Assessment of the Silver Penetration and Distribution in Carious Lesions of Deciduous Teeth Treated with Silver Diamine Fluoride

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Research Article


The aim of this study was to determine the effects of 38% silver diamine fluoride (SDF) on carious lesions of human deciduous teeth. Ten extracted deciduous incisors with caries were collected and treated with SDF. After the treatment, the teeth were sectioned through the center of the carious lesion. The extent of sliver precipitation was examined using quantitative backscattered electron scanning electron microscopy (qBSE-SEM), energy-dispersive X-ray spectroscopy (EDX), and micro-computed tomography (micro-CT). The qBSE-SEM images revealed that the silver particles could penetrate through the pellicle complex, along with the rod sheaths into the demineralized enamel rods and the dentinal tubules, and form silver-enriched barriers surrounding the carious lesions at depths up to 2,490.2 μm (mean 744.7 ± 448.7 μm) within the dentinal tubules of the carious lesions, but less likely in the sound enamel. The EDX spectrum analysis revealed that carbon, oxygen, phosphorus, chlorine, silver, and calcium were the main elements detected in the lesions treated with SDF. Additionally, sodium, magnesium, aluminum, silicon, zinc, sulfur, and fluorine were detected as the minor elements within the SDF precipitation “zone.” The micro-CT analysis further showed that in the deep cavitated lesions, the silver precipitation could be observed in the pulp chamber. These findings provide new evidence defining the SDF mode of action for arresting caries and suggest that the application of a highly concentrated SDF solution on deciduous teeth should be used with caution for various carious lesions.

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Non-invasive analysis of bleaching effect of hydrogen peroxide on enamel by reflectance confocal microscopy (RCM): study of series of cases


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The aim of this study is to evaluate in vivo the effects of in-office tooth whitening hydrogen peroxide (HP) agent on enamel-microstructured surface by a reflectance confocal microscopy (RCM). Ten healthy volunteers assisted at the Dental School presenting teeth with vital pulp were selected. The 35% HP whiteness product was applied in two visits on discolored teeth, 1-week interval between, via 20-min applications. A commercially available hand-held RCM (Vivascope3000®, Lucid, Rochester, NY, USA) was used to image in vivo the dental surface of the selected tooth of each volunteer. Twenty upper central incisors’ vestibular surfaces were imaged, before bleaching (T0), immediately after (T1) and 1 week later (T2). The peculiar structure of the enamel was seen at T0. After bleaching, white reflective circular bodies were found all over the teeth surfaces, which disappear 1 week later (T2). When the HP gel® was imaged, the same white circular areas were observed. Going deeper, the regular enamel architecture was preserved. Textural analysis of the images in T0 and T2 was performed: GLCM parameters were extracted. Mann–Whitney U test was performed to evaluate statistical differences between two groups of data (p > 0.05). Finally, 35 prisms were randomly selected from T0 and T2 image and diameters were measured; a paired t test was performed (p = 0.381). The RCM is a promisor tool for investigating the features of enamel in vivo, immediately after bleaching procedures, as well as longitudinally.
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A framework for oral health care value-based payment approaches.

J Am Dent Assoc. 2019 Mar;150(3):178-185. doi: 10.1016/j.adaj.2018.10.021.



Dental practice has remained relatively insulated from payment upheavals in the broader health care system. The prevailing value-based payment (VBP) models in health care are largely absent in oral health care. The authors present an oral health care value-based payment framework for dentistry.


The authors developed a VBP framework for oral health care, which describes 9 distinct methods to create VBP approaches in dentistry. The framework is based on the Centers for Medicare & Medicaid Services Learning Action Network framework for health care payment reform.


The oral health care value-based payment framework includes 4 payment categories and 9 separate payment mechanisms. These 9 payment mechanisms range on a value continuum, each with different financial risks and rewards as well as distinct value implications.


Although dental practice has made extraordinary advances in restorative dentistry, payers and policy makers are advocating for greater value outcomes. VBP models seek to deliver better care more efficiently by means of providing oral health providers the resources needed to increase the value proposition. With relatively minor modifications in practice patterns, VBP models can be developed and implemented for oral health care.


This article can be used as a road map to take steps toward oral health care VBP approaches. The framework highlights how dentistry can learn from payment reforms under way in the health care system and present a model for oral health care payment and care delivery reform, and provides recommendations to advance oral health care VBP.

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(Chicago, IL – February 27, 2019) 
As part of its annual Celebration of Smiles event held during the Chicago Dental Society’s MidWinter Meeting, America’s ToothFairy was proud to honor Mobile Care Chicago with a $5,000 grant to support their services to underserved children in the Chicago area. The contribution will provide resources for the dental clinic’s mobile program which served more than 7,500 children last year.
Through the National Mobile Care Initiative, sponsored by Patterson Dental, America’s ToothFairy clinical partners overcome barriers to care by providing dental services in mobile units, schools and childcare facilities, community centers and other familiar settings in order to bring dental services to underserved children who live in urban and rural Dental Healthcare Professional Shortage Areas or have limited transportation options.
“Many of the families we serve work multiple jobs or have multiple children to care for. Taking time off of work or away from other caregiving responsibilities to travel across or into the city and waiting for an appointment is particularly difficult for these families,” said Matt Siemer, Executive Director of Mobile Care Chicago. “The generosity of America’s ToothFairy enabled Mobile Care to not only maintain care in the deeply underserved Southern Suburbs of Chicago but to add over 140 new patients last year. We are so grateful for this grant as it will help us treat even more children in the coming year.”
“Thanks to support from Patterson Dental, our National Mobile Care Initiative provided critical resources and support to 42 mobile dental clinics serving 152,641 children last year,” America’s ToothFairy Executive Director, Jill Malmgren announced during the presentation. “We are so pleased to provide these additional resources to Mobile Care Chicago as they provide high-quality services to underserved children in and around Chicago.”
Patterson Dental’s Tim Rogan, Senior Vice President and General Manager, was on hand to participate in the grant presentation. “Patterson Dental has been proud to partner with America’s ToothFairy for many years,” he said. “And we are especially pleased to act as Title Sponsor of this important initiative to help provide exceptional care and essential preventive services to children who might otherwise have to go without.”
About Patterson
Patterson Companies Inc. (Nasdaq: PDCO) is a distributor serving the dental and animal health markets. Patterson’s Dental segment provides a complete range of consumable dental products, equipment and software, turnkey digital solutions and value-added services to dentists and dental laboratories throughout North America. To learn more visit
About America’s ToothFairy: National Children’s Oral Health Foundation
As a resource provider, America’s ToothFairy increases access to oral health care by supporting non-profit clinics and community partners delivering education, prevention and treatment services for underserved children. Since its inception in 2006, America’s ToothFairy has distributed more than $19 million in donated products, educational materials and financial grants to improve oral health outcomes for children and youth in need. For more information, visit
Tim Rogan (right), Patterson Dental’s Senior Vice President and General Manager, presents a $5,000 ToothFairy grant to Matt Siemer, Executive Director of Mobile Care Chicago.
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