Comprehensive evaluation of potassium iodide added silver diamine fluoride and silver fluoride in stage-II Early childhood caries- A clinical trial

Early Childhood Caries (ECC) is used to denote the occurrence of one or more primary teeth, in a child under the age of 6, that are decayed, restored, or missing. ECC has 4 stages, wherein any failure to address the initial reversible lesion will progress to the traumatic stage. In the traumatic stage of ECC, the teeth become so weak by caries that they fracture on minor trauma. Hence importance has to be given for the early reversal of the lesion and its arrest. ECC when left untreated results in pain, irritability, bacteremia, high treatment costs, reduced growth and development, speech disorders, and premature tooth loss with its sequelae of compromised chewing, loss of self-esteem, and permanent dentition hampering their mental attitude. 44% of children aged between 8 and 48 months have ECC in India. According to McDonald and Avery, the major three steps in preventing ECC are decreasing substrate concentration, decreasing microbial load, and increasing resistance of the tooth.6 Traditionally, the approach to managing carious lesions involves mechanical removal of the decayed tissue and replacing it with an appropriate restorative material. The treatment success with traditional approaches is highly influenced by the child’s behavior in the dental setting. As an alternative Minimal invasive dentistry (MID), which aims at maintenance of the sound tooth structure using non-invasive techniques has replaced the conventional procedures. Carol Anne et al, say that the “minimally invasive” approach to treating dental caries incorporates the dental science of detecting, diagnosing, intercepting, and treating dental caries on the microscopic level. ART, PRR, and SMART are among the many nonsurgical methods used in this approach to treating dental caries.SDF adheres to the philosophy of minimally invasive dentistry. Stebbins utilized SDF for the first time in 1969, and Japan approved it in August 2014 for therapeutic usage. SDF contains silver which is bactericidal and is used as an antimicrobial agent to arrest caries. It can be utilized extensively in pediatric dentistry since it is non-invasive, especially for children with unique healthcare needs and recalcitrant behavior, where traditional treatments can be technique-sensitive. It acts by obstructing dentinal tubules, promoting demineralized teeth to become more mineralized, and preventing the breakdown of dentinal collagen. The primary disadvantages of silver diamine therapy are the black stain left by the silver content and the strong taste and odor of ammonia, which also slightly irritates soft tissues. Studies were done on the effects of varying concentrations of silver diamine fluoride in arresting dental caries, but there is a dearth of information on how to prevent the tooth structure from discoloration after a procedure, cover up the smell, and lessen pain in the soft tissues. To prevent discoloration, our study applies potassium iodide (KI) after applying 38% silver fluoride with water as a solvent to overcome the soft tissue discomfort caused by ammonia. Thus this study aims to compare conventional 38% SDF added potassium iodide with 38% AgF added potassium iodide with water as a solvent.