Remineralisation of Enamel With Silver Diamine Fluoride and Sodium Fluoride

Dent Mater. 2018 Dec;34(12):e344-e352. doi: 10.1016/ Epub 2018 Oct 25.


Objective: To evaluate the remineralising effect of the adjunctive application of 38% silver diamine fluoride (SDF) solution and 5% sodium fluoride (NaF) varnish on artificial enamel caries lesions.

Methods: Forty-eight demineralised enamel specimens were allocated into four groups. Group 1 received 38% SDF and 5% NaF; Group 2 received 38% SDF; Group 3 received 5% NaF; and Group 4 received deionized water. After pH cycling, the surface morphology and fluoride content of the specimens were studied via scanning electron microscopy (SEM)/energy dispersive spectroscopy (EDS). The lesion depth and crystal characteristics were assessed using micro-computed tomography and X-ray diffraction (XRD) respectively. The crystallization reaction was performed by incubating hydroxyapatite powder with NaF or SDF for 48h. The precipitates were studied via transmission electron microscopy (TEM) and X-ray photoelectron spectroscopy (XPS).

Results: SEM demonstrated the destruction of the enamel surface in Group 4. EDS revealed that the mean fluoride weight percentage of Groups 1-4 were 1.28±0.15, 1.33±0.19, 1.03±0.09 and 0.87±0.04 respectively. The mean lesion depths of Groups 1-4 were 129±14μm, 131±16μm, 153±10μm and 181±21μm respectively. The addition of NaF to SDF did not reduce the lesion depths (p=0.779). XRD revealed that silver chloride formed as a main product in Groups 1 and 2. Meanwhile, TEM analysis indicated that silver nanoparticles were incorporated into hydroxyapatite crystal in SDF-treated hydroxyapatite. XPS spectra suggested that the chemical state of the silver was metallic.

Significance: The adjunctive application of SDF and NaF varnish had a similar remineralising effect to that of SDF on enamel caries.

Keywords: Caries; Demineralisation; Enamel; Remineralisation; Silver diamine fluoride; Sodium fluoride.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Crystallization
  • Dental Enamel / drug effects*
  • Durapatite / chemistry
  • Fluorides, Topical / chemistry
  • Humans
  • Hydrogen-Ion Concentration
  • In Vitro Techniques
  • Microscopy, Electron, Scanning
  • Microscopy, Electron, Transmission
  • Photoelectron Spectroscopy
  • Quaternary Ammonium Compounds / chemistry*
  • Silver Compounds / chemistry*
  • Sodium Fluoride / chemistry*
  • Spectrometry, X-Ray Emission
  • Surface Properties
  • Tooth Remineralization / methods*
  • X-Ray Diffraction
  • X-Ray Microtomography


  • Fluorides, Topical
  • Quaternary Ammonium Compounds
  • Silver Compounds
  • Sodium Fluoride
  • Durapatite
  • silver diamine fluoride