Weekly SDF use tied to Superior Erosion Resistance with Esthetic Trade-off compared to Daily SNF: Study

A new research published in the Journal of Dentistry revealed that weekly application of silver diamine fluoride (SDF) provides better protection against enamel erosion when compared to daily sodium fluoride (SNF). This enhanced effect is likely due to fluorapatite formation and strengthening of the enamel pellicle. However, SDF use is associated with enamel staining, making it less favorable in terms of esthetics.

This 3-phase crossover in situ investigation involving 15 adults aged 27 to 35 to compared the anti-erosive effects of SDF with a commonly used stannous chloride/amine fluoride/sodium fluoride mouth rinse (SNF), and distilled water as a control. Participants wore specially designed palatal appliances fitted with enamel samples, allowing scientists to simulate real-life oral conditions while maintaining experimental control.

Each participant underwent three separate 14-day treatment phases such as weekly application of 38% SDF, daily use of SNF mouth rinse, or weekly distilled water, with interspersed washout periods. To replicate dietary acid exposure, enamel samples were subjected to 5 daily cycles of citric acid challenges.

The findings revealed SDF to demonstrate the strongest resistance to enamel erosion, followed by SNF, with distilled water showing the least protection. Measurements of surface microhardness loss showed SDF-treated enamel experienced significantly less damage (21.7%) when compared to SNF (30.0%) and the control group (42.4%). Similarly, surface loss was lowest in the SDF group.

Advanced imaging techniques revealed that both SDF and SNF altered the structure of the salivary pellicle by making it more resistant to acid attack. Elemental analysis confirmed the deposition of silver ions in the SDF group and tin ions in the SNF group, both of which contributed to enhanced enamel protection. Both treatments promoted the formation of fluorapatite, a more acid-resistant mineral form than natural enamel.

SDF caused the most significant color change in enamel, with staining levels exceeding those seen in the SNF and control groups. While SNF also resulted in some discoloration, it was less pronounced.

Overall, this research highlighted the superior protective effect of SDF which is likely due to its ability to reinforce enamel through both chemical transformation and structural modification of the pellicle layer. Yet, the aesthetic impact remains a limiting factor for widespread cosmetic acceptance.

Source:

Chawhuaveang, D., Lam, W. Y. H., Chan, A. K. Y., Jakubovics, N. S., Chu, C. H., & Yu, O. Y. (2026). Anti-erosive effect of silver diamine fluoride against enamel erosion: An in situ study. Journal of Dentistry, 106646. https://doi.org/10.1016/j.jdent.2026.106646