, Lo ECM, Li JY. Silver diamine fluoride and education to prevent and arrest root caries among community-dwelling elders. Caries Res. 2013;47:284–290
  65. Dos Santos VE Jr, de Vasconcelos FMN, Ribeiro AG, Rosenblatt A. Paradigm shift in the effective treatment of caries in schoolchildren at risk. Int Dent J 2012;62:47–51
  66. Jabin Z, Vishnupriya V, Agarwal N, Nasim I, Jain M, Sharma A. Effect of 38% silver diamine fluoride on control of dental caries in primary dentition: A systematic review. J Family Med Prim Care 2020;9:1302–1307
  67. de Almeida L de FD, Cavalcanti YW, Valença AMG. In vitro antibacterial activity of silver diamine fluoride in different concentrations. Acta Odontol Latinoam 2011;24:127–131
  68. Mei ML, Ito L, Cao Y, Lo ECM, Li QL, Chu CH. An ex vivo study of arrested primary teeth caries with silver diamine fluoride therapy. J Dent 2014;42:395–402
  69. Chu C-H, Lee AH-C, Zheng L, Mei ML, Chan GC-F. Arresting rampant dental caries with silver diamine fluoride in a young teenager suffering from chronic oral graft versus host disease post-bone marrow transplantation: A case report. BMC Res Notes 2014:7:3-10
  70. Corrêa JM, Mori M, Sanches HL, da Cruz AD, Poiate E, Isis Andréa Venturini. Silver Nanoparticles in Dental Biomaterials. Int J Biomater 2015;1:1-9

Article Info

Contemp Pediatr Dent 2021:2(1):1-13

Received: 27 March 2021

Accepted: 05 May 2021

Online First: 05 May 2021


Full Text

File Downloads
pdf CPD_2021_47 2541

How to Cite

					Mohammed Zameer, Sameen Badiujjama Birajdar, Syed Wali Peeran, Syed Nahid Basheer, Syed Ali Peeran, and Arun Reddy. Nanosilver fluoride as a caries arresting agent: A narrative review. Contemp Pediatr Dent 2021:2(1):1-13

Related Articles

Share Article

Under a Creative Commons license