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Title Potassium Iodide May Be Effective in Reducing the Stains Caused by Silver Diamine Fluoride in Arresting Dental caries
Clinical Question In patients receiving silver diamine fluoride for dental caries, does the subsequent application of potassium iodide reduce staining as compared to no application?
Clinical Bottom Line In patients receiving silver diamine fluoride to arrest dental caries, the subsequent application of potassium iodide may aid in reducing the amount of tooth discoloration normally observed with SDF treatment. However, more evidence is needed in order to provide a definitive answer.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 27208876Li / 200683 elderly humans with 157 carious root surfacesRandomized Controlled Trial
Key results83 elders with 157 carious root surfaces randomly allocated into three groups – one group receiving soda water with a bitter flavor, one group receiving a 38% silver diamine fluoride (SDF) solution, and one group receiving a potassium iodide (KI) solution immediately after application of 38% SDF. Color of arrested lesions was measured using Pantone color plates. SDF group: 69% black, 25% dark brown. SDF/KI group: 62% black, 32% dark brown. The difference between the SDF and SDF/KI groups was not statistically significant (chi-square, p > 0.05).
#2) 29974546Patel / 201830 extracted carious primary molars, 5 clinically sound extracted premolarsLaboratory study
Key resultsThirty primary molars with caries allocated into 3 groups: one group receiving 38% SDF (n=10), one group receiving SDF + KI (n=10), and one group equally receiving either 38% SDF (n=5) or 12% SDF (n=5). Five clinically sound premolars used to assess the staining between enamel and cementum surfaces following 38% SDF application. The mean gray values were compared using image software and t-tests (significance level = 0.05). No statistically significant difference in gray values was observed following SDF + KI application as compared to baseline values of the carious lesions (p=0.123).
Evidence Search sdf[All Fields] AND potassium iodide[All Fields] AND caries[All Fields]
Comments on
The Evidence
Validity: The first study, being a randomized controlled trial, is a higher level of evidence than the second experimental study. In the Li study, the subjects were randomly allocated to the three groups using block randomization. The examiner and the subjects were blinded to group assignment. However, 16 subjects were lost in the study from baseline to the completion at 30 months. In the Patel study, the primary molars were matched by tooth type, size, and location of caries to reduce selection bias. All teeth were imaged in the same room, same camera settings, and same controlled lighting conditions. Perspective: In the Li study, the results did not demonstrate effectiveness in KI reducing stains caused by SDF. The caries treated with SDF and KI were located on cementum-containing root surfaces rather than coronal caries. In the Patel study, no significant color change was noted after application of KI. However, this is an in vitro study which is not representative of the oral environment. Further studies to provide higher level evidence are needed to reach a more definitive conclusion.
Applicability Silver diamine fluoride is becoming increasingly popular as a treatment modality for arresting dental caries. It can be used in high-risk pediatric and elderly populations to stop caries progression, allowing for more definitive treatment in the future. However, its use has been limited by esthetic concerns over the dark staining it causes. Recently, potassium iodide has been suggested in reducing this staining. The Li study mentioned shows no difference in staining between teeth treated with SDF and SDF+KI. The Patel study shows no significant difference in color change of carious teeth after application of SDF+KI. Further studies of higher evidence are needed on this topic in order to draw more definitive conclusions. Additionally, more studies are needed on coronal caries in pediatric populations in order to assess the effectiveness of KI applied after SDF.
Specialty/Discipline (Pediatric Dentistry) (Restorative Dentistry)
Keywords Silver diamine fluoride, SDF, potassium iodide, KI, caries, stain
ID# 3396
Date of submission: 11/05/2019spacer
E-mail acordh@livemail.uthscsa.edu
Author Hunter Acord, DDS
Co-author(s) Cody Calame, DDS
Co-author(s) e-mail calamec@livemail.uthscsa.edu
Faculty mentor/Co-author Jungyi Alexis Liu, DDS, MS
Faculty mentor/Co-author e-mail LiuJA@uthscsa.edu
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