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VOLUME 24 , ISSUE 5 ( May, 2023 ) > List of Articles


Inhibition of Silver Diamine Fluoride-induced Tooth Discoloration by Using Natural Antioxidant: In Vitro Study

AC Smriti Aryal, Maryam Fuad Abry, Noor Sayed Majed Salman, Zainab Mohamed Ahmed

Keywords : Alpha lipoic acid, Antioxidant, Ascorbic acid, Bonding materials, Silver diamine fluoride, Tooth discoloration

Citation Information : Aryal AS, Abry MF, Salman NS, Ahmed ZM. Inhibition of Silver Diamine Fluoride-induced Tooth Discoloration by Using Natural Antioxidant: In Vitro Study. J Contemp Dent Pract 2023; 24 (5):278-284.

DOI: 10.5005/jp-journals-10024-3512

License: CC BY-NC 4.0

Published Online: 07-07-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Aim: Silver diamine fluoride (SDF) is a well-known caries preventive aid capable of arresting carious lesions and preventing secondary caries formation. Despite having the caries prevention potential, the clinical use of SDF is limited due to the tooth discoloration caused by SDF. The objective of this study was to evaluate the efficiency of natural antioxidants to inhibit SDF-induced tooth discoloration. Materials and methods: A total of 32 bovine teeth were polished to create a 6 mm circular window on the middle 1/3 (for enamel) or on the cervical 1/3 (for dentin) of the labial surface. Specimens were treated either with SDF alone or SDF followed by ascorbic acid (AA)/alpha lipoic acid (ALA)/7th generation bonding materials. The color parameters Lightness (L*), Chroma (C*), and Hue (H*) of the tooth window were measured at pretreatment, 1-hour, 1-week, and 1-month posttreatment using a digital color chromometer. Results: Repeated measure ANOVA showed a significant tooth color alteration at 1-hour posttreatment. The L* and H* values dropped and C* value elevated significantly in 1-hour posttreatment measurement. All experimental groups showed significant tooth color alteration after treatment (p < 0.05) and were unable to reverse the discoloration even after 1-month period except the ALA group which did not show any significant (p > 0.05) color alteration compared with the pretreatment value. Conclusions: Within the limitation of the in vitro model and according to the results of this study, it can be concluded that ALA has the potential to prevent SDF-induced tooth discoloration; however, AA was unable to prevent the discoloration. Clinical significance: SDF induces discoloration of enamel and dentin can be reversed by applying Alpha lipoic acid immediacy after SDF application.

  1. Shah S, Bhaskar V, Chawla S, et al. Efficacy of silver diamine fluoride as a topical fluoride agent compared to fluoride varnish and acidulated phosphate fluoride gel: An in vivo study. J Pediatr Dent. 2014;24(5):575–581. DOI: 10.4103/2321-6646.130376.
  2. Featherstone JDB. The continuum of dental caries – evidence for a dynamic disease process. J Dent Res 2004;83(1):C39–C42. DOI: 10.1177/154405910408301s08.
  3. Manchery N, John J, Nagappan N, et al. Remineralization potential of dentifrice containing nanohydroxyapatite on artificial carious lesions of enamel: a comparative in vitro study. Dent Res J (Isfahan). 2019;16(5):310–317. DOI: 10.4103/1735-3327.266096.
  4. Soares AC, Cavalheiro A. A review of amalgam and composite longevity of posterior restorations. Rev Port Estomatol Med Dent e Cir Maxilofac. 2010;51(3):155–164. DOI: 10.1016/S1646-2890(10)70005-4.
  5. Mei ML, Chu CH, Low KH, et al. Caries arresting effect of silver diamine fluoride on dentine carious lesion with S. mutans and L. acidophilus dual-species cariogenic biofilm. Med Oral Patol Oral Cir Bucal 2013;18(6):e824–831. DOI: 10.4317/medoral.18831.
  6. Sulyanto RM, Kang M, Srirangapatanam S, et al. Biomineralization of dental tissues treated with silver diamine fluoride. J Dent Res 2021;100(10):1099–1108. DOI: 10.1177/00220345211026838.
  7. Sayed M, Matsui N, Hiraishi N, et al. Evaluation of discoloration of sound/demineralized root dentin with silver diamine fluoride: In-vitro study. Dent Mater J 2019;38(1):143–149. DOI: 10.4012/dmj.2018-008.
  8. Chu CH, Lo ECM. Promoting caries arrest in children with silver diamine fluoride: a review. Oral Health Prev Dent. 2008;6(4):315–321. PMID: 19178097.
  9. Rosenblatt A, Stamford TCM, Niederman R. Silver diamine fluoride: a caries “silver-fluoride bullet.” J Dent Res 2009; 88(2):116–125. DOI: 10.1177/0022034508329406.
  10. Quock RL, Barros JA, Yang SW, et al. Effect of silver diamine fluoride on microtensile bond strength to dentin. Oper Dent 2012;37(6):610–616. DOI: 10.2341/11-344-L.
  11. Bagher SM, Sabbagh HJ, Aljohani SM, et al. Parental acceptance of the utilization of silver diamine fluoride on their child's primary and permanent teeth. Patient Prefer Adherence 2019;13:829–835. DOI: 10.2147/PPA.S205686.
  12. Sabbagh H, Othman M, Khogeer L, et al. Parental acceptance of silver diamine fluoride application on primary dentition: a systematic review and meta-analysis. BMC Oral Health 2020;20:227. DOI: 10.1186/s12903-020-01195-3.
  13. Duangthip D, Chu CH, Lo ECM. A randomized clinical trial on arresting dentine caries in preschool children by topical fluorides – 18 month results. J Dent 2016;44:57–63. DOI: 10.1016/j.jdent.2015.05.006.
  14. Llodra JC, Rodriguez A, Ferrer B, et al. 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(8):721–724. 10.1177/154405910508400807.
  15. Haiat A, Ngo HC, Samaranayake LP, et al. 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;16:e0252734. DOI: 10.1371/journal.pone.0252734.
  16. Islam MS, Majed Salman NS, Ahmed ZM, et al. Inhibition of silver diamine fluoride induced tooth discoloration – a literature review. Int J Clin Dent 2022;15(4):707–717.
  17. Islam MS, Hiraishi N, Nassar M, et al. In vitro effect of hesperidin on root dentin collagen and de/re-mineralization. Dent Mater J. 2012;31(3):362–367. DOI: 10.4012/dmj.2011-203.
  18. Islam MS, Hiraishi N, Nassar M, et al. Effect of hesperidin incorporation into a self-etching primer on durability of dentin bond. Dent Mater 2014;30(11):1205–1212. DOI: 10.1016/
  19. Yassen GH, Platt JA, Hara AT. Bovine teeth as substitute for human teeth in dental research: a review of literature. J Oral Sci 2011;53(3):273–282. DOI: 10.2334/josnusd.53.273.
  20. Crystal YO, Janal MN, Hamilton DS, et al. Parental perceptions and acceptance of silver diamine fluoride staining. J Am Dent Assoc 2017;148(7):510–518.e4. DOI: 10.1016/j.adaj.2017.03.013.
  21. Knight GM, McIntyre JM, Mulyani. The effect of silver fluoride and potassium iodide on the bond strength of auto cure glass ionomer cement to dentine. Aust Dent J 2006;51(1):42–45. DOI: 10.1111/j.1834-7819.2006.tb00399.x.
  22. Nguyen V, Neill C, Felsenfeld J, et al. Potassium iodide. The solution to silver diamine fluoride discoloration? Adv Dent Oral Heal 2017;5(1): 1–6.
  23. Miller MB, Lopez LA, Quock RL. Silver diamine fluoride, potassium iodide, and esthetic perception: an in vitro pilot study. Am J Dent 2016;29(5):248–250. PMID: 29178735.
  24. Zhao IS, Mei ML, Burrow MF, et al. 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(2):340. DOI: 10.3390/ijms18020340.
  25. Detsomboonrat P, Thongmak P, Lertpayab P, et al. Optimal concentration of potassium iodide to reduce the black staining of silver diamine fluoride. J Dent Sci 2022;17(1):300–307. DOI: 10.1016/j.jds.2021.03.014
  26. Varvara M, Bozzo G, Celano G, et al. The use of ascorbic acid as a food additive: technical-legal issues. Ital J Food Saf 2016;5(1):4313. DOI: 10.4081/ijfs.2016.4313.
  27. Ali MA, Yusof YA, Chin NL, et al. Effect of different drying treatments on colour quality and ascorbic acid concentration of guava fruit. Int Food Res J 2016;23:S155–S161.
  28. Funieru C, Obagiu IA, Oancea R, et al. Erosive potential of three different beverages on human enamel and dentine: An in vitro Study. Rev Chim 2020;71(3):192–196. DOI: 10.37358/Rev. Chim.1949.
  29. Søvik JB, Skudutyte-Rysstad R, Tveit AB, et al. Sour sweets and acidic beverage consumption are risk indicators for dental erosion. Caries Res. 2015; 49(3):243–250. DOI: 10.1159/000371896.
  30. Gomes MB, Negrato CA. Alpha-lipoic acid as a pleiotropic compound with potential therapeutic use in diabetes and other chronic diseases. Diabetol Metab Syndr 2014; 6(1):80. DOI: 10.1186/1758- 5996-6-80.
  31. Kim KH, Lee B, Kim YR, et al. Evaluating protective and therapeutic effects of alpha-lipoic acid on cisplatin-induced ototoxicity. Cell Death Dis. 2018; 9(8):827. DOI: 10.1038/s41419-018-0888-z.
  32. Demir Ü, Demir T, Ilhan N. The protective effect of alpha-lipoic acid against oxidative damage in rabbit conjunctiva and cornea exposed to ultraviolet radiation. Ophthalmologica 2005;219(1):49–53. DOI: 10.1159/000081783.
  33. Aksoy U, Savtekin G, Şehirli A, et al. Effects of alpha-lipoic acid therapy on experimentally induced apical periodontitis: a biochemical, histopathological and micro-CT analysis. Int Endod J 2019;52(9): 1317–1326. DOI: 10.1111/iej.13121.
  34. Hamdy D, Giraki M, Abd Elaziz A, et al. Laboratory evaluation of the potential masking of color changes produced by silver diamine fluoride in primary molars. BMC Oral Health 2021;21(1):337. DOI: 10.1186/s12903-021-01697-8.
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