Staining Outcomes of Silver Diamine Fluoride as an Adjunct in Caries Risk Assessment: A Case Series Evaluation.

Objective: To investigate the staining outcomes of Silver Diamine Fluoride (SDF) after its application on healthy enamel and its implications on patient's caries risk assessment.

Study Design: A review of dental and photographic records of 61 caries-free subjects under age 3, who received SDF application as part of a prevention protocol in a private pediatric dental clinic was performed. The age, gender, caries risk assessment and resulting staining were analyzed.

Results: Three groups of staining outcomes after SDF application were found: Group 1: no staining (32.8%). Group 2: removable staining (31.1%). Group 3: permanent staining (36.1%). The patterns of the staining were similar to initial lesion distributions in Early Childhood Caries (ECC). The deft scores for all subjects were zero before treatment and remained so at the end of this study except one subject from Group 3 who showed clinical signs of caries at follow-up visits.

Conclusions: There are three possible staining outcomes following SDF application on clinically healthy enamel for children under age three without previous caries history; no staining, removable staining and permanent staining. The patterns of the staining were similar to initial lesion distributions in ECC. SDF application may be of use in identifying previously undetected young children with high caries risk. Further research is needed to elucidate the mechanism and cause of staining and to examine the association of the staining outcomes with the future caries incidence of the subject.