Impact of Capping Agent Incorporation on pH Stability of Silver Diamine Fluoride: An in Vitro Analysis

  • Mehmood Asghar Army Medical College, Rawalpindi, Pakistan
  • Ros Anita Omar University of Malaya, Kuala Lumpur, Malaysia
  • Adrian UJin Yap Ng Teng Fong General Hospital and Faculty of Dentistry, National University Health System, Singapore
  • Nida Zehra Bano Army Medical College, Rawalpindi, Pakistan
  • Rosiyah Yahya University of Malaya, Kuala Lumpur, Malaysia
  • Ahmad Danial Azzahari University of Malaya, Kuala Lumpur, Malaysia
Keywords: pH, Silver Diamine Fluoride, Tooth Remineralization

Abstract

Objective: To determine the chemical stability by evaluating time-dependent pH changes in 38% silver diamine
fluoride with or without incorporating different concentrations of tannic acid and glutathione as capping
agents.
Study Design: Experimental, in vitro study.
Place and Duration of Study: The study was conducted at the Faculty of Dentistry, University of Malaya, Kuala
Lumpur, Malaysia from January 2021 to April 2022.
Methods: Tannic acid and Glutathione-modified silver diamine fluoride solutions were prepared by
incorporating tannic acid or Glutathione at different concentrations (5,10,15% w/v) into silver diamine fluoride.
pH changes in the solutions were measured at different time points: from 1 hour after the bottles were opened
to day 90.
Results: The pH of 38% silver diamine fluoride from baseline till day-90 ranged between 7.73±0.02 and
7.69±0.01. The incorporation of tannic acid and glutathione resulted in a significant increase in the pH of the
silver diamine fluoride solution. In tannic acid-modified silver diamine fluoride, the highest 90-day pH was
shown by silver diamine fluoride + 5% tannic acid (w/v) (9.00±0.01), while in the glutathione-modified silver
diamine fluoride, silver diamine fluoride + 15% Glutathione (w/v) had the highest 90-day pH (9.80±0.02).
Repeated measures analysis of variance showed a statistically significant difference between the groups' pH
values. A pairwise comparison showed significant differences in the pH of all the possible pairs at all-time points
(P<0.05), except the pairs silver diamine fluoride + 15% tannic acid (w/v) and silver diamine fluoride + 15%
glutathione (w/v) after the 1st hour and day 1 (P > 0.05).
Conclusion: Silver diamine fluoride and tannic acid/glutathione-modified silver diamine fluoride solutions
remain stable for up to 90 days. Capping agent incorporation significantly increases the pH of silver diamine
fluoride, thereby enhancing its long-term stability and shelf life.

Author Biographies

Mehmood Asghar, Army Medical College, Rawalpindi, Pakistan

 

 

Ros Anita Omar, University of Malaya, Kuala Lumpur, Malaysia

 

 

Adrian UJin Yap, Ng Teng Fong General Hospital and Faculty of Dentistry, National University Health System, Singapore

 

 

Nida Zehra Bano, Army Medical College, Rawalpindi, Pakistan

 

 

Rosiyah Yahya, University of Malaya, Kuala Lumpur, Malaysia

 

 

Ahmad Danial Azzahari, University of Malaya, Kuala Lumpur, Malaysia

 

 

Published
2025-04-07
Section
Original Article