Systematic review and meta-analysis demonstrates dose-dependent cytotoxicity of silver diamine fluoride in human dental pulp cells, suggesting caution near pulp.
Key Points
To systematically evaluate and quantitatively synthesize the cytotoxic and biological effects of silver diamine fluoride on human dental pulp cells.
Conducted a PRISMA-compliant systematic review and meta-analysis (PROSPERO: CRD420251166805) searching PubMed, Scopus, Cochrane CENTRAL, and Google Scholar.
Identified and analyzed seven in vitro studies published between 2022 and 2024 evaluating cell viability using random-effects meta-analytic models.
Silver diamine fluoride displayed minimal cytotoxicity at 0.00001–0.0005% (pooled effect = 0.99, 95% CI: 0.97–1.00), but viability declined significantly at 0.001–0.005% (pooled effect = 0.73, 95% CI: 0.46–0.93).
Severe toxicity occurred at concentrations ≥0.008% (pooled effect = 0.14, 95% CI: 0.00–0.41), with most studies reporting half-maximal inhibitory concentrations at or below 0.001% compared to clinical strengths of 3.8% to 38%.