Silver compounds used in dentistry for caries management: a review

Abstract

OBJECTIVE: Silver compounds have been used for their medical properties for centuries and in dentistry for more than a century. The aim of this review is to examine the evidence supporting the therapeutic use of silver in dentistry and the outcomes from the clinical trials, as well as mode of action and biocompatibility. DATA SOURCES: Literature was searched using the PubMed database between the year 1966 and 2011, with principle key terms such as 'Silver Nitrate', 'Silver Fluoride', 'Silver Diammine Fluoride', 'Silver compounds' and 'Dental caries'. Hand searching was performed for relevant papers cited in the indices back to the year 1905. RESULTS: In vitro, in vivo and clinical evidence have demonstrated that silver compounds are viable agents for preventing and arresting caries both in the primary and permanent dentition; however they are associated with adverse tooth discolouration and some reports that pulp irritation may occur. Further research has investigated its effectiveness as a dentine desensitiser, root canal disinfectant and even in silver impregnated restorative materials. The mode of action of silver compounds on carious tooth tissues is thought to include inhibition of the demineralization process, as well as an anti-bacterial effect by interference of bacterial cell membranes, cytoplasmic enzymes and inhibition of bacterial DNA replication. CONCLUSION: Silver compounds have been shown to be an effective anti-caries agent; however, there is an incomplete understanding of how silver compounds prevent caries. Further research is required to help identify its most efficacious use and limitations.