What is a notable esthetic limitation of applying silver diamine fluoride?

• A. It stains carious lesions black.
• B. It causes white spot lesions.
• C. It causes blue-green color.
• D. It brightens the tooth color.

Answer: (A)

The main idea here is that silver diamine fluoride has a notable esthetic drawback: it stains treated carious areas black. This happens because silver ions react with sulfur compounds in the decayed tissue and bacterial byproducts to form dark silver sulfide, and the porous, demineralized area readily absorbs these pigments. The stain is permanent and most noticeable on visible anterior teeth, which is why it’s considered an esthetic limitation. It does not brighten the tooth color, nor does it cause white spots or blue-green discoloration. In practice, clinicians may restore the treated area with a tooth-colored material to mask the stain or use SDF selectively in non-visible regions.