This paper aims to review the challenges, toxicity, and routes of synthesis and usage of silver nanoparticles in different medical applications but also highlighting their sustainability from both medical and environmental issues. Regarding their toxicity, it is known that silver nanoparticles can destroy over 650 microorganisms comparing with antibiotics. Supplementary, will be presented in a comparative manner some conventional synthesis routes (physical and chemical methods) and green synthesis routes using plant extracts. The approach using plant extracts have various advantages comparing with physical, chemical and microbial synthesis methods because there is no need to use chemicals, wasteful purifications and high energy requirements. The main focus in “green nanotechnology” was to use either biological micro-organisms or plant extracts which are an alternative to the classical chemical and physical methods. An important issue that is discussed in the paper is the potential toxicity of silver nanoparticles that may have on human health or on the environment, which powerfully indicates that, the usage and removal of silver nanoparticles must be carefully examined. Also, it needs to focus our attention on the dismissal of silver nanoparticles into the environment and especially in water systems, fact which suggests that this issue must be fully understood and apply accordingly the law.