Nanosilver in dentistry: Antimicrobial benefits, clinical uses, and safety considerations

Silver’s role in modern dentistry and medicine

When you say the word “silver” in dentistry, a lot of the public associates it with filling material. While dental professionals are aware that amalgam fillings are an alloy of many metals and not entirely silver, many of us are unaware of the amount of silver used in medicine today, specifically in dentistry. Currently, silver is used in general medicine for wound dressing and to treat and heal burns.^1,2 The most popular forms of silver in modern medicine are silver nitrate, silver sulfadiazine, and colloidal silver.¹ Silver is used in dental medicine for restorative materials and the treatment of dentinal hypersensitivity.^1-3 More recently, silver has been researched as a caries management tool and an oral cancer treatment due to its ability to kill viruses, bacteria, and fungi.^1,2

What is nanosilver and how does it work?

Silver—specifically nanosilver (NS)—is emerging as a new tool for use in the dental operatory due to its multiple benefits, coupled with its low cost and low risk profile. This article aims to educate dental professionals on NS and where we may begin to see its increased usage in dentistry.

NS is a microscopic particle of a silver ion. These particles can range in size from 1 to 100 nanometers.^2,4,5 Research has shown that the smaller the NS particle, the more its size will affect its ability to be antibacterial, antiviral, anti-inflammatory, or antifungal.^1,2,4,5 In addition, the shape of the NS particle also determines its ability to act upon specific microorganisms.^4,5

Antimicrobial benefits of nanosilver in dentistry

Researchers have become increasingly interested in using NS in the dental operatory because it exhibits antimicrobial properties against several key pathogens associated with carious lesions and periodontal disease. Research has shown that NS can disrupt the biofilm of Pseudomonas aeruginosa and infiltrate and disrupt the cell walls of Streptococcus mutans and Lactobacillus.^4,5

Clinical applications: From caries management to orthodontics

Beyond treating dental caries and periodontal disease, NS is also being explored for pit and fissure sealants, glass ionomer cement, and orthodontic applications.² NS also shows two other significant benefits that dental practitioners may be thrilled to learn. The first is that, despite using silver as its main ingredient, NS does not stain because the nanosized particles are too small to oxidize.^2,4,5 Thus, NS can be applied almost anywhere in the smile line without cosmetic concerns. Secondly, silver is more effective than most antibiotics in destroying oral pathogens. Studies have shown that NS can impact up to 650 oral pathogens without building resistance like antibiotics do.¹

Nanosilver fluoride for noninvasive caries treatment

NS is marketed as a mechanism to remineralize teeth by coupling it with fluoride. NS fluoride is well tolerated by most patients, easy to apply, and low in cost, helping to avoid unnecessary tooth structure removal since it can be applied directly to the incipient lesion without requiring tooth preparation. Several studies have shown it to be effective in treating incipient lesions without the need for a drill, leaving no evidence that it has been applied.^5-7

Challenges and concerns about nanosilver use

Unfortunately, despite the benefits of NS, skepticism remains. Some argue that there is insufficient clinical data to support the use of silver nanoparticles in dental offices. Various clinical data utilize different concentrations of silver nanoparticles, so the argument can be made that we need more research on each specific concentration. Sometimes, NS has chitosan added to its inactive ingredient mixture, and researchers say that individuals with shellfish allergies may be unable to have NS applied.

Still others say that the patient populations selected for participation in the studies are not always representative of the pediatric segment, and further research is needed to ensure this product is safe for use on them. Finally, some have argued that silver is a metal that could build up toxicity in our systems, and more research is needed to monitor the long-term effects of how NS affects the hosts it is used in. What may help NS become more accepted is the same argument made for another silver product often used in dentistry, namely silver diamine fluoride (SDF).^1,4,5

Nanosilver vs. silver diamine fluoride (SDF)

SDF is a product that uses silver to kill carious lesions. Because SDF is a mixture of ammonia, fluoride, and larger silver ions than those that are considered nanosize, when this silver mixture penetrates Streptococcus mutans bacteria, it does kill them; however, it does cause a reaction of silver oxide and silver phosphate, which ultimately stains the hard and soft tissues of the structures it penetrates.² SDF was marketed initially as an adjunct tool to help desensitize the dentin.⁸

After numerous studies citing its benefits against cariogenic bacteria, clinicians made evidence-based decisions and started using SDF to treat incipient lesions on the enamel. SDF became widely popular because sufficient research supported its use in ways other than those initially marketed. Clinicians noted that SDF was easy to apply, tolerated by most patients, and did not incur significant costs for either the provider or the patient, while also preserving more natural tooth structure. SDF, despite never being cleared to arrest incipient lesions, began to be used in community outreach programs for medically complex patients, underserved patients in dentistry, and/or patients with minimal access to care, as sufficient evidence supported its use in these cases.^2,6,7

The future of nanosilver in dental care

As health-care providers, we all strive to deliver the most benefits to our patients without causing harm. In dentistry, we have long voiced concerns about antibiotic resistance. Dental professionals also recognize that preserving more natural tooth structure, especially for younger patients, increases their chances of maintaining healthy teeth throughout their lifetime. Science is a commitment to continuous growth, where our understanding evolves to create more competent and compassionate care for our patients. If we already know that silver is used in medicine and dentistry and has multiple benefits, perhaps over time we will also use evidence-based decision-making to determine whether we should recommend and apply NS more or just as much as we currently use SDF.

Editor’s note: This article first appeared in Clinical Insights newsletter, a publication of the Endeavor Business Media Dental Group. Read more articles and subscribe.

References

1. Talapko J, Matijević T, Juzbašić M, Antolović-Požgain A, Škrlec I. Antibacterial activity of silver and its application in dentistry, cardiology and dermatology. Microorganisms. 2020;8(9):1400. doi:3390/microorganisms8091400
2. Khubchandani M, Thosar NR, Dangore-Khasbage S, Srivastava R. Applications of silver nanoparticles in pediatric dentistry: an overview. Cureus. 2022;14(7):e26956. doi:10.7759/cureus.26956
3. Surendranath P, Krishnappa S, Srinath S. Silver diamine fluoride in preventing caries: a review of current trends. 2022. Int J Clin Pediatr Dent. 2022;15(Suppl 2):S247-S251. doi:10.5005/jp-journals-10005-2167
4. More PR, Pandit S, De Filippis, A, Franci G, Mijakovic I, Galdiero M. Silver nanoparticles: bactericidal and mechanistic approach against drug resistant pathogens. Microorganisms. 2023;11(2):369. doi:10.3390/microorganisms11020369
5. Hatfield S. Nano silver fluoride: a possible solution to preventing and arresting dental caries? Today’s RDH. October 13, 2023. https://www.todaysrdh.com/nano-silver-fluoride-a-possible-solution-to-preventing-and-arresting-dental-caries/
6. Quritum M, Abdella A, Amer H, El Desouky LM, El Tantawi M. Effectiveness of nanosilver fluoride and silver diamine fluoride in arresting early childhood caries: a randomized controlled clinical trial. BMC Oral Health. 2024;24(1):701. doi:10.1186/s12903-024-04406-3
7. Mareddy AR, Reddy VN, Rehaman T, Reddy D, Manchikatia R, Kanugula A. Comparison of anticariogenic efficacy of 600 ppm nano-silver fluoride and 38% silver diamine fluoride in primary molars: a preliminary clinical trial. Int J Clin Pediatr Dent. 2025;18(3):271-275. doi:10.5005/jp-journals-10005-3033
8. Silver diamine fluoride. American Dental Association. Updated September 19, 2023. https://www.ada.org/resources/ada-library/oral-health-topics/silver-diamine-fluoride