Open Access Open Badges Research article

Short term serum pharmacokinetics of diammine silver fluoride after oral application

Elsa Vasquez1, Graciela Zegarra2, Edgar Chirinos1, Jorge L Castillo3, Donald R Taves4, Gene E Watson5, Russell Dills6, Lloyd L Mancl4 and Peter Milgrom4*

Author affiliations

1 Area of Pediatric Dentistry, Universidad Catolica Santa Maria de Arequipa, San Jose S/N, Arequipa, Peru

2 Private practice in Arequipa, Garcilazo de la Vega 102- Umacollo, Arequipa, Peru

3 Department of Dentistry for Children and Adolescents, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Lima 31, Peru

4 Department of Oral Health Sciences, Northwest Center to Reduce Oral Health Disparities, University of Washington, Box 357475, Seattle, WA, 98195-7475, USA

5 Eastman Institute for Oral Health, University of Rochester, Rochester, NY, 14642, USA

6 Department of Environmental Health, University of Washington, Seattle, WA, 98195-7234, USA

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Citation and License

BMC Oral Health 2012, 12:60  doi:10.1186/1472-6831-12-60

Published: 31 December 2012



There is growing interest in the use of diammine silver fluoride (DSF) as a topical agent to treat dentin hypersensitivity and dental caries as gauged by increasing published research from many parts of the world. While DSF has been available in various formulations for many years, most of its pharmacokinetic aspects within the therapeutic concentration range have never been fully characterized.


This preliminary study determined the applied doses (3 teeth treated), maximum serum concentrations, and time to maximum serum concentration for fluoride and silver in 6 adults over 4 h. Fluoride was determined using the indirect diffusion method with a fluoride selective electrode, and silver was determined using inductively coupled plasma-mass spectrometry. The mean amount of DSF solution applied to the 3 teeth was 7.57 mg (6.04 μL).


Over the 4 hour observation period, the mean maximum serum concentrations were 1.86 μmol/L for fluoride and 206 nmol/L for silver. These maximums were reached 3.0 h and 2.5 h for fluoride and silver, respectively.


Fluoride exposure was below the U.S. Environmental Protection Agency (EPA) oral reference dose. Silver exposure exceeded the EPA oral reference dose for cumulative daily exposure over a lifetime, but for occasional use was well below concentrations associated with toxicity. This preliminary study suggests that serum concentrations of fluoride and silver after topical application of DSF should pose little toxicity risk when used in adults.

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Acute pain; Tooth; Medical device; Topical agent; Pharmacology; Toxicology