Physicochemical properties, biological chemistry and mechanisms of action of caries-arresting diammine-silver(I) fluoride and silver(I)-fluoride solutions for clinical use: a critical review.

This paper serves as a Part II follow-up of our research investigations performed on the molecular structures of silver(I)-fluoride (SF) and diammine-silver(I) fluoride (SDF) complexes in solution-based commercial products for clinical application, their precise chemical compositions, and their nature in aqueous solution, the latter including rapid fluoride-exchange processes at the silver(I) ion centre monitored by F NMR analysis (Part I). Part I of this series also explores the mechanisms of action (MoA) of these complexes, and is therefore largely focused on their chemical reactions with constituents of human saliva, which has access to their sites of application. Such reactions were found to slowly promote the generation of potentially physiologically-active Ag/AgCl nanoparticles from primarily-generated discoloured silver(I) chloride (AgCl) precipitates, a process involving salivary electron-donors such as thiocyanate and L-cysteine.

Back to the future: the medical management of caries introduction.

Based on the literature, a protocol was developed involving the application of 25 percent silver nitrate directly to cavitated caries lesions, immediately followed by 5 percent sodium fluoride varnish. This protocol results in arrest of active caries lesions. This minimally invasive treatment is well-accepted by patients and reduces anxieties related to dental office visits.

Managing caries in the high-risk child.

Dentists often report that treating children in their practices is either the most rewarding or the most challenging of all their professional experiences. Special considerations must be made for the biology of the caries process, the psychological development of the child, parental involvement, the complex environmental factors that contribute to caries, and the wide variety of clinical treatment options available. Caries management by risk assessment (CAMBRA) is becoming the standard of care for dental professionals.