An innovative approach to treating dental decay in children. A new anti-caries agent

Caries prevention effects of nano silver fluoride sustained release orthodontic elastomerics in dental microcosm biofilms

OBJECTIVES

To evaluate the clinical applicability of nano silver fluoride sustained release orthodontic elastomerics (NSF-RE) by investigating its effects on inhibiting biofilm formation and enamel demineralization using dental microcosm biofilms.

METHODS

Two types of 23 % NSF coating solutions were prepared depending on the presence or absence of the plasticizer (polyethylene glycol [PEG] 6000: NSF-EP and NSF-E); the elastomerics were dip-coated individually with these. Biofilms were allowed to form on bovine enamel specimens with the elastomerics. Biofilm maturity (red/green ratio) was measured. After 7 days, biofilm thickness, live/dead cell ratio, and cell viability were evaluated. Microbiome taxonomic profiling was conducted on days 3 and 7. Mineral loss beneath the biofilm was quantified from fluorescence loss (ΔF) and ΔFmax values obtained. Demineralization at varying distances from the specimen center was evaluated based on the difference in ΔF between the control and experimental groups.

RESULTS

The NSF-EP (elastomerics treated with NSF coating containing PEG) had a 6.7 % significantly lower R/G ratio from day 3 and a 36.1 % thinner biofilm compared to the negative control with uncoated elastomerics. In the NSF-EP group, cell viability assessments indicated reductions in total and aciduric bacterial counts by 9.4 % and 13.0 %, respectively. NSF-EP also had the lowest relative abundance of five caries-related bacteria. Additionally, NSF-EP significantly increased ΔF and ΔFmax by 34.8 % and 38.7 %, respectively, indicating reduced mineral loss. Demineralization did not differ according to distance from the elastomerics.

CONCLUSION

NSF-RE significantly reduces biofilm formation and demineralization, offering a promising caries prevention strategy in orthodontic patients.

CLINICAL SIGNIFICANCE

By inhibiting both biofilm formation and demineralization, NSF-RE provides a dual-function approach that may effectively prevent dental caries in orthodontic patients.

Evaluation of the cytotoxicity of new formulations of cariostatic agents containing nano silver fluoride: an in vitro study

The objective of the study was to assess the indirect cytotoxicity of 600 ppm and 1500 ppm nano silver fluoride (NSF) compared to other commercial cariostatic agents. 56 dentin discs with 0.4 mm in thickness were obtained from intact human molars and adapted to artificial pulp chambers (APCs). The discs were divided into seven groups according to treatment (n = 8): no treatment (positive control-PC), 29% hydrogen peroxide (negative control-NC), 30% Cariestop (CS30), 38% Riva Star (RS38), 38% Advantage Arrest (AA38), 600 ppm NSF (NSF600), and 1500 ppm NSF (NSF1500). The cariostatic agents were applied on the occlusal surface of the dentin discs (facing upward), and the pulp surface (facing downward) remained in contact with the culture medium. Immediately after the treatments, the extracts (DMEM + cariostatic agent components diffused through the discs) were collected and applied to MDPC-23 cells, which were assessed for viability (CV-alamarBlue, live/dead), adhesion/spreading (F-actin), alkaline phosphatase (ALP) activity, and mineralization nodule (MN) formation. The data were statistically analyzed by ANOVA/Games-Howell (p = 0.05). CV and ALP activity in CS30, RS38, AA38, and NSF600 were similar to PC (p > 0.05). MN formation significantly decreased only in NC, CS30, RS38, and AA38 compared to PC (p < 0.001). Only NSF600 and NSF1500 did not differ from PC (p > 0.05) with mineralization nodules, and this specific cell activity significantly decreased in all other groups (p < 0.05). NSF solutions (600 ppm and 1500 ppm) did not cause transdentinal toxicity on MDPC-23 cells.

Synergistic effect of nanosilver fluoride with L-arginine on remineralization of early carious lesions

The synergistic effect of nanosilver fluoride (NSF) with L-arginine on early carious lesions was evaluated. NSF was synthesized from chitosan, acetic acid, silver nitrate, sodium borohydride, and sodium fluoride. NSF + Arg was synthesized by adding L-arginine. After demineralization the enamel slabs from extracted molar, remineralization agents were applied by randomly dividing them into five groups (n = 15): sodium fluoride varnish (NaF), silver diamine fluoride (SDF), NSF, NSF + Arg, and control. The surface microhardness (SMH), remineralization effects using microcomputed tomography and color changes using a spectrophotometer were measured before and after pH cycling. SMH was analyzed by Kruskal-Wallis test with Dunn's test. Remineralization effects, and color changes were analyzed using the one-way analysis of variance with Duncan's test; p-value < 0.05 was considered significant. SMH recovered to similar levels in all groups (p > 0.05), except in the control group after pH cycling. The NSF + Arg and SDF groups showed a higher remineralization than the NaF and NSF groups (p < 0.05). SDF caused the largest discoloration (p < 0.05). The other groups showed no difference in discoloration. NSF + Arg could be an alternative to SDF given its ability to remineralize early caries lesions without discoloration.

Nanomaterial-based synergistic strategies for combating dental caries: progress and perspectives

Dental caries, as the predominant global oral disease, remains a critical public health issue worldwide, particularly in socioeconomically disadvantaged communities. However, common caries prevention approaches (e.g., oral health education, mechanical plaque removal, and delivery of fluoride agents) are still insufficient for optimal caries management, and therefore, alternative regimens that can supplement existing strategies are highly warranted. Nanomaterials exhibit considerable potential in combating cariogenic pathogens and biofilms owing to their promising antimicrobial capacity, improved penetration into biofilms, targeted precision delivery, and versatile physicochemical properties. As unifunctional materials are limited in caries management, this review underscores the latest advancement in multifunctional anti-caries nanomaterials/nanomedicines. It highlights the cutting-edge materials developed or engineered to (i) incorporate diagnostic capabilities to prevent caries at an early stage, thus enhancing treatment efficiency, (ii) integrate mechanical "brushing" with anti-caries approaches to mechanochemically eradicate biofilms, (iii) exert antimicrobial/antibiofilm effects while preserving dental hard tissue. The current work also outlines future directions for optimizing nanosystems in the management of dental caries while emphasizing the need for innovative solutions to improve preventive and therapeutic efficacies.

Silver nanoparticles versus chitosan nanoparticles effects on demineralized enamel

BACKGROUND

To compare the impacts of different remineralizing agents on demineralized enamel, we focused on chitosan nanoparticles (ChiNPs) and silver nanoparticles (AgNPs).

METHODS

This study was conducted on 40 extracted human premolars with artificially induced demineralization using demineralizing solution. Prior to the beginning of the experimental procedures, the samples were preserved in artificial saliva solution. The nanoparticles were characterized by transmission electron microscopy (TEM) and teeth were divided into four equal groups: Group A was utilized as a control group (no demineralization) and received no treatment. Group B was subjected to demineralization with no treatment. Group C was subjected to demineralization and then treated with ChiNPs. Group D was subjected to demineralization and then treated with AgNPs. The teeth were evaluated for microhardness. The enamel surfaces of all the samples were analysed by scanning electron microscopy (SEM) for morphological changes and energy dispersive X-ray analysis (EDX) for elemental analysis.

RESULTS

The third and fourth groups had the highest mean microhardness and calcium (Ca) and phosphorous (P) contents. SEM of these two groups revealed relative restoration of homogenous remineralized enamel surface architecture with minimal micropores.

CONCLUSION

Chitosan nanoparticles (NPs) and silver NPs help restore the enamel surface architecture and mineral content. Therefore, chitosan NPs and AgNPs would be beneficial for remineralizing enamel.

The Effectiveness of Remineralization with Compound Silver Nanoparticles and Fluoride Varnish in Carious Lesions in Primary Teeth: A Randomized Split-Mouth Clinical Trial

Background: Anti-cariogenic properties of silver nanoparticles and fluorides have been probed mainly in vitro and with the objetive to evaluate the remineralizing effects of an applied silver nanoparticle compound plus fluoride varnish, a randomized split-mouth clinical trial was conducted in children aged 6 to 7 years. Methods: The project was approved by the ethics committee of the faculty. Primary molars were randomly distributed into two groups, as follows: Group A was treated with a compound based on silver nanoparticles plus fluoride varnish (SNP-FV), and Group B was treated with a silver diamine fluoride compound (SDF-KI), which is the current standard treatment. Laser fluorescence with a DIAGNOdent pen was used for the evaluation, with follow-up examinations at 15 days, 6 months, and 12 months. ANOVA test was used to compare the groups. The results showed a decrease in demineralization was observed after treatment with SNP-FV; similar results were observed after treatment with SDF-KI. Within each group, there were favorable changes. In the SDF-KI group, the differences in demineralization were 25.63 at 15 days, 29.37 at 6 months, and 30.6 at one year (p < 0.05). Meanwhile, in the SNP-FV group, the decreases were 22.7 at 15 days, 28.78 at 6 months, and 31.11 at one year (p < 0.05). Conclusions: The SNP-FV combined treatment represents an alternative remineralizing treatment for the management of carious lesions in the dentin of primary molars.

Synthesis and Application of Silver Nanoparticles for Caries Management: A Review

Silver nanoparticles have unique physical, chemical, and biological properties that make them attractive for medical applications. They have gained attention in dentistry for their potential use in caries management. This study reviews the different synthesis methods of silver nanoparticles and the application of them for caries management. Silver nanoparticles are tiny silver and are typically less than 100 nanometres in size. They have a high surface area-to-volume ratio, making them highly reactive and allowing them to interact with bacteria and other materials at the molecular level. Silver nanoparticles have low toxicity and biocompatibility. Researchers have employed various methods to synthesise silver nanoparticles, including chemical, physical, and biological methods. By controlling the process, silver nanoparticles have defined sizes, shapes, and surface properties for wide use. Silver nanoparticles exhibit strong antibacterial properties, capable of inhibiting a broad range of bacteria, including antibiotic-resistant strains. They inhibit the growth of cariogenic bacteria, such as Streptococcus mutans. They can disrupt bacterial cell membranes, interfere with enzyme activity, and inhibit bacterial replication. Silver nanoparticles can inhibit biofilm formation, reducing the risk of caries development. Additionally, nano silver fluoride prevents dental caries by promoting tooth remineralisation. They can interact with the tooth structure and enhance the deposition of hydroxyapatite, aiding in repairing early-stage carious lesions. Silver nanoparticles can also be incorporated into dental restorative materials such as composite resins and glass ionomer cements. The incorporation can enhance the material's antibacterial properties, reducing the risk of secondary caries and improving the longevity of the restoration.

Parental Knowledge, Attitudes, and Utilization of Preventive Dentistry Modalities in Al Qassim, Saudi Arabia: A Cross-Sectional Study

Background Parents play a vital role in modeling good oral hygiene practices for their children; thus, their attitude, knowledge, and awareness toward preventive dentistry can be one of the major factors contributing to children's oral health. Objectives The objective of this study is to determine the parental knowledge and attitudes toward the modalities of preventive dentistry for their children in Al Qassim, Saudi Arabia. Materials and methods A cross-sectional study was carried out using an online self-administered questionnaire designed for parents living in the Al Qassim region. The questionnaire included demographic data, parent knowledge and attitude toward preventive dentistry, and awareness of preventive dentistry procedures. The data collected were analyzed using RStudio. Results Data were collected from 392 Saudi parents (male: n = 190 (48.5%), female: n = 202 (51.5%)). The majority of participants (n = 336, 85.7%) considered the importance of primary teeth for general body health, while 320 participants (81.6%) believed that primary dentition influences permanent teeth. Awareness regarding special preventive measures like using toothpaste with fluorides comprised 87.5% (n = 343), and that of the benefits of early dental visits was 77.3% (n = 303). However, there was marked unawareness and use of preventive procedures such as serial extraction (n = 226, 57.7% of respondents unaware) and silver diamine fluoride (n = 276, 70.4% unaware). The higher levels of education and income were positively related to better knowledge and attitudes about preventive dentistry. Conclusions The current paper highlights the importance of educational interventions for enhancing parental knowledge and awareness about preventive dentistry. Community-based educational programs and increased availability of preventive dentistry services might be helpful in eliminating the knowledge gap among parents about good oral health practice.

Drug delivery and antibiofilm efficacy of nano silver fluoride sustained release orthodontic elastomerics against Streptococcus mutans

We aimed to investigate the chemical and physical properties of nano silver fluoride sustained release orthodontic elastomerics (NSF-RE) and determine their antimicrobial and antibiofilm formation activities against Streptococcus mutans. Orthodontic elastomerics were dip-coated with NSF solution in ethyl cellulose (EC) and polyethylene glycol 6000 (PEG). The studied groups included NSF (no EC/PEG), NSF-E (EC), NSF-EP1 (EC:PEG, 4:1), and NSF-EP2 (EC:PEG, 2:1). The cumulative release of silver nanoparticles (AgNPs) and fluoride, along with the compatibility of the tensile force with orthodontic brackets, was evaluated. The antimicrobial activity was evaluated using an agar diffusion test. The inhibition of biofilm formation was evaluated using colony-forming units (CFUs), biofilm thickness, and the live/dead cell ratio. NSF-RE containing EC sustained the release of AgNPs and fluoride for > 7 days. Tensile forces were not significantly different among the groups. The inhibition zone was 2.64- and 1.31-fold larger with NSF-EP2 than that with NSF and NSF-E, respectively. NSF-EP2 was the most effective in inhibiting biofilm formation with significant reductions in CFUs, biofilm thickness, and live/dead cell ratio by 57, 86, and 96%, respectively, as compared to those in the control group. Overall, sustained release of AgNPs and fluoride by NSF-RE provides antimicrobial and antibiofilm effects against S. mutans.

Antibacterial effects of silver diamine fluoride, potassium iodide and nanosilver fluoride on dual-species biofilm

OBJECTIVES

This study aims to evaluate antibacterial effects of silver diamine fluoride (SDF), SDF/potassium iodide (KI), and nanosilver fluoride (NSF).

METHODS

Antimicrobial activity of sterile saline, 5% sodium hypochlorite (NaOCl), 2% chlorhexidine (CHX), SDF, SDF/KI, NSF, and KI solutions against Streptococcus mutans and Lactobacillus casei was assessed through disc diffusion tests. A dual-species biofilm of S. mutans-L. casei was formed on 48 enamel samples, divided into six groups (n = 8). Group 1 was treated with sterile saline, Group 2 with 5% NaOCl, Group 3 with 2% CHX, Group 4 with SDF, Group 5 with SDF/KI, and Group 6 with NSF. The samples were analysed using confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM). Statistical analysis utilized Shapiro-Wilk and Kruskal-Wallis tests and multiple comparisons were conducted using Dunn test.

RESULTS

SDF, SDF/KI, and NaOCl displayed significantly higher antibacterial activity against dual-species biofilm compared to NSF and CHX (p < 0.050).

CONCLUSIONS

In conclusion, SDF and SDF/KI demonstrated greater antibacterial activity than NSF. SDF's antibacterial activity was unaffected by KI. Further research is needed to determine the appropriate content and concentration for achieving effective antibacterial activity with NSF.

CLINICAL SIGNIFICANCE

The use of silver-containing materials is increasing in popularity within pediatric dentistry. In this study, an endeavor has been made to assist pediatric dentists in determining which solution might be more advantageous for preventing caries.

Biological properties of a novel solution based on silver nanoclusters for arresting dentin caries

Objectives

To test the biological properties of a novel non-restorative treatment method for arresting dentin caries based on silver nanoclusters (AgNCls) synthesized in polymethacrylic acid (PMAA).

Methods

Synthesis of AgNCls was performed by photoreduction of AgNO3 in PMAA with 355 nm/wavelength light. AgNCls/PMAA was characterized by absorption/fluorescence spectroscopy and optical and atomic force microscopy. The stability of the clusters in an aerated PMAA solution was evaluated by means of fluorescence spectroscopy. Cytotoxicity was assessed using the MTT assay and antibacterial effect was determined for minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC) and colony forming (CFU) of Streptococcus mutans (S. mutans) and Lactobacillus acidophilus (L. acidophilus). 38% Silver Diammine Fluoride (SDF) was used for the control groups.

Results

Chemical and structural identity of the clusters did not change within 9 months; Cell viability of 92%-89% was found after 24-48 h respectively. MIC and MBC were determined from 1:16 and 1:8 dilutions, respectively. Log CFU counts of S. mutans, and L. acidophilus treated with AgNCls/PMAA (3.4 ppm of silver) were significantly lower than in the control groups and even lower than when the same bacterial strains were treated with SDF (15,525 ppm of silver).

Conclusions

AgNCls/PMAA presented chemical stability, acceptable cytotoxicity, and a potential antibacterial effect for strains associated with caries lesions at very low concentrations of silver.

Mapping the Dental Applications of Nanosilver Fluoride: A Narrative Review

Advances in nanotechnology have been changing the face of dentistry with their diverse range of dental applications. Silver nanoparticles (AgNPs) are a relatively new breakthrough in dentistry.

Aim

The main objective of this paper is to discuss the current progress in the field of dentistry and highlight the aspects regarding silver nanoparticle incorporation, emphasizing the properties, applications, and advantages of nanosilver fluoride (NSF) that it brings to dentistry.

Materials and methods

An extensive electronic scientific search was conducted on published articles in various databases, such as Medline (PubMed), CENTRAL (Cochrane), Scopus, and Web of Science, using the search terms AgNPs, nano dentistry, caries prevention, and oral health. Further brief communications, randomized controlled trials (RCT), in vitro research, and animal studies written in English were also considered. Case reports, editorial reviews, and opinion letters were excluded from the first phase of our research.

Results

Pertaining to various kinds of literature reviews in journals, around 345 articles were retrieved. After screening, about 28 articles met all the selection criteria, focusing on NSF for the contemporary management of dental caries, emphasizing microinvasive therapeutic methods that can successfully halt the progression of caries at the initial level and minimize the loss of sound tooth structure.

Conclusion

Due to its exceptional properties and wide range of clinical applications, AgNPs incorporated in fluoride may be employed as an effective, affordable, and improved anticaries agent that brings about superior enhancements in the fields of orthodontics, restorative dentistry, and pediatric and preventive dentistry.

How to cite this article

Thimmaiah C, Thomas NA, Baskaradoss JK, et al. Mapping the Dental Applications of Nanosilver Fluoride: A Narrative Review. Int J Clin Pediatr Dent 2024;17(7):833-837.

Effectiveness of nanosilver fluoride and silver diamine fluoride in arresting early childhood caries: a randomized controlled clinical trial

BACKGROUND

One of the most prevalent health problems affecting children worldwide is untreated caries in primary teeth. Agents to arrest caries are used to manage untreated decay in children in disadvantaged communities. Nano Silver Fluoride (NSF) overcomes the staining problems of Silver Diamine Fluoride (SDF). This study compared the clinical cariostatic effect of NSF to 38% SDF for arresting caries lesions.

METHODS

The study included 360 children younger than 4 years, with at least one active lesion, ICDAS score ≥ 3, recruited from nurseries in a rural area in Alexandria, Egypt, in 2022. They were randomly assigned to receive a single application of NSF at baseline, or two applications of SDF at baseline and after 6 months. The arrest of active carious lesions was assessed after 6 and 12 months using ICDAS criteria, and parents' satisfaction with child appearance was also assessed. Chi-Square test was used to compare the groups and multi-level multiple logistic regression was used to assess the effect of the intervention on caries arrest at lesion level and binary logistic regression was used to assess the effect at patient level.

RESULTS

1853 active lesions were included in children whose mean (SD) age was 42.3 (8.2) months. The arrest rate was significantly higher in the NSF than the SDF group at lesion level (78.4% and 65.0% at 6 months and 71.3% and 56.3% at 12 months, p < 0.001). In regression analysis, NSF had significantly higher odds of caries arrest than SDF at lesion level (at 6 months, AOR = 2.57, 95% CI: 1.55, 4.26 and at 12 month, AOR = 3.27, 95% CI: 1.89, 5.67). Parents of children receiving NSF had significantly greater satisfaction with their children's dental appearance than those receiving SDF: (97.2% and 76.1%, respectively, p < 0.001).

CONCLUSION

NSF demonstrated greater effectiveness in arresting caries in preschool children without inducing black staining of teeth and with greater parental satisfaction than SDF. NSF can be an alternative to SDF in arresting caries especially in underprivileged communities.

TRIAL REGISTRATION

The trial was registered in the clinicaltrials.gov registry (#NCT05255913)-16/02/2022.

Assessment of Nanosilver Fluoride Application on the Microtensile Bond Strength of Glass Ionomer Cement and Resin-modified Glass Ionomer Cement on Primary Carious Dentin: An In Vitro Study

Background and objectives

Nanosilver sodium fluoride (NSF) has recently gained popularity in dentistry as an alternative to silver diamine fluoride (SDF) due to its drawbacks of staining the tooth black and possibly causing soft tissue injury, which has been eliminated in NSF due to the nanoparticle size of silver. This study aims to assess the microtensile bond strength of glass ionomer cement (GIC) and resin-modified glass ionomer cement (RMGIC) with pretreatment of NSF on extracted primary carious teeth.

Materials and methods

Teeth were stored in 10% formalin. The roots were severed, and the pulp chambers were cleaned. The occlusal enamel was ground, reducing the dentin thickness by 1 mm. The specimens were covered with nail varnish, leaving only the area of flat dentin exposed. Caries were induced microbiologically by inoculating Streptococcus mutans. Group I-NSF with GIC restoration, group II-NSF with RMGIC restoration, group III-restoration with GIC, and group IV-restoration with RMGIC. After different surface treatments of the carious dentin were performed, each specimen was placed in the testing jig of a universal testing machine and stressed in tension at a crosshead speed of 1 mm/minute until bond failure was observed. They were air-dried and placed under a scanning electron microscope. The failure modes-adhesive, cohesive, and mixed failure were recorded for statistical evaluation.

Results

Maximum results of microtensile bond strength were seen in the pretreatment group with NSF sealant, followed by RMGIC restoration, and the least results were observed in the conventional GIC restoration group. Of all the types of failures in our study, adhesive was the maximum type.

Interpretation and conclusion

The microtensile bond strength of pretreatment with NSF showed higher values when compared to conventional restorations of GIC and RMGIC. The failure modes in each group were not significantly varied. Pretreatment with NSF will prevent secondary caries formation, and the restorations will also be stronger.

How to cite this article

Das A, Ramamurthy N, Srinivasan I, et al. Assessment of Nanosilver Fluoride Application on the Microtensile Bond Strength of Glass Ionomer Cement and Resin-modified Glass Ionomer Cement on Primary Carious Dentin: An In Vitro Study. Int J Clin Pediatr Dent 2024;17(5):565-569.

Comparative Evaluation of the Mechanical Efficiency of Nanosilver Fluoride and Sodium Fluoride Varnish: An In Vitro Study

Background

Dental caries is the most common disease in childhood and has an impact on general health status. The topical application of fluoride varnishes has been used for the prevention and control of dental caries due to their high fluoride content, adhesion capacity, and safety. Silver has a varied application in medicine as well as in dentistry due to its anticaries, antimicrobial, and antirheumatic potentials. The introduction of nanosilver fluoride (NSF) was made with advancements in technology to overcome the drawbacks of silver diamine fluoride (SDF).

Aim

To compare and evaluate the microhardness and microleakage of NSF varnish and sodium fluoride (NaF) varnish.

Materials and methods

An in vitro comparative experimental study was carried out between synthesized NSF and commercially available NaF, with 20 samples in each group. The specimens were sectioned and subjected to microhardness evaluation using Vickers microhardness testing and the dye penetration method to evaluate the microleakage.

Results

The average microhardness was found to be 230.7218 VMH for NSF (group I), 198.9841 VMH for NaF (group II), and 91.6120 VMH for group III. These differences were statistically significant when compared with each other (p = 0.002). In 50% of the samples, no dye penetration was seen in the NSF group, compared to the NaF varnish group, where 75% of the samples exhibited penetration onto the varnish interface or the varnish and tooth interface.

Conclusion

Nanosilver fluoride proves to be an effective alternative to commercially available topical fluoride agents such as NaF. It has greater microhardness and lower microleakage than NaF and the control teeth.

Clinical significance

Nanosilver fluoride varnish can be used as a cost-effective alternative to NaF varnish and SDF. It can be applied with minimal training by healthcare workers or general practitioners.

How to cite this article

Kritivasan S, Sogi HS, Jain M, et al. Comparative Evaluation of the Mechanical Efficiency of Nanosilver Fluoride and Sodium Fluoride Varnish: An In Vitro Study. Int J Clin Pediatr Dent 2024;17(5):539-544.

A Comparative Evaluation of Nanosilver Fluoride, Chlorhexidine, and Sodium Fluoride When Used as a Varnish on Streptococcus mutans Levels in Children with Caries

Aim

The purpose of the present study is to evaluate the effect of nanosilver fluoride (NSF), chlorhexidine (CHX), and sodium fluoride (NaF) when used as a varnish on Streptococcus mutans levels in children with dental caries.

Study design

A total of 120 children (age range 8-12 years) with incipient caries were randomly assigned to four groups (n = 30): group I-NSF varnish, group II-CHX varnish, group III-NaF varnish, and group IV-control. Varnish application at baseline was performed once. To assess the levels of S. mutans using the culture method [colony-forming units (CFUs)] and optical density (OD), plaque and samples were taken at baseline (T0), 1 month (T1), and 3 months (T3). Additionally, the oral hygiene index-simplified (OHI-S) was noted for clinical assessment.

Results

By the end of 3 months, a statistically significant reduction in plaque CFU and salivary CFU was found in group II. At the conclusion of the 3 months, group I had the greatest decrease in OHI-S. After 3 months, the plaque CFU score did not differ significantly across groups I, II, and III. However, a statistically significant difference in OD values (p-value of 0.00) was discovered between group I and all other groups.

Conclusion

Children with early caries can effectively lower their S. mutans count by using NSF varnish.

How to cite this article

Raja T, Agarwal N, Jabin Z, et al. A Comparative Evaluation of Nanosilver Fluoride, Chlorhexidine, and Sodium Fluoride When Used as a Varnish on Streptococcus mutans Levels in Children with Caries. Int J Clin Pediatr Dent 2024;17(4):410-416.

Effect of silver diamine fluoride and nano silver fluoride on oral health-related quality of life of children with early childhood caries: A randomized clinical trial

OBJECTIVES

Untreated caries in primary teeth is one of the most prevalent health problems in children worldwide. Silver diamine fluoride (SDF) non-invasively arrests caries but causes staining unlike Nano Silver Fluoride (NSF) which causes no stains. This study compared the effect of NSF and 38 % SDF on the oral health related quality of life (OHRQoL) of preschool children after 6 months.

METHODS

Children were included if they were younger than 4 years, with at least one active lesion, ICDAS score ≥3, attending nurseries in a rural area in Alexandria, Egypt. They were randomly assigned to receive NSF once at baseline, or SDF at baseline and after 6 months. The Arabic version of the Early Childhood Oral Health Impact Scale (A-ECOHIS) was used to assess the OHRQoL. The groups were compared using chi-square test and the effect of the intervention on OHRQoL was assessed using multiple linear regression.

RESULTS

360 children were included, mean (SD) age = 42.3 (8.2) months. After 6 months, NSF had significantly lower A-ECOHIS scores than SDF in bivariate analysis (p< 0.05) and in regression analysis (B= -5.02, p = 0.001) after adjusting for confounders. There were significant reductions in the A-ECOHIS total and domains' scores in both study groups, except for the social interaction domain in the SDF group.

CONCLUSION

After 6-month, both agents significantly improved children's OHRQoL although NSF had a significantly better impact on OHRQoL than SDF.

CLINICAL SIGNIFICANCE

Patient-reported outcomes support the inclusion of the two agents among the options for ECC management with better effect on quality of life after NSF.

TRIAL REGISTRATION

The trial was registered in the clinicaltrials.gov registry (#NCT05255913).

Silver compounds used in pediatric dentistry for caries arrest: A review of current materials and new technologies

Silver compounds have been used in medicine and dentistry for centuries. Their use in pediatric dentistry has long been restricted because of some drawbacks, chief among them being the discoloration of teeth with black stains. However, recent advances in technology have resulted in the development of new silver agents that do not have the limitations of previously used ones. This led to the reintroduction of silver compounds in pediatric dentistry. The aim of the present review was to examine the evidence supporting the therapeutic use of silver compounds in pediatric dentistry for caries arrest, as well as the mode of action and biocompatibility, characteristics, advantages, and disadvantages of different silver-containing agents.

The effect of nano silver fluoride, self-assembling peptide and sodium fluoride varnish on salivary cariogenic bacteria: a randomized controlled clinical trial

OBJECTIVES

To compare the antibacterial effect of Nanosilver Fluoride varnish (NSF) varnish, P11-4 and Sodium Fluoride (NaF) varnish against salivary Streptococcus mutans (S. mutans) and Lactobacilli.

METHODS

66 patients aged 10-24 years old were randomly assigned to receive single application of NSF, P11-4 or NaF varnish. Baseline unstimulated saliva samples were collected before the agents were applied and S.mutans and Lactobacilli colony forming units (CFU) were counted. After one, three and six months, microbiological samples were re-assessed. Groups were compared at each time point and changes across time were assessed. Multivariable linear regression compared the effect of P11-4 and NSF to NaF on salivary S. mutans and Lactobacilli log count at various follow up periods.

RESULTS

There was a significant difference in salivary S. mutans log count after 1 month between P11-4 (B= -1.29, p = 0.049) and NaF but not at other time points nor between NSF and NaF at any time point. The significant reduction in bacterial counts lasted up to one month in all groups, to three months after using P11-4 and NaF and returned to baseline values after six months.

CONCLUSION

In general, the antimicrobial effect of P11-4 and NSF on salivary S. mutans and Lactobacilli was not significantly different from NaF varnish. P11-4 induced greater reduction more quickly than the two other agents and NSF antibacterial effect was lost after one month.

CLINICAL RELEVANCE

NSF varnish and P11-4 have antimicrobial activity that does not significantly differ from NaF by 3 months. P11-4 has the greatest antibacterial effect after one month with sustained effect till 3 months. The antibacterial effect of NSF lasts for one month. NaF remains effective till 3 months.

TRIAL REGISTRATION

This trial was prospectively registered on the clinicaltrials.gov registry with ID: NCT04929509 on 18/6/2021.

Evaluation of Cytotoxicity and Antimicrobial Activity of Experimental Composites Containing Chitosan-Silver Oxide Particles Against Two Main Pathogenic Bacteria in Periodontal Disease

INTRODUCTION

Bacterial biofilm is known as the main cause of periodontal disease. Generally, the anaerobic Gram-negative, such as Porphyromonas gingivalis and Fusobacterium nucleatum, are considered the most identified bacteria.

OBJECTIVE

This study aimed to investigate the antimicrobial effect and cytotoxicity of two experimental composites containing chitosan-silver oxide (CH-Ag2O) particles.

MATERIALS AND METHODS

Four experimental groups, including Ag2O and CH, along with two composites of CH-Ag2O 20 and CH-Ag2O 60 mg, were prepared. Antimicrobial activity was performed against Porphyromonas gingivalis (ATCC#33277) and Fusobacterium nucleatum (ATCC#25586) using the agar dilution method. Moreover, the cytotoxicity assay was performed on human gingival fibroblasts (HGF) by the use of the MTT method. The obtained data were analyzed with descriptive methods, one-way ANOVA, and Tukey's LSD tests.

RESULTS

The antibacterial activity of both composites was higher than both CH and Ag2O, and the greatest antibacterial properties were presented in CH-Ag2O 60. In all three measurements (24, 48, and 72 h), the greatest cytotoxicity was seen in Ag2O, followed by CH, CH-Ag2O 20, and CHAg2O 60 in descending order, respectively. The cytotoxicity of these components was related to the concentration and not to the time of exposure. The results showed that Ag2O in 3.7 and 7.5 μg/ml concentrations and CH-containing groups in 250 and 500 μg/ml were toxic to the cultured HGF.

CONCLUSION

The experimental composite containing CH-Ag2O 60 showed the greatest antibacterial properties against two periodontal pathogens evaluated. In order to clarify the clinical significance of composite cytotoxicity, further clinical studies are necessary.

Antibacterial Effects of Silver Diamine Fluoride with and without Potassium Iodide against Streptococcus mutans

Introduction

Silver diamine fluoride (SDF) is a topical treatment for carious lesions and a primary preventative for newly exposed high-risk surfaces such as fissures and roots in the first molars. Using potassium iodide (KI) after applying SDF has been recommended as a way of reducing the severity of black staining, as well as preserving its antibacterial effect useful in deep caries.

Objective

The objective of this research was to compare the antibacterial effect of SDF, with and without KI, on Streptococcus mutans (S. mutans) and dental biofilm.

Methods

The antibacterial effects of SDF, KI, and the combination of both were measured using three different techniques (inhibition halo, minimum inhibitory effect [MIE], and colony-forming unit [CFU], testing).

Results

The results were then subjected to statistical analysis. Analyzed by means of the Kruskal-Wallis statistical test, the inhibition halos yielded a value of P = 0.3309. Using the MIE test, only the SDF treatment produced an antibacterial effect, at 10%, compared to the KI group, with P = 0.001. Finally, the CFU test revealed a total absence of colonies for all three reagents. All three substances analyzed achieved total inhibition of S. mutans. SDF is effective even in its minimal commercial concentration. Its antibacterial capacity decreases with the addition of KI.

Conclusions

The three substances analyzed at their maximum concentrations exhibited an antibacterial effect against S. mutans, resulting in total inhibition.

A Randomized Controlled Trial Evaluating the Effectiveness of Nanosilver Fluoride in Arresting Dental Caries in School Children

Aim

The study evaluated the effectiveness of nanosilver fluoride (NSF) in arresting dental caries in 4-8-year-old school children.

Materials and methods

The two-arm, parallel-group randomized controlled trial included a total of 148 children aged 4-8 years with active carious lesions. Children were randomly divided into two groups: group I-NSF (n = 74); and group II-water (placebo and n = 74). Baseline data were recorded using the International Caries Detection and Assessment System (ICDAS) II criteria, and the teeth were treated with either of the solutions. Later, the teeth were evaluated by two blinded examiners for the lesion activity using ICDAS II criteria at 1, 3, and 6-month intervals. The obtained data were analyzed using the Chi-squared test for intergroup comparison and Cochran's Q test for intragroup comparison. Cohen's κ test was used to check the interexaminer and intraexaminer variability.

Results

Carious teeth treated with NSF have shown 56.3, 59.2, and 62% arrested carious lesions, whereas the placebo group has shown 0, 2.9, and 4.4% arrested lesions at 1, 3, and 6-month intervals, respectively. NSF showed a high statistically significant difference (p < 0.001) in arresting dental caries compared to the control group at all the time intervals.

Conclusion

Nanosilver fluoride (NSF) is found to be effective in arresting dental caries without staining carious lesions. Therefore, it can be used to reduce the bacterial load for caries stabilization in the initial phase of the comprehensive treatment protocol for the management of children with active caries lesions.

Clinical significance

Most of the decayed teeth in the primary dentition remain untreated either because of inaccessible dental services or the uncooperativeness of children. Hence, there is an absolute need for a cariostatic agent which arrests the progression of caries in a simple and noninvasive manner. The results of this study evidence that NSF effectively arrests dental caries in primary teeth. Hence, this can be a very economical way of arresting caries in the population who don't have access to regular dental treatment.

How to cite this article

Devi C, Chandrasekhar R, Vinay C, et al. A Randomized Controlled Trial Evaluating the Effectiveness of Nanosilver Fluoride in Arresting Dental Caries in School Children. Int J Clin Pediatr Dent 2023;16(5):667-670.

A Comparison of Antimicrobial Efficacy of Silver-based Preventive Restorations (Silver Nitrate, Silver Diamine Fluoride, and Silver Nanoparticles) against Streptococcus mutans Monospecies Biofilm Model

Aim

The ability of the Streptococcus mutans (S. mutans) to form biofilms is not only crucial in the initiation of early childhood caries (ECC) but is also a challenge to its treatment. The current management protocols focus on remineralization and use of antimicrobial formulations which penetrate biofilms, control their formation, and decrease the incidence of caries in children. The paradigm shift toward preventive protocols and increasing antibiotic resistance rekindled the use of silver as a promising antibacterial agent. To gain further insight into the therapeutic potential, aim of the present study was to compare the antibacterial efficacy of silver-based preventive restorations [silver nitrate (AgNO3), silver diamine fluoride (SDF), and silver nanoparticles (AgNPs)] against S. mutans species.

Materials and methods

Using an ex vivo monospecies biofilm model of S. mutans; the antimicrobial efficacy of three treatment groups (SDF, AgNO3, and AgNPs) was evaluated.

Results

There was a significant difference between the negative control and three treatment groups (SDF, AgNO3, and AgNPs). The results showed that the mean diameter of inhibition zones obtained in biofilms treated with AgNPs was 40.3 ± 0.25 mm which was greater than both SDF (37.7 ± 0.18 mm) and AgNO3 (36.26 ± 0.18 mm).

Conclusion

The study concluded that the number of viable bacteria was significantly reduced by all three medicaments (p < 0.05). However, AgNPs showed the highest antimicrobial activity in comparison to SDF and AgNO3 against S. mutans biofilm.

Clinical significance

The present study thus supports that AgNPs are a promising preventive anticaries agent due to their better antibacterial activity in comparison to other silver-based preventive restorations and can be effectively used as an alternative to SDF or AgNO3 for the noninvasive treatment of ECC in the young.

How to cite this article

Sharma P, Dhawan P, Rajpal SK, et al. A Comparison of Antimicrobial Efficacy of Silver-based Preventive Restorations (Silver Nitrate, Silver Diamine Fluoride, and Silver Nanoparticles) against Streptococcus mutans Monospecies Biofilm Model. Int J Clin Pediatr Dent 2023;16(S-1):S13-S19.

Caries arrest using silver diamine fluoride: Knowledge, attitude, and perception of parents in Saudi Arabia

Objectives

The objective was to assess the current knowledge, attitudes, and perceptions of parents toward the use of Silver Diamine Fluoride in children's primary teeth and identify related factors.

Materials and Methods

In this cross-sectional study, data were collected from Parents of pediatric patients who had appointments at the King Saud University Pediatric Dentistry Clinic and several private clinics in Riyadh, Saudi Arabia from Jan to April 2021. A simple random sampling method was used. An electronic questionnaire was designed to collect data regarding participants' demographics and their knowledge, attitude, and perception toward the use of SDF for their children.

Results

A higher proportion of parents/relatives (87.3%) was strongly satisfied with the speed of treatment and its benefits. In terms of disadvantages, 23.8% and 30.4% of the parents/relatives were satisfied and dissatisfied, respectively (P < 0.05). Regarding attitudes, the majority of participants 22.8% responded as neutral to using SDF to treat their children's anterior primary teeth (P < 0.05), whereas 32.2% agreed to the use of SDF in their children's posterior primary teeth (P < 0.05). A higher proportion of parents/relatives who were in the age group of >50 years (27.8%) had responded as "satisfied" compared with the responses of other age groups (P < 0.05).

Conclusion

The present study demonstrates that SDF is acceptable among Saudi parents/relatives to arrest dental caries. However, pigmentation of anterior teeth is a major concern.

Nanotechnology for Dentistry: Prospects and Applications

In the XXI century, application of nanostructures in oral medicine has become common. In oral medicine, using nanostructures for the treatment of dental caries constitutes a great challenge. There are extensive studies on the implementation of nanomaterials to dental composites in order to improve their properties, e.g., their adhesive strength. Moreover, nanostructures are helpful in dental implant applications as well as in maxillofacial surgery for accelerated healing, promoting osseointegration, and others. Dental personal care products are an important part of oral medicine where nanomaterials are increasingly used, e.g., toothpaste for hypersensitivity. Nowadays, nanoparticles such as macrocycles are used in different formulations for early cancer diagnosis in the oral area. Cancer of the oral cavity-human squamous carcinoma-is the sixth leading cause of death. Detection in the early stage offers the best chance at total cure. Along with diagnosis, macrocycles are used for photodynamic mechanism-based treatments, which possess many advantages, such as protecting healthy tissues and producing good cosmetic results. Application of nanostructures in medicine carries potential risks, like long-term influence of toxicity on body, which need to be studied further. The introduction and development of nanotechnologies and nanomaterials are no longer part of a hypothetical future, but an increasingly important element of today's medicine.

Efficacy of Nano Silver Fluoride and/or Diode Laser In Enhancing Enamel Anticariogenicity around orthodontic brackets

PURPOSE

This in vitro study aimed to compare the anticariogenic effect of using diode laser irradiation and/or nano silver fluoride varnish around orthodontic brackets.

MATERIALS AND METHODS

60 caries-free and intact premolars were randomly divided into 3 experimental groups as follow: (1) Group I (nano silver fluoride treated group, n = 20), (2) Group II (diode laser treated group, n = 20) and (3) Group III (combined nano silver fluoride and diode laser treated group, n = 20). Anticariogenicity was assessed using polarized light, scanning electron microscope, elemental and shear bond strength analyses.

RESULTS

PLM and SEM showed presence of few demineralized areas in group I. Group II revealed a dramatic increased demineralization. Group III disclosed almost typical homogenous surface enamel. elemental analysis showed a highly significant difference between Group III and II and a significant difference between Group III and I. Shear bond strength analysis revealed a significant difference between group I and II and between group III and II. The difference between group III and I was non-significant.

CONCLUSION

Both diode laser and nano silver fluoride positively affected dental enamel with the most superior enhancement in enamel criteria was achieved by surface pretreatment by combined nano silver fluoride varnish and diode laser irradiation.

Dental Pulp Response to Silver-Containing Solutions: A Scoping Review

Dentists used silver-containing solutions for deep cavity disinfection before restoration. This review aims to identify the silver-containing solutions reported in the literature for deep cavity disinfection and summarize their effects on dental pulp. An extensive search was performed using the search words "(silver) AND (dental pulp OR pulp)" in ProQuest, PubMed, SCOPUS, and Web of Science to identify English publications on silver-containing solutions for cavity conditioning. The pulpal response to the included silver-containing solutions was summarized. The initial search identified 4112 publications and 14 publications met the inclusion criteria. Silver fluoride, silver nitrate, silver diamine nitrate, silver diamine fluoride, and nano-silver fluoride were used in deep cavities for antimicrobial purposes. Indirect silver fluoride application induced pulp inflammation and reparative dentine in most cases, and pulp necrosis in some cases. Direct silver nitrate application caused blood clots and a wide inflammatory band in the pulp, whilst indirect silver nitrate application caused hypoplasia in shallow cavities and partial pulp necrosis in deep cavities. Direct silver diamine fluoride application induced pulp necrosis, while indirect silver diamine fluoride application induced a mild inflammatory response and reparative dentine formation. No evidence of the dental pulpal response to silver diamine nitrate or nano-silver fluoride was available in the literature.

Amelioration Strategies for Silver Diamine Fluoride: Moving from Black to White

Topical cariostatic agents have become a reasonable alternative for managing dental caries in young children. Silver diamine fluoride (SDF) is a practical topical approach to arrest caries and avoid extensive and risky dental treatment. However, the literature demonstrates a parental hesitation towards accepting SDF because of black unaesthetic tooth discolouration following application. The rapid oxidation of ionic silver darkens demineralised tooth structure permanently. In this regard, nano-metallic antimicrobials could augment or substitute for silver, and thereby enhance SDF aesthetic performance. Recently, biomedical research has drawn attention to selenium nanoparticles (SeNPs) due to their antimicrobial, antioxidant, and antiviral potencies. Various in vitro studies have examined the effect of SeNPs on the virulence of bacteria. This narrative review explores practical issues when using SDF and suggests future directions to develop it, focusing on antimicrobial metals. Several methods are described that could be followed to reduce the discolouration concern, including the use of nanoparticles of silver, of silver fluoride, or of selenium or other metals with antimicrobial actions. There could also be value in using remineralising agents other than fluoride, such as NPs of hydroxyapatite. There could be variations made to formulations in order to lower the levels of silver and fluoride in the SDF or even to replace one or both of the silver and fluoride components completely. Moreover, since oxidation processes appear central to the chemistry of the staining, adding SeNPs which have antioxidant actions could have an anti-staining benefit; SeNPs could be used for their antimicrobial actions as well. Future research should address the topic of selenium chemistry to optimise how SeNPs would be used with or in place of ionic silver. Incorporating other antimicrobial metals as nanoparticles should also be explored, taking into account the optimal physicochemical parameters for each of these.

Bacterial sensitivity to chlorhexidine and povidone-iodine antiseptics over time: a systematic review and meta-analysis of human-derived data

Surgical site infection (SSI) is the most common complication of surgery, increasing healthcare costs and hospital stay. Chlorhexidine (CHX) and povidone-iodine (PVI) are used for skin antisepsis, minimising SSIs. There is concern that  resistance to topical biocides may be emergeing, although the potential clinical implications remain unclear. The objective of this systematic review was to determine whether the minimum bactericidal concentration (MBC) of topical preparations of CHX or PVI have changed over time, in microbes relevant to SSI. We included studies reporting the MBC of laboratory and clinical isolates of common microbes to CHX and PVI. We excluded studies using non-human samples and antimicrobial solvents or mixtures with other active substances. MBC was pooled in random effects meta-analyses and the change in MBC over time was explored using meta-regression. Seventy-nine studies were included, analysing 6218 microbes over 45 years. Most studies investigated CHX (93%), with insufficient data for meta-analysis of PVI. There was no change in the MBC of CHX to Staphylococci or Streptococci over time. Overall, we find no evidence of reduced susceptibility of common SSI-causing microbes to CHX over time. This provides reassurance and confidence in the worldwide guidance that CHX should remain the first-choice agent for surgical skin antisepsis.

Antibacterial effect and impact on caries activity of nanosilver fluoride and silver diamine fluoride in dentin caries of primary teeth: a randomized controlled clinical trial

BACKGROUND

The use of silver diamine fluoride (SDF) in caries treatment in children has increased despite the disadvantage of causing tooth discoloration. Nanosilver fluoride (NSF) is a possible alternative. This study aimed to assess the antibacterial effect of NSF and SDF and their impact on the activity of dentin caries in primary teeth.

METHODS

Synthesis and characterization of the physical and biological properties of NSF were conducted. Fifty children aged 4-6 years with dentin caries (active caries corresponding to ICDAS code 5) in deciduous teeth were randomly assigned to treatment by NSF or SDF. Baseline assessment of Streptococcus mutans (S. mutans) and lactobacilli counts as CFU/mL in caries lesions was done, followed by the application of the agents. After one month, microbiological samples were recollected, and lesion activity was reassessed. Groups were compared using Mann-Whitney and Chi-Square tests, while intragroup comparisons were done using Wilcoxon and McNemar tests. Multilevel logistic regression analysis was used to assess the effect of different variables on the outcomes.

RESULTS

There were 130 teeth in 50 children; mean ± SD age = 4.75 ± 0.76 years, 63% were posterior teeth. At the one-month follow-up appointment, both groups showed a significant decrease from baseline bacterial counts. There was a significant difference in the reduction of S. mutans between NSF and SDF (21.3% and 10.5%, respectively, p = 0.002), while not in lactobacilli (13.9% and 6.0%, respectively, p = 0.094). In both groups, there was a significant reduction in the number of active caries from baseline (p < 0.0001) with no significant difference between groups (percentage inactive = 64.4% and 63.4%, p = 0.903). Multilevel regression revealed non-significant differences in S. mutans and lactobacilli counts (AOR 1.281, p = 0.737 and 1.888, p = 0.341, respectively), and in the number of inactive lesions (AOR 1.355, p = 0.731) between groups.

CONCLUSION

The short-term antibacterial efficacy of NSF was similar to that of SDF. In both groups there was a significant reduction of S. mutans and lactobacilli counts in active dentin caries, and two-thirds of the lesions became inactive with no differences between the two interventions. Further research is needed to investigate the long-term efficacy of NSF and its suitability for clinical use in caries management.

TRIAL REGISTRATION

This trial was prospectively registered on the clinicaltrials.gov registry with ID: NCT05221749 on 03/02/2022.

Applications of Silver Nanoparticles in Pediatric Dentistry: An Overview

Nanoscience and nanotechnology are emerging fields involved in the synthesis and application of nanoscale materials and structures. Metallic nanoparticles and metallic oxide are being used extensively in dentistry as they interfere with bacterial metabolism and prevent biofilm formation. AgNPs are a class of zero-dimensional materials with distinctive morphologies. The metallic nanoparticles demonstrate the significant antimicrobial activity by ion release, oxidative stress induction, and non-oxidative mechanisms. Metallic silver has been known for its antimicrobial activity since ancient times. Through the years, silver-containing compounds have been used in various forms to treat several medical conditions. Incorporating silver nanoparticles into dental materials may enhance the mechanical features and antibacterial properties of dental materials. Therefore, an increasing number of dental materials with the inclusion of silver nanoparticles are being developed that improve the overall oral health status of patients. This paper aims to review the literature on specific characteristics of silver nanoparticles and their applications in pediatric dentistry.

The antibacterial effect of nanosilver fluoride in relation to caries activity in primary teeth: a protocol for a randomized controlled clinical trial

BACKGROUND

Minimally invasive dentistry is a highly convenient and efficient method of managing caries in pediatric patients. Silver diamine fluoride (SDF) is commonly used to arrest active caries lesions. However, the associated black stain, possibility of soft tissue injury, and unpleasant taste often limit its use. Recently, nanosilver fluoride (NSF) emerged as a promising topical fluoride agent with potent cariostatic and antibacterial potentials. This novel anticaries agent has gained attention as an alternative to overcome the drawbacks of SDF in caries arrest.

OBJECTIVES

To assess the antibacterial effect of NSF in relation to caries activity in dentin caries lesions, as well as to investigate the change in saliva bacterial levels in primary teeth in comparison to SDF after 1 and 3 months.

MATERIALS AND METHODS

Fifty children aged 4 to 6 years old with active dentin caries lesions (score 5 according to International Detection and Assessment System (ICDAS II) criteria) will be enrolled in the study. They will be equally and randomly allocated into 2 groups: a group receiving NSF and a control group receiving SDF treatment. Microbiological samples will be collected from the carious lesions and from unstimulated saliva at the baseline and at the 1 and 3 months' follow-up appointments. Bacterial counts will be assessed using Mitis Salivarius agar (selective culture media for S. mutans) and Rogosa agar (selective culture media for lactobacilli), and the results will be expressed in colony-forming units. Data regarding the children's oral health will be collected and their dmf index will be scored. The arrest of active carious lesions will be measured at the follow-up appointments according to ICDAS II criteria.

RESULTS

The relation between bacterial colony counts and lesion activity for both groups will be assessed, as well as the change in salivary bacterial counts. The collected data will be statistically evaluated and tabulated. This clinical trial has been registered on ClinicalTrials.gov in January 2022 (original version) with ID: NCT05221749.

The Anticariogenic Efficacy of Nano Silver Fluoride

Dental caries is a common chronic disease, and anyone can be at threat of it throughout their lifespan. In school-aged children, dental caries is the most frequent disease related with oral health. Contemporary dental caries management focuses on non-restorative, non-invasive, and micro-invasive therapeutic techniques that effectively eliminate the caries progression at the lesion level and decrease the loss of healthy tooth structure. One of these strategies is to use caries apprehending agents with antibacterial and remineralizing characteristics. Due to recent regulatory approval in the United States, the use of silver diamine fluoride (SDF) for the therapy of dental caries has received substantial interest. SDF has successfully prevented and reversed both primary tooth caries and permanent teeth root caries. Even though SDF is an effective anti-caries agent, but it is associated with certain drawbacks like gum irritation, metallic taste, and irreversible dark stains on applying on cavities. As an alternative agent Nano Silver Fluoride (NSF) is preferable because it performs like SDF without tooth staining. It has comparable preventive and antibacterial activities as SDF. Further, it is ergonomic, economic and safe in children and adults. The current article aims to highlight the superior properties of NSF as a better anti-caries agent outstripping the limitations of discoloration of SDF.

Preventive potential of nano silver fluoride versus sodium fluoride varnish on enamel caries like lesions in primary teeth: in vitro study

Background

Professionally applied topical fluoride preparations have been commonly used and have proven to prevent dental decay. Alternative preparations that provide further benefits may be of interest to investigate. This study aimed to investigate the effect of experimental nano silver fluoride (NSF) formulation compared to commercial sodium fluoride varnish (FV) on prevention of in vitro demineralization of initially sound enamel in primary teeth.

Methods

Forty-eight extracted/exfoliated sound molars were sectioned buccolingually into 96 specimens then assigned randomly into two equal groups. Each group was further subdivided into two equal subgroups (Ia: NSF, IIa: FV, Ib and IIb as negative controls). The test materials were applied, then all the specimens were subjected to a demineralization pH cycling model for 7 days. Specimens were examined for surface microhardness using Vickers microhardness device and lesion depth was evaluated by polarized light microscope using image J 1.46r software. Data were analyzed using paired t-test, independent t-test, and Mann Whitney U test.

Results

The test materials were significantly superior to their negative controls, (P < 0.001) and comparable to each other, (P > 0.05) regarding microhardness and lesion depth. In comparison to FV, NSF showed lower yet statistically insignificant percent increase in microhardness and decrease in lesion depth, (P = 0.81, 0.86, respectively). Qualitative evaluation revealed that both agents reduced the lesion depth formation.

Conclusion

NSF showed similar effect to that of FV in limiting in vitro enamel demineralization caused by acidic challenge. Hence, it could be regarded as a promising alternative preventive agent in primary teeth.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02271-6.

Anticaries Agent Based on Silver Nanoparticles and Fluoride: Characterization and Biological and Remineralizing Effects—An In Vitro Study

Objective

The aim of the study was to characterize and evaluate the stability, antimicrobial activity, cytotoxicity, and remineralizing effects of silver nanoparticles and fluoride anticaries agent (AgF) on staining dental enamel.

Materials and Methods

An experimental AgF solution was prepared and compared to silver diamine fluoride (SDF). First, the AgF was characterized and the stability was evaluated by transmission electron microscopy (TEM). Streptococcus mutans, Enterococcus faecalis, and Escherichia coli strains were used to evaluate the minimum inhibitory and bactericidal concentration and cytotoxicity performed using L929 fibroblastic cells by MTT test. Caries-like lesions induced by pH-cycling in human enamel were obtained, and then, the superficial microhardness, cross-sectional microhardness (CSMH), scanning electron microscopy (SEM), and energy-dispersive X-ray spectroscopy (EDS) were performed. Photographic images were taken to analyze the enamel staining.

Results

The AgF showed stableness in long term with bacteriostatic and bactericidal actions without cytotoxicity. Enamel remineralization, in surface and in depth (CSMH), was observed when the AgF was used, and it was similar to SDF. SEM showed enamel precipitation, and EDS observed the presence of P, Ca, Au, Ag, and Cl elements. Contrary to SDF, AgF did not stain the enamel.

Conclusion

The nano silver fluoride anticaries agent tested presented long-term stability, superficial and in-depth remineralizing capacity with antimicrobial potential and biocompatibility and did not stain the enamel.

The Application of Chitosan Nanostructures in Stomatology

Chitosan (CS) is a natural polymer with a positive charge, a deacetylated derivative of chitin. Chitosan nanostructures (nano-CS) have received increasing interest due to their potential applications and remarkable properties. They offer advantages in stomatology due to their excellent biocompatibility, their antibacterial properties, and their biodegradability. Nano-CSs can be applied as drug carriers for soft tissue diseases, bone tissue engineering and dental hard tissue remineralization; furthermore, they have been used in endodontics due to their antibacterial properties; and, finally, nano-CS can improve the adhesion and mechanical properties of dental-restorative materials due to their physical blend and chemical combinations. In this review, recent developments in the application of nano-CS for stomatology are summarized, with an emphasis on nano-CS’s performance characteristics in different application fields. Moreover, the challenges posed by and the future trends in its application are assessed.

Polysaccharide-Based Micro- and Nanosized Drug Delivery Systems for Potential Application in the Pediatric Dentistry

The intensive development of micro- and nanotechnologies in recent years has offered a wide horizon of new possibilities for drug delivery in dentistry. The use of polymeric drug carriers turned out to be a very successful technique for formulating micro- and nanoparticles with controlled or targeted drug release in the oral cavity. Such innovative strategies have the potential to provide an improved therapeutic approach to prevention and treatment of various oral diseases not only for adults, but also in the pediatric dental practice. Due to their biocompatibility, biotolerance and biodegradability, naturally occurring polysaccharides like chitosan, alginate, pectin, dextran, starch, etc., are among the most preferred materials for preparation of micro- and nano-devices for drug delivery, offering simple particle-forming characteristics and easily tunable properties of the formulated structures. Their low immunogenicity and low toxicity provide an advantage over most synthetic polymers for the development of pediatric formulations. This review is focused on micro- and nanoscale polysaccharide biomaterials as dental drug carriers, with an emphasis on their potential application in pediatric dentistry.

Silver nanoparticles-chitosan composites activity against resistant bacteria: tolerance and biofilm inhibition

This study aimed to evaluate the effectiveness of silver nanoparticles-chitosan composites (AgNPs) with different morphologies and particle size distributions against resistant bacteria and biofilm formation. Four different samples were prepared by a two-step procedure using sodium borohydride and ascorbic acid as reducing agents and characterized by UV-Vis absorption spectra, scanning transmission electron microscopy. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of the AgNPs were determined according to the Clinical and Laboratory Standards Institute (CLSI) against clinical isolates multidrug-resistant and strains of the American Type Culture Collection (ATCC). An assay was performed to determine the MICs during 20 successive bacteria exposures to AgNPs to investigate whether AgNPs induce tolerance in bacteria. The antibiofilm activities of AgNPs were also evaluated by determining the minimum biofilm inhibitory concentration (MBIC). The spherical AgNPs present diameters ranging from 9.3 to 62.4 nm, and some samples also have rod-, oval-, and triangle-shaped nanoparticles. The MIC and MBC values ranged from 0.8 to 25 μg/mL and 3.1 to 50 μg/mL, respectively. Smaller and spherical AgNPs exhibited the highest activity, but all the AgNPs developed in this study exhibit bactericidal activity. There was no significant MIC increase after 20 passages to the AgNPs. Regarding the antibiofilm activity, MBICs ranged from 12.5 to 50 μg/mL. Again, smaller and spherical nanoparticles presented the best results with phenotypic inhibition of production of slime or exopolysaccharide (EPS) matrix. Thus, it was concluded that AgNPs have a promising potential against resistant bacteria and bacteria that grow on biofilms without inducing tolerance.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s11051-021-05314-1.

Nano-silver Fluoride at Higher Concentration for Caries Arrest in Primary Molars: A Randomized Controlled Trial

Aim and objective

To compare the arresting caries effectiveness of two different silver nanoparticle (AgNP) concentrations of nano-silver fluoride (NSF), namely 400 and 600 ppm. The hypothesis is that in posterior primary teeth with occlusal and approximal active dentin carious lesions, NSF 600's effectiveness will be higher than that of the NSF 400 solution over a 6-month follow-up period.

Materials and methods

This was a double-blind randomized clinical trial (RCT) conducted in the city of Recife, Brazil. A total of 337 children aged 5–7 years who attended the University of Pernambuco Dental School's clinics were examined. A single-blinded investigator conducted the examinations and treatment of the children. After baseline examination and recording of the dmft index, children were allocated to one of two study groups (NSF 600—intervention and NSF 400—positive control). In both groups, each tooth received two drops of NSF and treatments were performed only once in 6 months. The follow-up examinations were visual and tactile, performed in 30, 90, and 180 days to determine the activity of caries. The carious lesions that were not arrested in 30 days were recorded and referred for restorative treatment.

Results

The NSF 600 showed higher rate of success in arresting caries (72.7%, p = 0.025) compared with NSF 400 (56.5%).

Conclusion

The higher rate of success of NSF 600 can be explained by the higher concentration of AgNPs.

Clinical significance

Nano-silver fluoride has emerged as an excellent alternative to silver diamine fluoride (SDF), as it adds a high antibacterial effect to better esthetic results. Treatment is simple, non-invasive, and incurs low cost. It is ideal for use in community-based programs to increase the access to dental care without staining teeth black like other silver products.

How to cite this article

Arnaud M, Junior PCM, Lima MGS, et al. Nano-silver Fluoride at Higher Concentration for Caries Arrest in Primary Molars: A Randomized Controlled Trial. Int J Clin Pediatr Dent 2021;14(2):207–211.

An Insight into Nano Silver Fluoride-Coated Silk Fibroin Bioinspired Membrane Properties for Guided Tissue Regeneration

The current work focuses on the development of a novel electrospun silk fibroin (SF) nonwoven mat as a GTR membrane with antibacterial, biomineralization and biocompatible properties. The γ-poly glutamic acid (γ-PGA)-capped nano silver fluoride (NSF) and silver diamine fluoride (SDF) were first synthesized, which were dip-coated onto electrospun silk fibroin mats (NSF-SF and SDF-SF). UV-Vis spectroscopy and TEM depicted the formation of silver nanoparticles. NSF-SF and SDF-SF demonstrated antibacterial properties (against Porphyromonas gingivalis) with 3.1 and 6.7 folds higher relative to SF, respectively. Post-mineralization in simulated body fluid, the NSF-SF effectively promoted apatite precipitation (Ca/P ~1.67), while the SDF-SF depicted deposition of silver nanoparticles, assessed by SEM-EDS. According to the FTIR-ATR deconvolution analysis, NSF-SF portrayed ~75% estimated hydroxyapatite crystallinity index (CI), whereas pure SF and SDF-SF demonstrated ~60%. The biocompatibility of NSF-SF was ~82% when compared to the control, while SDF-coated samples revealed in vitro cytotoxicity, further needing in vivo studies for a definite conclusion. Furthermore, the NSF-SF revealed the highest tensile strength of 0.32 N/mm and 1.76% elongation at break. Therefore, it is substantiated that the novel bioactive and antibacterial NSF-SF membranes can serve as a potential candidate, shedding light on further in-depth analysis for GTR applications.

The Manufacture and Characterization of Silver Diammine Fluoride and Silver Salt Crosslinked Nanocrystalline Cellulose Films as Novel Antibacterial Materials

There is an unmet need for biocompatible, anti-infective, and mechanically strong hydrogels. This study investigated the use of poly vinyl alcohol (PVA), polysaccharides, and nanocrystalline cellulose (CNC) to deliver silver in a controlled manner for possible use against oral or wound bacteria. Silver was included in solvent cast films as silver diammine fluoride (SDF) or as nitrate, sulphate, or acetate salts. Hydrogel formation was assessed by swelling determinations and silver release was measured using inductively coupled plasma methods. Antibacterial studies were performed using Gram-positive and negative bacteria turbidity assays. PVA formed homogenous, strong films with SDF and swelled gently (99% hydrolyzed) or vigorously with dissolution (88% hydrolyzed) and released silver slowly or quickly, respectively. CNC-SDF films swelled over a week and formed robust hydrogels whereas CNC alone (no silver) disintegrated after two days. SDF loaded CNC films released silver slowly over 9 days whereas films crosslinked with silver salts were less robust and swelled and released silver more quickly. All silver loaded films showed good antibacterial activity. CNC may be crosslinked with silver in the form of SDF (or any soluble silver salt) to form a robust hydrogel suitable for dental use such as for exposed periodontal debridement areas.

Current status and future of delivery systems for prevention and treatment of infections in the oral cavity

Oral health reflects the general health, and it is fundamental to well-being and quality of life. An infection in the oral cavity can be associated with serious complications in human health. Local therapy of these infections offers many advantages over systemic drug administration, targeting directly to the diseased area while minimizing systemic side effects. Specialized drug delivery systems into the oral cavity have to be designed in such a fashion that they resist to the aqueous environment that is constantly bathed in saliva and subject to mechanical forces. Additionally, a prolonged release of drug should also be provided, which would enhance the efficacy and also decrease the repeated dosing. This review is aimed to summarize the current most relevant findings related to local drug delivery of various drug groups for prevention and treatment of infections (viral, bacterial, fungal) and infection-related manifestations in the oral cavity. Current therapeutic challenges in regard to effective local drug delivery systems will be discussed, and the recent approaches to overcome these obstacles will be reviewed. Finally, future prospects will be overviewed to promote novel strategies that can be implemented in clinical management for prevention and treatment of oral infections.

Can silver diamine fluoride or silver nanoparticle-based anticaries agents to affect enamel bond strength?

Objectives

The aim of the current study is to investigate the effect of different anticaries agents, such as experimental agents based on silver nanoparticles (SNPs) and silver diamine fluoride (SDF), on the micro-shear bond strength (μ-SBS) of composite resin applied to intact enamel (IE) or demineralized enamel (DE).

Materials and Methods

Sixty dental enamel fragments were collected from human third molars and categorized into 6 groups (n = 10): positive control (IE), negative control (DE), IE + SDF, DE + SDF, IE + SNP and DE + SNP. Samples from DE, DE + SDF and DE + SNP groups were subjected to pH cycling; superficial microhardness test was performed to confirm demineralization. Resin composite build-ups were applied to the samples (0.75-mm diameter and 1-mm height) after the treatments (except for IE and DE groups); μ-SBS was also evaluated. Samples were analyzed under a stereomicroscope at 40× magnification to identify failure patterns. Data were subjected to one-way analysis of variance, followed by Tukey's and Dunnett's tests (p < 0.05).

Results

There was no significant difference among the IE, IE + SNP, DE + SDF, and DE + SNP groups. The IE + SDF and DE groups recorded the highest and the lowest μ-SBS values, respectively. Adhesive-type failures were the most frequent for all treatments.

Conclusions

Anticaries agents did not have a negative effect on the μ-SBS of composite resin when it was used on IE or DE.

Nanomaterials Application in Orthodontics

Nanotechnology has gained importance in recent years due to its ability to enhance material properties, including antimicrobial characteristics. Nanotechnology is applicable in various aspects of orthodontics. This scientific work focuses on the concept of nanotechnology and its applications in the field of orthodontics, including, among others, enhancement of antimicrobial characteristics of orthodontic resins, leading to reduction of enamel demineralization or control of friction force during orthodontic movement. The latter one enables effective orthodontic treatment while using less force. Emphasis is put on antimicrobial and mechanical characteristics of nanomaterials during orthodontic treatment. The manuscript sums up the current knowledge about nanomaterials' influence on orthodontic appliances.

Development of an enzyme-enhancer system to improve laccase biological activities

The present investigation reports an in-vitro study using combination of laccase and an enhancer capable of inhibiting the growth of pathogenic microorganisms, preventing biofilm formation, and whitening teeth. Laccase-cinnamic acid system remarkably inhibited the growth of Aggregatibacter actinomycetemcomitans, Candida albicans, S. aureus, and Streptococcus mutans whilst showed no significant effects on Gram-negative bacteria. Data presented that cinnamic acid (10 mM) with laccase (0.125 U ml^-1) led to a maximum decrease of about 90%, in S. mutans biofilm formation. The confocal laser scanning microscopy showed considerable detachment of S. mutans cells from glass substratum. The combined laccase-cinnamic acid system could remove teeth discoloration caused by coffee. SEM of the teeth surface exhibited no damages such as surface cracking or fracture. Liquid chromatography-tandem mass spectrometry (LC-MS) and cyclic voltammetry (CV) studies showed that laccase can catalyze the one-electron oxidation of cinnamic acid to the respective radical. This radical can then undergo several fates, including recombination with another radical to form a dimeric species, dismutation of the radical back to cinnamic acid or decarboxylation to give various reduced oxygen species. Therefore, the redox potential values of phenolic monomers/oligomers are related with their biological activities.

Demineralization Inhibitory Effects of Highly Concentrated Fluoride Dentifrice and Fluoride Gels/Solutions on Sound Dentin and Artificial Dentin Caries Lesions in vitro

OBJECTIVES

The aim of this in vitro study was to compare the demineralization inhibitory effect of gels/solutions used in combination with either standard or highly fluoridated dentifrices on sound dentin as well as on artificial dentin caries-like lesions.

METHODS

Bovine dentin specimens (n = 240) with two different surfaces each (sound [ST] and artificial caries lesion [DT]) were prepared and randomly allocated to twelve groups. Weekly interventions during pH-cycling (28 days, 6 × 120 min demineralization/day) were: the application of gels/solutions containing amine fluoride/sodium fluoride (12,500 ppm F [ppm]; pH = 4.4; AmF); NaF (12,500 ppm; pH = 6.6; NaF1); NaF (12,500 ppm; pH = 6.3; NaF2); silver diamine fluoride (14,200 ppm; pH = 8.7; SDF); acidulated phosphate fluoride (12,500 ppm; pH = 3.8; APF), and no intervention (standard control; S). Furthermore, half of the specimens in each group were brushed (10 s; twice per day) with dentifrice slurries containing either 1,450 ppm (e.g., AmF1450) or 5,000 ppm (e.g., AmF5000). Differences in integrated mineral loss (ΔΔZ) and lesion depth (ΔLD) were calculated between values before and after pH-cycling using transversal microradiography.

RESULTS

After pH-cycling Ss showed significantly increased ΔZDT and LDDT values, indicating further demineralization. In contrast, except for one, all groups including fluoride gels/solutions showed significantly decreased ΔZDT values. Additional use of most fluoride gels/solutions significantly enhanced mineral gain, mainly in the surface area; however, acidic gels/solutions seemed to have negative effects on lesion depths.

SIGNIFICANCE

Under the present pH-cycling conditions the highly fluoridated dentifrice significantly reduced caries progression and additional application of nearly all of the fluoride gels/solutions resulted in remineralization. However, there was no difference in the remineralizing capacity of fluoride gels/solutions when used in combination with either standard or highly fluoridated dentifrices.

In vitro demineralization prevention by fluoride and silver nanoparticles when applied to sound enamel and enamel caries-like lesions of varying severities

OBJECTIVES

To investigate the effect of fluoride and silver nanoparticles on the prevention of in vitro demineralization of sound enamel and enamel caries-like lesions of varying severities.

METHODS

Caries-like lesions of different severities (1/6/15 days) were created in bovine enamel specimens. One group remained sound. All specimens were demineralized again using a partially saturated acetic acid solution. Mimicking the intra-oral retention of fluoride and silver in vitro, this solution was supplemented with fluoride (0/1/10 ppm) and/or silver nanoparticles (0/10 ppm) in a factorial design. Changes in lesion depth (ΔL) and integrated mineral loss (ΔΔZ) were evaluated by digital transverse microradiography. Data was analyzed using three-way ANOVA.

RESULTS

Lesion severity significantly affected ΔΔZ and ΔL, after no treatment and after the treatment of fluoride and silver independently (p = 0.012 and p = 0.037, respectively). Fluoride and the fluoride × lesion severity interaction were shown to be significant (p < 0.001) on ΔΔZ and ΔL. Silver nanoparticles significantly affected ΔΔZ (p = 0.041), but not ΔL (p = 0.15). The silver nanoparticles × lesion severity interaction was significant for ΔΔZ and ΔL (p = 0.032 and p = 0.024, respectively). No interaction was observed for ΔΔZ and ΔL between fluoride and silver (p = 0.962 and p = 0.971, respectively) as well as lesion severity and the use of fluoride and silver combined (p = 0.722 and p = 0.158, respectively).

CONCLUSION

Fluoride and silver nanoparticles had a significant effect on the prevention of in vitro demineralization of sound enamel and enamel caries-like lesions of varying severities.

CLINICAL SIGNIFICANCE

Fluoride and silver nanoparticles may potentially allow for more tailored caries prevention.

The antibacterial efficacy of silver diamine fluoride (SDF) is not modulated by potassium iodide (KI) supplements: A study on in-situ plaque biofilms using viability real-time PCR with propidium monoazide

Silver diamine fluoride (SDF) is commonly used to arrest caries lesions, especially in early childhood caries. Recently, it was suggested that SDF can be combined with potassium iodide (KI) to minimize the discoloration of demineralized dentine associated with SDF application. However, the antibacterial efficacy of SDF alone or combined with KI on in-situ biofilm is unknown. Hence, we compared the anti-plaque biofilm efficacy of two different commercially available SDF solutions, with or without KI, using an in-situ biofilm, analysed using viability real-time PCR with propidium monoazide (PMA). Appliance-borne in-situ biofilm samples (n = 90) were grown for a period of 6 h in five healthy subjects who repeated the experiment on three separate occasions, using a validated, novel, intraoral device. The relative anti-biofilm efficacy of two SDF formulations; 38.0% Topamine (SDFT) and 31.3%, Riva Star (SDFR), KI alone, and KI in combination with SDFR (SDFR+KI) was compared. The experiments were performed by applying an optimized volume of the agents onto the biofilm for 1min, mimicking the standard clinical procedure. Afterwards the viability of the residual biofilm bacteria was quantified using viability real-time PCR with PMA, then the percentage of viable from total bacteria was calculated. Both SDF formulations (SDFT and SDFR) exhibited potent antibacterial activities against the in-situ biofilm; however, there was non-significant difference in their efficacy. KI alone did not demonstrate any antibacterial effect, and there was non-significant difference in the antibacterial efficacy of SDF alone compared to SDF with KI, (SDFT v SDFR/KI). Thus, we conclude that the antibacterial efficacy of SDF against plaque biofilms is not modulated by KI supplements. Viability real-time PCR with PMA was successfully used to analyze the viability of naturally grown oral biofilm; thus, the same method can be used to test the antimicrobial effect of other agents on oral biofilms in future research.

The role of sodium alginate and gellan gum in the design of new drug delivery systems intended for antibiofilm activity of morin

The use of controlled drug delivery systems represents an alternative and promising strategy for the use of antimicrobials in the oral cavity. Microparticles, films and oral tablets based on alginate and gellan gum were developed also as a strategy to overcome the low aqueous solubility of morin. The systems were characterized in terms of morphological characteristics, mucoadhesion and in vitro drug release. Antibiofilm activity was analyzed for acidogenicity, microbial viability and the composition of the extracellular matrix of single-species biofilms. Scanning Electron Microscopy demonstrated that the microparticles were spherical, rough and compact. The film and the tablet presented smooth and continuous surface and in the inner of the tablet was porous. These systems were more mucoadhesive compared to the microparticles. The in vitro morin release profiles in artificial saliva demonstrated that the microparticles controlled the release better (39.6%), followed by the film (41.1%) and the tablet (91.4%) after 20 h of testing. The morin released from the systems reduced the acidogenicity, microbial viability, concentration of insoluble extracellular polysaccharides and dry weight of biofilms, when compared to the control group. The findings of this study showed that the morin has antibiofilm activity against cariogenic microorganisms.

Therapeutic Use of Silver Nanoparticles in the Prevention and Arrest of Dental Caries

Dental caries is one of the major diseases of the oral cavity affecting humans worldwide. Different alternatives have been used for its control, but its incidence and prevalence are still high. On the other hand, silver has been used for centuries due to its antimicrobial properties. With advances in nanotechnology, the use and research in nanomaterials has increased, recently, and silver nanoparticles have become an essential part of the dental practice, giving materials physical and chemical improvements in their properties, used for their antibacterial capacity preventing and arresting dental caries. The objective of this review was to examine the use of silver nanoparticles, in the treatment of dental caries in the remineralization of teeth hard tissues, as well as the antimicrobial potential, cytotoxicity, and long-term effectiveness.