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Silver Diamine Fluoride — MFDS Part 1 MCQ

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ModeratePharmacologySilver Diamine FluorideMFDS Part 1

A child with an active cavitated dentinal caries lesion is managed non-restoratively using 38% silver diamine fluoride. Which pharmacological action best explains arrest of the lesion?

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Correct answer: AAntimicrobial silver activity combined with fluoride-driven remineralisation and reduced dentine collagen breakdown

Explanation lettering: D = shown as C · C = shown as D

A is correct. Silver ions exert antimicrobial effects against cariogenic bacteria and biofilm and inhibit enzymes involved in dentine collagen degradation. Fluoride promotes remineralisation, reduces further demineralisation and also contributes to preservation of the dentine matrix. These complementary effects harden and arrest the active lesion. SDF is therefore a non-restorative caries-control agent: it does not physically fill the cavity or replace missing enamel or dentine, excluding B and E. Reparative dentine formation is not its principal action, excluding C. It is not used to devitalise the pulp or as a direct pulp-capping agent; direct pulpal exposure may instead cause injury, excluding D. Arrested carious dentine commonly becomes hard and dark or black, an important consent issue.

Reference: Mei ML, Lo ECM, Chu CH. Arresting Dentine Caries with Silver Diamine Fluoride: What's Behind It? Journal of Dental Research. 2018;97(7):751-758. https://pubmed.ncbi.nlm.nih.gov/29768975/