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Anti-erosive effect of silver diamine fluoride against enamel erosion: An in situ study

Lookup NU author(s): Professor Nicholas JakubovicsORCiD

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This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).

Abstract

© 2026 The Author(s)Objective: To investigate anti-erosive effect of silver diamine fluoride (SDF) against enamel erosion and assessed associated color change. Methods: This three-phase crossover in situ study compared anti-erosive effect of SDF and stannous chloride/amine fluoride/sodium fluoride mouthrinse (SNF) against distilled water (DW, control), while evaluating enamel color changes. Fifteen adults (27–35 years) wore palatal appliances with four-enamel blocks per phase, alternating 14-day intervention periods (weekly 38% SDF [255,000 ppm Ag, 44,800 ppm F], daily SNF mouthrinse [800 ppm Sn, 500 ppm F], or weekly DW) separated by 7-day washouts. Appliances were exposed with five 2 min extraoral erosive challenges (citric acid, pH 3.2) daily. Post-intervention analyses included salivary pellicle morphology (atomic force microscopy, AFM), enamel surface integrity (scanning electron microscopy, SEM), elemental composition (energy-dispersive X-ray spectroscopy, EDS), crystal structure (X-ray diffraction, XRD), surface microhardness loss (hardness tester), surface loss (optical profilometry), and color change (spectrophotometry). Results: AFM revealed altered pellicle morphology in SDF and SNF groups. SEM demonstrated reduced enamel erosion in SDF and SNF versus DW. EDS confirmed Ag+ deposition in SDF and Sn2+ in SNF. XRD identified fluorapatite in SDF and SNF groups. SDF showed the lowest surface microhardness loss (21.7±1.0%) and surface loss (µm) (2.7±0.6), followed by SNF (30.0±1.1%; 3.2±0.7), and DW (42.4±1.0%; 5.4±0.8) (p<0.001). However, SDF caused greatest color change (ΔE00=6.6±2.1), followed by SNF (ΔE00=5.8±1.0), and DW (ΔE00=3.6±1.7) (p<0.001). Conclusion: Weekly SDF application demonstrated superior erosion resistance compared to daily SNF, likely attributed to silver-fluoride-induced fluorapatite crystallization and pellicle structural reinforcement. However, enamel staining is an esthetic trade-off.

Publication metadata

Author(s): Chawhuaveang D, Lam WYH, Chan AKY, Jakubovics NS, Chu CH, Yu OY

Publication type: Article

Publication status: Published

Journal: Journal of Dentistry

Year: 2026

Volume: 169

Print publication date: 01/06/2026

Online publication date: 20/03/2026

Acceptance date: 20/03/2026

Date deposited: 13/04/2026

ISSN (print): 0300-5712

ISSN (electronic): 1879-176X

Publisher: Elsevier Ltd

URL: https://doi.org/10.1016/j.jdent.2026.106646

DOI: 10.1016/j.jdent.2026.106646

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