Effect of 38% Silver Diamine Fluoride on the Discoloration of Sound Primary and Permanent Enamel: A Spectrophotometric Study
Abstract
Objectives: Silver diamine fluoride (SDF) is widely recognized as an effective, minimally invasive agent for caries management. Despite its cariostatic and preventive benefits, the main drawback is the dark discoloration of dental hard tissues. This in vitro study aimed to evaluate the discoloration potential of 38% SDF on sound enamel surfaces of primary and permanent teeth, and to assess the mitigating effects of potassium iodide (KI) and post-treatment rinsing.
Materials and Methods: A total of 120 extracted molars (primary and permanent, n = 60 each) with intact enamel were randomly allocated into eight groups (n = 15) according to treatment protocol: SDF without rinsing, SDF with rinsing, SDF + KI without rinsing, and SDF + KI with rinsing. Color measurements (CIE Lab* system) were recorded using a spectrophotometer at baseline, immediately after application, 24 hours, 72 hours, and 1 week. Color change (ΔE) values were calculated, with ΔE ≥ 3.7 considered clinically perceptible. Statistical analysis was performed with significance set at p< 0.05.
Results: SDF without rinsing produced the greatest discoloration in both dentition types (p < 0.001), with ΔE values exceeding the perceptibility threshold at all time points. The combination of SDF + KI followed by rinsing resulted in the lowest ΔE values, remaining below clinical significance during early intervals. Groups treated with KI alone or rinsing alone exhibited intermediate levels of staining, without significant differences between them (p > 0.05). Permanent teeth generally showed more pronounced darkening than primary teeth.
Conclusions: Within the limitations of this in vitro study, 38% SDF caused clinically perceptible discoloration on sound enamel of both primary and permanent teeth, especially without rinsing. The adjunctive use of KI with immediate rinsing effectively minimized staining. Clinicians should exercise caution when applying SDF to esthetically sensitive areas, and inform patients or caregivers of potential discoloration risks.
Keywords
Silver Diamine Fluoride Potassium Iodide Tooth Discoloration Primary Dentition Permanent Dentition
Ethical Statement
The experimental procedures were approved by the Scientific Research Ethics Committee of the University of Lokman Hekim (Protocol No:2025/009).
Supporting Institution
There are no individuals, grants, funds, or conflicts of interest relevant to this work. This was a self-financed study.
Thanks
Acknowledgments: There are no individuals, grants, funds, or conflicts of interest relevant to this work.
References
- 1. World Health Organization. WHO model list of essential medicines – 23rd list. Geneva: World Health Organization; 2023.
- 2. American Academy of Pediatric Dentistry. Fluoride therapy. In: The Reference Manual of Pediatric Dentistry. Chicago (IL): Wiley 2023:352-358.
- 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. Gao SS, Zhao IS, Hiraishi N, Duangthip D, Mei ML, Lo ECM, et al. Clinical trials of silver diamine fluoride in arresting caries among children: a systematic review. JDR Clin Trans Res 2016;1:201-210.
- 5. Gao SS, Amarquaye G, Arrow P, Bansal K, Bedi R, Campus G, et al. Global oral health policies and guidelines: using silver diamine fluoride for caries control. Front Oral Health 2021;2:685557.
- 6. Horst JA, Heima M. Prevention of dental caries by silver diamine fluoride. Compend Contin Educ Dent 2019;40:158-163.
- 7. Ericson D, Kidd E, McComb D, Mjör I, Noack MJ. Minimally invasive dentistry—concepts and techniques in cariology. Oral Health Prev Dent 2003;1:59-72.
- 8. Ballikaya E, Ünverdi GE, Cehreli ZC. Management of initial carious lesions of hypomineralized molars (MIH) with silver diamine fluoride or silver-modified atraumatic restorative treatment (SMART): 1-year results of a prospective, randomized clinical trial. Clin Oral Investig 2022;26:2197-2205.
- 9. Liu BY, Lo ECM, Chu CH, Lin HC. Randomized trial on fluorides and sealants for fissure caries prevention. J Dent Res 2012;91:753-758.
- 10. Nishino M, Ono S, Kita Y, Tsuchitani Y. Caries prevention in pits and fissures with diammine silver fluoride solution and fissure sealant. J Osaka Univ Dent Sch 1974;14:1-7.
- 11. Yamaga R, Nishino M, Yoshida S, Yokomizo I. Diamine silver fluoride and its clinical application. J Osaka Univ Dent Sch 1972;12:1-20.
- 12. 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.
- 13. Sultan A, Uppal S, Siddiqui M, Deka PB, Mehta A, Juneja A. Assessment of parental perception and clinical efficacy of silver diamine fluoride application in primary dentition: a prospective study. Cumhuriyet Dent J 2025;28:315-321.
- 14. 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.e4.
- 15. Lou YL, Botelho MG, Darvell BW. Reaction of silver diamine fluoride with hydroxyapatite and protein. J Dent 2011;39:612-618.
- 16. Almuqrin A, Kaur IP, Walsh LJ, Seneviratne CJ, Zafar S. Amelioration strategies for silver diamine fluoride: moving from black to white. Antibiotics 2023;12:298.
- 17. 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.
- 18. Shah S, Bhaskar V, Venkatraghavan K, Choudhary P, Mahadevan G, Trivedi K. Silver diamine fluoride: a review and current applications. J Adv Oral Res 2014;5:25-35.
- 19. Sayed M, Matsui N, Hiraishi N, Inoue G, Nikaido T, Burrow MF, et al. Evaluation of discoloration of sound/demineralized root dentin with silver diamine fluoride: in vitro study. Dent Mater J 2019;38:143-149.
- 20. Hamdy D, Giraki M, Abd Elaziz A, Badran A, Allam G, Ruettermann S. Laboratory evaluation of the potential masking of color changes produced by silver diamine fluoride in primary molars. BMC Oral Health 2021;21:337.
- 21. Cömert H, Olmez A. Effects of glutathione and potassium iodide on silver diamine fluoride application on remineralisation and colour change in dentine caries of primary teeth: an in vitro study. Eur Arch Paediatr Dent 2025;26:169-181.
- 22. Albar N, Basheer SN, Moaleem MMA, Ageel S, Abbas R, Hakami R, et al. Color masking ability of guided enamel regeneration with a novel self-assembling peptide and resin infiltration on artificial enamel lesions under various challenges: an in vitro spectrophotometric analysis. Biomimetics (Basel) 2024;9:764
- 23. Oncu A, Ozdemir M. Evaluating the impact of material type and blood contamination on tooth color stability post external cervical root resorption repair: a spectrophotometric study. BMC Oral Health 2025;25:784.
- 24. Aly MM, Yousry YM. Potential discolouration of silver diamine fluoride versus silver diamine fluoride/potassium iodide in primary teeth: a randomised clinical study. Br Dent J 2022;232:1-6.
- 25. Yılmaz N, Ocak M, Ökte Z. Remineralization of primary molar dentine with silver diamine fluoride and sodium fluoride: an in vitro study. Cumhuriyet Dent J 2020;23:340-347.
- 26. Tsai ATP, Chan HC, Chang YH, Kupietzky A. Staining outcomes of silver diamine fluoride as an adjunct in caries risk assessment: a case series evaluation. J Clin Pediatr Dent 2022;46:6-11.
- 27. Nguyen V, Neill C, Felsenfeld C, Primus P. Potassium iodide: the solution to silver diamine fluoride discoloration? Adv Dent Oral Health 2017;5:555655.
- 28. Zheng FM, Yan IG, Duangthip D, Gao SS, Lo ECM, Chu CH. Silver diamine fluoride therapy for dental care. Jpn Dent Sci Rev 2022;58:249-257.
38% Gümüş Diamin Florürün Sağlam Süt ve Daimi Mine Üzerindeki Renklenme Etkisi: Spektrofotometrik Bir İn Vitro Çalışma
Abstract
Amaç: Gümüş diamin florür (SDF), çürük yönetiminde etkili, minimal invaziv bir ajan olarak yaygın şekilde kullanılmaktadır. Ancak, sahip olduğu çürük önleyici ve tedavi edici avantajlarına rağmen, en önemli dezavantajı dental sert dokularda oluşturduğu koyu renklenmedir. SDF’nin sağlam mine dokusunda renklenmeye neden olma potansiyeline ilişkin kanıtlar sınırlı olup, özellikle süt ve daimi dişler arasında karşılaştırmalı veriler yetersizdir. Bu çalışmanın amacı, %38 SDF’nin sağlam süt ve daimi mine yüzeylerinde oluşturduğu renklenme potansiyelini değerlendirmek ve potasyum iyodür (KI) ile uygulama sonrası durulamanın etkisini incelemektir.
Gereç ve Yöntemler: Klinik olarak sağlam mineye sahip toplam 120 çekilmiş molar diş (60 süt, 60 daimi) rastgele sekiz gruba (n=15) ayrıldı: SDF durulama yapılmadan, SDF durulama ile, SDF + KI durulama yapılmadan ve SDF + KI durulama ile. Renk ölçümleri (CIE Lab* sistemi) spektrofotometre ile başlangıçta, uygulamadan hemen sonra, 24 saat, 72 saat ve 1 hafta sonra yapıldı. Renk değişimi (ΔE) değerleri hesaplandı ve ΔE ≥ 3.7 klinik olarak fark edilebilir eşik olarak kabul edildi. İstatistiksel anlamlılık p < 0.05 düzeyinde değerlendirildi.
Bulgular: SDF’nin durulama yapılmadan uygulandığı gruplarda her iki diş tipinde de en yüksek renklenme gözlendi (p < 0.001) ve tüm zaman noktalarında ΔE değerleri eşik değerin üzerinde bulundu. SDF + KI uygulamasını takiben yapılan durulama, en düşük ΔE değerlerini verdi ve erken dönemlerde klinik açıdan anlamlılık eşiğinin altında kaldı. Yalnızca KI ya da yalnızca durulama uygulanan gruplar orta düzeyde renklenme gösterdi ve aralarında anlamlı fark bulunmadı (p > 0.05). Daimi dişlerdeki renklenme süt dişlerine kıyasla daha belirgindi.
Sonuçlar: Bu in vitro çalışmanın sınırlılıkları dahilinde, %38 SDF hem süt hem de daimi sağlam mine üzerinde klinik olarak fark edilebilir renklenmeye yol açmıştır, özellikle de durulama yapılmadığında. KI’nin ek olarak kullanılması ve hemen ardından yapılan durulama renklenmeyi etkin biçimde azaltmıştır. Klinik uygulamalarda, özellikle estetik açıdan önemli bölgelerde dikkatli olunmalı ve olası renklenme riski konusunda hasta ve ebeveynler bilgilendirilmelidir.
Ethical Statement
Bu çalışma kapsamında uygulanan deneysel prosedürler, Lokman Hekim Üniversitesi Bilimsel Araştırmalar Etik Kurulu tarafından onaylanmıştır (Protokol No: 2025/009)
Supporting Institution
Bu çalışma ile ilişkili herhangi bir kişi, hibe, fon veya çıkar çatışması bulunmamaktadır. Çalışma kendi imkânlarımızla finanse edilmiştir
Thanks
Bu çalışma ile ilişkili herhangi bir kişi, hibe, fon veya çıkar çatışması bulunmamaktadır.
References
- 1. World Health Organization. WHO model list of essential medicines – 23rd list. Geneva: World Health Organization; 2023.
- 2. American Academy of Pediatric Dentistry. Fluoride therapy. In: The Reference Manual of Pediatric Dentistry. Chicago (IL): Wiley 2023:352-358.
- 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. Gao SS, Zhao IS, Hiraishi N, Duangthip D, Mei ML, Lo ECM, et al. Clinical trials of silver diamine fluoride in arresting caries among children: a systematic review. JDR Clin Trans Res 2016;1:201-210.
- 5. Gao SS, Amarquaye G, Arrow P, Bansal K, Bedi R, Campus G, et al. Global oral health policies and guidelines: using silver diamine fluoride for caries control. Front Oral Health 2021;2:685557.
- 6. Horst JA, Heima M. Prevention of dental caries by silver diamine fluoride. Compend Contin Educ Dent 2019;40:158-163.
- 7. Ericson D, Kidd E, McComb D, Mjör I, Noack MJ. Minimally invasive dentistry—concepts and techniques in cariology. Oral Health Prev Dent 2003;1:59-72.
- 8. Ballikaya E, Ünverdi GE, Cehreli ZC. Management of initial carious lesions of hypomineralized molars (MIH) with silver diamine fluoride or silver-modified atraumatic restorative treatment (SMART): 1-year results of a prospective, randomized clinical trial. Clin Oral Investig 2022;26:2197-2205.
- 9. Liu BY, Lo ECM, Chu CH, Lin HC. Randomized trial on fluorides and sealants for fissure caries prevention. J Dent Res 2012;91:753-758.
- 10. Nishino M, Ono S, Kita Y, Tsuchitani Y. Caries prevention in pits and fissures with diammine silver fluoride solution and fissure sealant. J Osaka Univ Dent Sch 1974;14:1-7.
- 11. Yamaga R, Nishino M, Yoshida S, Yokomizo I. Diamine silver fluoride and its clinical application. J Osaka Univ Dent Sch 1972;12:1-20.
- 12. 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.
- 13. Sultan A, Uppal S, Siddiqui M, Deka PB, Mehta A, Juneja A. Assessment of parental perception and clinical efficacy of silver diamine fluoride application in primary dentition: a prospective study. Cumhuriyet Dent J 2025;28:315-321.
- 14. 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.e4.
- 15. Lou YL, Botelho MG, Darvell BW. Reaction of silver diamine fluoride with hydroxyapatite and protein. J Dent 2011;39:612-618.
- 16. Almuqrin A, Kaur IP, Walsh LJ, Seneviratne CJ, Zafar S. Amelioration strategies for silver diamine fluoride: moving from black to white. Antibiotics 2023;12:298.
- 17. 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.
- 18. Shah S, Bhaskar V, Venkatraghavan K, Choudhary P, Mahadevan G, Trivedi K. Silver diamine fluoride: a review and current applications. J Adv Oral Res 2014;5:25-35.
- 19. Sayed M, Matsui N, Hiraishi N, Inoue G, Nikaido T, Burrow MF, et al. Evaluation of discoloration of sound/demineralized root dentin with silver diamine fluoride: in vitro study. Dent Mater J 2019;38:143-149.
- 20. Hamdy D, Giraki M, Abd Elaziz A, Badran A, Allam G, Ruettermann S. Laboratory evaluation of the potential masking of color changes produced by silver diamine fluoride in primary molars. BMC Oral Health 2021;21:337.
- 21. Cömert H, Olmez A. Effects of glutathione and potassium iodide on silver diamine fluoride application on remineralisation and colour change in dentine caries of primary teeth: an in vitro study. Eur Arch Paediatr Dent 2025;26:169-181.
- 22. Albar N, Basheer SN, Moaleem MMA, Ageel S, Abbas R, Hakami R, et al. Color masking ability of guided enamel regeneration with a novel self-assembling peptide and resin infiltration on artificial enamel lesions under various challenges: an in vitro spectrophotometric analysis. Biomimetics (Basel) 2024;9:764
- 23. Oncu A, Ozdemir M. Evaluating the impact of material type and blood contamination on tooth color stability post external cervical root resorption repair: a spectrophotometric study. BMC Oral Health 2025;25:784.
- 24. Aly MM, Yousry YM. Potential discolouration of silver diamine fluoride versus silver diamine fluoride/potassium iodide in primary teeth: a randomised clinical study. Br Dent J 2022;232:1-6.
- 25. Yılmaz N, Ocak M, Ökte Z. Remineralization of primary molar dentine with silver diamine fluoride and sodium fluoride: an in vitro study. Cumhuriyet Dent J 2020;23:340-347.
- 26. Tsai ATP, Chan HC, Chang YH, Kupietzky A. Staining outcomes of silver diamine fluoride as an adjunct in caries risk assessment: a case series evaluation. J Clin Pediatr Dent 2022;46:6-11.
- 27. Nguyen V, Neill C, Felsenfeld C, Primus P. Potassium iodide: the solution to silver diamine fluoride discoloration? Adv Dent Oral Health 2017;5:555655.
- 28. Zheng FM, Yan IG, Duangthip D, Gao SS, Lo ECM, Chu CH. Silver diamine fluoride therapy for dental care. Jpn Dent Sci Rev 2022;58:249-257.
Details
| Primary Language | English |
|---|---|
| Subjects | Paedodontics, Dental Materials |
| Journal Section | Research Article |
| Authors | |
| Submission Date | October 1, 2025 |
| Acceptance Date | December 8, 2025 |
| Publication Date | March 27, 2026 |
| DOI | https://doi.org/10.7126/cumudj.1794805 |
| IZ | https://izlik.org/JA53SF48MM |
| Published in Issue | Year 2026 Volume: 29 Issue: 1 |
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