Fluoride Action Network


Purpose: The purpose of this study was to measure serum levels and characterize the pharmacokinetics of silver and fluoride in healthy children receiving silver diamine fluoride (SDF) treatment for dental caries lesions.

Methods: Children (three to 13 years old with at least one caries lesion) were recruited at the University of California, San Francisco Pediatric Dental Clinic from August 2019 through March 2020. Blood was obtained at one randomly selected timepoint up to 168 hours after SDF application. Serum fluoride and silver were measured, and population pharmacokinetic modeling was used to estimate pharmacokinetic parameters and simulate silver concentration versus time profiles in cohorts of children (15 to 50 kg).

Results: Fifty-five children completed the study. Serum fluoride had no discernable temporal pattern. Silver concentra- tions were best described by a one-compartment model with first-order absorption and elimination, and weight as a covariate. Simulated 15 kg children had higher predicted peak silver concentrations than simulated 50 kg children (22.0 ng/mL [95 percent confidence interval {95 percent CI} equals 19.4 to 24.6] versus 12.8 ng/mL [95 percent CI equals 11.3 to 14.3]), and a longer predicted silver half-life (15.5 days [95 percent CI equals 12.5 to 18.5] versus 4.0 days [95 percent CI equals 2.7 to 5.3]).

Conclusions: Evidence presented indicate that topical silver diamine fluoride application in children is safe, and serum concentrations of fluoride and silver pose little risk of toxicity.

*Original abstract online at https://pubmed.ncbi.nlm.nih.gov/35484770/
*Full PhD thesis online at https://escholarship.org/uc/item/4nq8s2f8



This work was supportedby unrestricted donations to University of California San Francisco Foundation and the University of Washington Foundation by Advantage Silver Dental Arrest, LLC and Elevate Oral Care, LLC. ITHS Translational Research Unit is supported by grants UL1 TR002319, KL2 TR002317, and TL1 TR002318 from the NIH National Center for Advancing Translational Sciences through the Clinical and Translational Science Awards Program (CTSA). The authors acknowledge the support of the Pediatric Clinical Research Centerand Sample Processing Lab at the University of California San Franciscoand the Environmental Health Laboratory and Trace OrganicsAnalysis Center at the University of Washington,andthank Stuart Ganksy, MS, DrPHfor statistical assistance and Vinitha Gopal for her assistance in the participant care.