Effect of Silver Diamine Fluoride as Cariostatic Agent in Irradiated Permanent Teeth
Keywords:
Silver diamine fluoride, Permanent tooth, Irradiation, RemineralizationAbstract
Background: Oral and pharyngeal cancers have a high incidence among the elderly population. Most patients receive radiotherapy as a treatment. Radiation-induced dental caries is a common long-term complication that may lead to infection of jawbone and result in risk of osteoradionecrosis. Silver diamine fluoride (SDF) at 38% concentration is effective in inhibiting formation of new caries and arrested root caries in older adults. However, there is a lack of studies examining the effects of SDF on remineralization in permanent teeth that have undergone radiotherapy and developed caries. Objective: This study aims to investigate the effects of SDF on promoting remineralization in irradiated teeth with artificial caries lesions. Method: A total of forty permanent tooth specimens were prepared. All specimens were irradiated by fractional radiation to achieve a total dose of 70 Gy and created artificial caries lesions. 20 samples in each study group were applied with silver diamine fluoride (SDF) and 1,500 ppm fluoride toothpaste. Hydroxyapatite density was quantified by X-ray microcomputed tomography (µCT35) before and after application. Mean hydroxyapatite density and the percentage of remineralization in enamel and dentin were calculated and statistically analyzed by paired t test and unpaired t test. Result: The results demonstrate that SDF and fluoride toothpaste increased mineral density in enamel and dentin after application in all experimental groups. The mineral recovery percentage in enamel was statistically different between SDF and fluoride toothpaste applications. Furthermore, the percentage of mineral recovery in dentin after SDF application was higher than that of fluoride toothpaste. Conclusion: Treatment with SDF can increase mineral density in carious lesions and promote remineralization in irradiated teeth.
References
Rojanamatin J, Ukranun W, Supaattagorn P, Chaiwiriyabunya I, Wongsena M, Chaiwerawattana A, et al., editors. Cancer in Thailand Vol.X, 2016-2018. Bangkok: Medical Record and Databaseed Cancer Unit, National Cancer Institute; 2021.
Laowahutanont P, Chotipanich A, Pitchaya P, Laoaree O, Wongmanee S, Wanglikitkoon S, et al. Cancer Registry Hospital-based 2022 [e-book]. Chonburi: Chonburi cancer hospital; 2023 [cited 2024 Aug 30]. Available from: https://www.cch.go.th/newweb/images/registry/hos/Hos-2022.pdf
Gupta N, Pal M, Rawat S, Grewal MS, Garg H, Chauhan D, et al. Radiation-induced dental caries, prevention and treatment - a systematic review. Natl J Maxillofac Surg 2015;6(2):160-6.
Weyant RJ, Tracy SL, Anselmo TT, Beltrán-Aguilar ED, Donly KJ, Frese WA, et al. Topical fluoride for caries prevention: executive summary of the updated clinical recommendations and supporting systematic review. J Am Dent Assoc 2013;144(11):1279-91.
Konjhodzic-Prcic A. Incidence of radiation caries in patients undergoing radiation therapy in the head and neck region. Pesqui Bras Em Odontopediatria E Clinica Integrada 2010;10(3):489-92.
Deng J, Jackson L, Epstein JB, Migliorati CA, Murphy BA. Dental demineralization and caries in patients with head and neck cancer. Oral Oncol 2015;51(9):824-31.
Hong CHL, Napeñas JJ, Hodgson BD, Stokman MA, Mathers-Stauffer V, Elting LS, et al. A systematic review of dental disease in patients undergoing cancer therapy. Support Care Cancer 2010;18(8):1007-21.
Hendre AD, Taylor GW, Chavez EM, Hyde S. A systematic review of silver diamine fluoride: effectiveness and application in older adults. Gerodontology 2017;34(4):411-9.
The Dental Association of Thailand. Guideline on use of fluoride in dentistry. J Dent Assoc Thai 2023;2(73): 92-103.
Sroussi HY, Epstein JB, Bensadoun RJ, Saunders DP, Lalla RV, Migliorati CA, et al. Common oral complications of head and neck cancer radiation therapy: mucositis, infections, saliva change, fibrosis, sensory dysfunctions, dental caries, periodontal disease, and osteoradionecrosis. Cancer Med 2017;6(12):2918-31.
Mei ML, Lo EC, Chu CH. Clinical use of silver diamine fluoride in dental treatment. Compend Contin Educ Dent 2016;37(2):93-8; quiz100.
Swain MV, Xue J. State of the art of Micro-CT applications in dental research. Int J Oral Sci 2009;1(4): 177-88.
Sroussi HY, Epstein JB, Bensadoun RJ, Saunders DP, Lalla RV, Migliorati CA, et al. Common oral complications of head and neck cancer radiation therapy: mucositis, infections, saliva change, fibrosis, sensory dysfunctions, dental caries, periodontal disease, and osteoradionecrosis. Cancer Med 2017;6(12):2918-31.
Anneroth G, Holm LE, Karlsson G. The effect of radiation on teeth. A clinical, histologic and microradiographic study. Int J Oral Surg 1985;14(3):269-74.
Siripamitdul P, Sivavong P, Osathanon T, Pianmee C, Sangsawatpong W, Bunsong C, et al. The effects of radiotherapy on microhardness and mineral composition of tooth structures. Eur J Dent 2023;17(2):357-64.
Rosenblatt A, Stamford TCM, Niederman R. Silver diamine fluoride: a caries "silver-fluoride bullet". J Dent Res 2009;88(2):116-25.
Lou YL, Botelho MG, Darvell BW. Reaction of silver diamine fluoride with hydroxyapatite and protein. J Dent 2011;39(9):612-8.
Mei ML, Nudelman F, Marzec B, Walker JM, Lo ECM, Walls AW, et al. Formation of fluorohydroxyapatite with silver diamine fluoride. J Dent Res 2017;96(10):1122-8.
Bannakiatkul C, Panich M. The effect of silver diamine fluoride and potassium iodideon microtensile bond strength of resin composite restorationand dentin. SWU Dent J 2021;14(1):51-63.
Zhang W, McGrath C, Lo EC, Li JY. Silver diamine fluoride and education to prevent and arrest root caries among community-dwelling elders. Caries Res 2013;47(4):284-90.
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