Formulation modification of silver diamine fluoride to improve clinical handling and dentin tubule occlusion

Authors

• Liangyu Chang, Graduate Institute of Nanomedicine and Medical Engineering, Taipei Medical University, Taipei, Taiwan
• Yutzu Wu, Graduate Institute of Nanomedicine and Medical Engineering, Taipei Medical University, Taipei, Taiwan
• Powen Lu, Graduate Institute of Biomedical Materials and Tissue Engineering, Taipei Medical University, Taipei, Taiwan
• Iwen Chen, School of Dentistry, Taipei Medical University, Taipei, Taiwan.
• Weifang Lee, School of Dental Technology, Taipei Medical University, Taipei, Taiwan.
• Chunche Lin, Institute of Organic and Polymeric Materials, National Taipei University of Technology, Taipei, Taiwan.
• Renjei Chung, Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, Taipei, Taiwan
• Poonam Negi, Chitkara College of Pharmacy, Chitkara University, Rajpura, Punjab, India.
• Naichia Teng, School of Dentistry, Taipei Medical University, Taipei, Taiwan.Follow
• Jenchang Yang, Graduate Institute of Nanomedicine and Medical Engineering, Taipei Medical University, Taipei, TaiwanFollow

Abstract

Background/purpose: Silver diamine fluoride (SDF) is clinically effective for treating dentinal hypersensitivity and arresting caries, but its poor clinical handling due to low viscosity remain concerns. This study aimed to enhance the rheological properties of SDF by incorporating sodium carboxymethylcellulose (CMC) to improve its clinical manageability. Materials and methods: A 39.34 wt% SDF solution (TMU-SDF) was prepared via wet processing. Its matrix metalloproteinase (MMP) inhibition was evaluated using a fluorogenic MMP-1 assay, and antibacterial activity was tested via an inhibition zone assay. Biocompatibility was assessed using a modified cytotoxicity-agar diffusion test and a skin sensitization test. Rheological properties, including flow curves and thixotropy, were measured with a cone-plate rheometer. Dentin tubule occlusion was examined on human root dentin specimens treated with gelled TMU-SDF/CMC, followed by SEM/EDX analysis. Results: Both commercial Advantage Arrest^® (AA-SDF) and TMU-SDF showed high MMP-1 inhibition and antibacterial effects, with no significant difference between them (P > 0.05). Cytotoxicity tests indicated severe reactivity (grade 4) for both, but TMU-SDF elicited no irritation or skin sensitization. Increasing CMC concentration raised zero-shear viscosity and reduced thixotropic index, confirming improved gel-like behavior. Dentin tubule occlusion was significantly greater with TMU-SDF/CMC (82.5 ± 8.0%) compared to TMU-SDF alone (70.2 ± 3.0%) (P < 0.05). Conclusion: The addition of CMC to SDF enhances its viscosity and dentin tubule sealing capability without compromising antibacterial or MMP-inhibitory activity. While the formulation shows no skin irritation or sensitization, its cytotoxicity warrants caution. These rheological modifications improve clinical handling, but in vivo studies are needed to confirm efficacy for dentinal hypersensitivity.

Recommended Citation

Chang, Liangyu; Wu, Yutzu; Lu, Powen; Chen, Iwen; Lee, Weifang; Lin, Chunche; Chung, Renjei; Negi, Poonam; Teng, Naichia; and Yang, Jenchang (2026) "Formulation modification of silver diamine fluoride to improve clinical handling and dentin tubule occlusion," Journal of Dental Sciences: Vol. 21: Iss. 4, Article 48.
Available at: https://jds.ads.org.tw/journal/vol21/iss4/48

Publication Date

2026