Advantage Arrest Consent Form for Silver Diamine Fluoride (SDF) Treatment

 

Credit : Dr. Jeanette MacLean

Understanding Silver Diamine Fluoride (SDF) Treatment: What Patients Need to Know

Silver Diamine Fluoride (SDF) is a revolutionary dental treatment that is transforming how we approach tooth decay and cavities. If you’re considering SDF treatment or have been recommended it by your dentist, here’s everything you need to know about its mechanism, benefits, and clinical applications.

Purpose and Effect

Purpose: SDF is used to treat cavities by hardening and stopping decay. It is a liquid applied to the tooth surface.

Effect: Turns the cavity black while the healthy tooth remains white.

Mechanism of Action

When SDF is applied to a decayed tooth surface, several actions take place to combat decay and strengthen the tooth:

  1. Formation of a Protective Layer: SDF creates a layer of silver protein conjugate and silver minerals that bolster the tooth’s resistance to acid and enzymatic attacks. This layer significantly increases the mineral density and hardness of the treated area.
  2. Antimicrobial Action: Silver in SDF acts as a potent antimicrobial agent, effectively killing bacteria that cause cavities.
  3. Remineralization: The fluoride component helps in the remineralization process, restoring lost minerals to the tooth and strengthening it.
  4. Enzyme Inhibition: SDF inhibits the proteins that break down dentin, further protecting the tooth structure.
  5. Stabilization: Ammonia in SDF stabilizes the solution, keeping the silver and fluoride ions active and effective.

It’s important to note that SDF will permanently discolor any decayed or demineralized areas, as well as any soft tissues it contacts, but it does not affect healthy tooth structure.

Benefits of SDF

SDF offers a host of benefits that make it a preferred choice for many dental practitioners and patients:

  • Antimicrobial: Effectively kills bacteria that cause tooth decay.
  • Increases Tooth Hardness: Boosts mineral density and resistance to acids.
  • Immediate Treatment: Enables same-day treatment without restrictions on post-treatment activities.
  • Non-aerosol Generating: Safer in terms of infection control.
  • Odorless: Pleasant for patient comfort.
  • Effective: Outperforms other treatments in eliminating cariogenic bacteria.
  • Quick and User-friendly: Application takes less than 5 minutes and requires no air, anesthesia, instruments, or water.

How Deep Does SDF Penetrate?

SDF is effective in penetrating and treating different layers of the tooth:

  • Enamel: 25-30 microns
  • Dentin: 200-300 microns
  • Deep Lesions: Up to 2 mm

SDF Quick Facts

  • Pain-free: No needles or drilling required.
  • Treatment Frequency: At least 2 treatments 2-4 weeks apart are recommended for best results.
    • 74% of cavities are stopped by one application.
    • 96% are stopped by a second application.
  • Safety: Safe for use in children.
    • A 2020 study on children ages 12 months to 17 years confirmed its safety, with no concerns for use on children under age 3.
  • History: Used for over 50 years with no reported adverse effects.
  • Additional Treatments: Depending on the extent of decay, other treatments like fluoride varnish or fillings may be necessary.
  • Risks: There is a small risk the procedure may not stop the decay.

Clinical Uses

SDF is versatile and can be used in various clinical situations:

  • Alternative to Restorative Treatment: Ideal for patients who can’t undergo traditional restorative procedures.
  • Around Lesion Margins: Prevents secondary decay.
  • Avoiding General Anesthesia or Sedation: Useful for patients who can’t tolerate these methods.
  • Managing Difficult Cases: Perfect for carious lesions that can’t be treated in one visit or in patients with limited access to dental care.
  • High-risk Caries: Effective for patients prone to frequent cavities.

Ideal Clinical Situations

SDF is particularly beneficial in the following scenarios:

  • Behavioral or Medical Management Patients: Suitable for patients with special needs.
  • Untreatable Lesions in One Visit: Provides interim protection until comprehensive treatment can be completed.
  • Difficult-to-treat Lesions: Ideal for hard-to-reach areas.
  • Non-aerosol Generating: Preferred in scenarios where aerosol production must be minimized.
  • Pediatrics: Safe and effective for children.
  • Root Caries: Excellent for treating decay on tooth roots.
  • Tooth Sensitivity: Helps alleviate sensitivity issues.

Conclusion

Silver Diamine Fluoride (SDF) is a groundbreaking treatment that offers an effective, quick, and affordable solution for managing tooth decay. Its ease of application, cost-efficiency, and superior antibacterial properties make it an excellent choice for many patients. If you have any questions or think SDF might be right for you, consult with your dentist to explore this innovative treatment option.

References

  1. National Institute for Dental and Craniofacial Research. Dental caries (tooth decay).  2022. “https://www.nidcr.nih.gov/research/data-statistics/dental-caries“. Accessed September 8, 2023.
  2. Wen P, Chen M, Zhong Y, Dong Q, Wong H. Global burden and inequality of dental caries, 1990 to 2019. Journal of Dental Research 2022;101(4):392-99.
  3. Pitts NB, Twetman S, Fisher J, Marsh PD. Understanding dental caries as a non-communicable disease. British Dental Journal 2021;231(12):749-53.
  4. Lin M, Griffin SO, Gooch BF, et al. Oral health surveillance report: trends in dental caries and sealants, tooth retention, and edentulism, United States: 1999–2004 to 2011–2016.  2019.
  5. Iheozor‐Ejiofor Z, Worthington HV, Walsh T, et al. Water fluoridation for the prevention of dental caries. Cochrane Database of Systematic Reviews, 2015(6).
  6. O’Mullane D, Baez R, Jones S, et al. Fluoride and oral health. Community Dental Health 2016;33(2):69-99.
  7. Kassebaum NJ, Bernabé E, Dahiya M, et al. Global burden of untreated caries:a systematic review and metaregression. J Dent Res 2015;94(5):650-58.
  8. Elevate Oral Care. Safety Data Sheet–Advantage Arrest Silver Diamine Fluoride 38%.  2023. “https://www.elevateoralcare.com/site/images/AASDS082415.pdf“.
  9. Seifo N, Robertson M, MacLean J, et al. The use of silver diamine fluoride (SDF) in dental practice. British Dental Journal 2020;228(2):75-81.
  10. Mei ML, Chu CH, Lo EC, Samaranayake LP. Fluoride and silver concentrations of silver diammine fluoride solutions for dental use. Int J Paediatr Dent 2013;23(4):279-85.
  11. Crystal YO, Rabieh S, Janal MN, Rasamimari S, Bromage TG. Silver and fluoride content and short-term stability of 38% silver diamine fluoride. J Am Dent Assoc 2019;150(2):140-46.
  12. Yan IG, Zheng FM, Yin IX, et al. Stability of silver and fluoride contents in silver diamine fluoride solutions. International Dental Journal 2023.
  13. Burgette JM, Weintraub JA, Birken SA, Lewis TA, White BA. Development of a silver diamine fluoride protocol in safety net dental settings. Journal of Dentistry for Children 2019;86(1):32-39.
  14. Horst JA. Silver fluoride as a treatment for dental caries. Adv Dent Res 2018;29(1):135-40.
  15. Llodra JC, Rodriguez A, Ferrer B, et al. Efficacy of silver diamine fluoride for caries reduction in primary teeth and first permanent molars of schoolchildren: 36-month clinical trial. J Dent Res 2005;84(8):721-4.
  16. Li R, Lo EC, Liu BY, Wong MC, Chu CH. Randomized clinical trial on arresting dental root caries through silver diammine fluoride applications in community-dwelling elders. J Dent 2016.
  17. Zhang W, McGrath C, Lo EC, Li JY. Silver diamine fluoride and education to prevent and arrest root caries among community-dwelling elders. Caries Res 2013;47(4):284-90.
  18. Hendre AD, Taylor GW, Chavez EM, Hyde S. A systematic review of silver diamine fluoride: Effectiveness and application in older adults. Gerodontology 2017;34(4):411-19.
  19. Chan AKY, Tamrakar M, Jiang CM, et al. Clinical evidence for professionally applied fluoride therapy to prevent and arrest dental caries in older adults: a systematic review. Journal of Dentistry 2022;125:104273.
  20. Grandjean ML, Maccarone NR, McKenna G, Müller F, Srinivasan M. Silver diamine fluoride (SDF) in the management of root caries in elders: a systematic review and meta-analysis. Swiss Dent J 2021;131(5):417-24.
  21. Giusti L, Steinborn C, Steinborn M. Use of silver diamine fluoride for the maintenance of dental prostheses in a high caries-risk patient: A medical management approach. J Prosthet Dent 2018;119(5):713-16.
  22. Gao SS, Zhao IS, Hiraishi N, et al. Clinical trials of silver diamine fluoride in arresting caries among children: a systematic review. JDR Clin Trans Res 2016;1(3):201-10.
  23. American Academy of Pediatric Dentistry. Policy on the use of silver diamine fluoride for pediatric dental patients. American Academy of Pediatric Dentistry, 2023. “https://www.aapd.org/globalassets/media/policies_guidelines/p_silverdiamine.pdf“. Accessed September 12, 2023.
  24. Zhao IS, Gao SS, Hiraishi N, et al. Mechanisms of silver diamine fluoride on arresting caries: a literature review. International Dental Journal 2018;68(2):67-76.
  25. Young DA, Quock RL, Horst J, et al. Clinical instructions for using silver diamine fluoride (SDF) in dental caries management. Compend Contin Educ Dent 2021;42(6):e5-e9.
  26. Cifuentes-Jiménez CC, Bolaños-Carmona MV, Enrich-Essvein T, González-López S, Álvarez-Lloret P. Evaluation of the remineralizing capacity of silver diamine fluoride on demineralized dentin under pH-cycling conditions. Journal of Applied Oral Science 2023;31:e20220306.
  27. Roberts A, Bradley J, Merkley S, et al. Does potassium iodide application following silver diamine fluoride reduce staining of tooth? A systematic review. Aust Dent J 2020;65(2):109-17.
  28. Rosenblatt A, Stamford TC, Niederman R. Silver diamine fluoride: a caries “silver-fluoride bullet”. J Dent Res 2009;88(2):116-25.
  29. Horst JA, Ellenikiotis H, Milgrom PL. UCSF protocol for caries arrest using silver diamine fluoride: rationale, indications and consent. J Calif Dent Assoc 2016;44(1):16-28.
  30. Mei ML, Lo EC, Chu CH. Clinical use of silver diamine fluoride in dental treatment. Compend Contin Educ Dent 2016;37(2):93-8; quiz100.
  31. Milgrom P, Horst JA, Ludwig S, et al. Topical silver diamine fluoride for dental caries arrest in preschool children: A randomized controlled trial and microbiological analysis of caries associated microbes and resistance gene expression. J Dent 2018;68:72-78.
  32. Crystal YO, Niederman R. Evidence-Based Dentistry Update on Silver Diamine Fluoride. Dent Clin North Am 2019;63(1):45-68.
  33. Mei ML, Lo ECM, Chu CH. Arresting dentine caries with silver diamine fluoride: what’s behind it? J Dent Res 2018;97(7):751-58.
  34. Sorkhdini P, Gregory RL, Crystal YO, Tang Q, Lippert F. Effectiveness of in vitro primary coronal caries prevention with silver diamine fluoride-chemical vs biofilm models Journal of Dentistry 2020;99:103418.
  35. Crystal YO, Marghalani AA, Ureles SD, et al. Use of silver diamine fluoride for dental caries management in children and adolescents, including those with special health care needs. Pediatr Dent  2017;39(5):E135-E145. “https://www.aapd.org/media/policies_guidelines/g_sdf.pdf“. Accessed September 15, 2023.
  36. Castillo J, Rivera S, Aparicio T, et al. The short-term effects of diammine silver fluoride on tooth sensitivity: a randomized controlled trial. J Dent Res 2011;90(2):203-08.
  37. de Almeida Piovesan É T, Alves JB, Ribeiro C, et al. Is silver diamine fluoride effective in reducing dentin hypersensitivity? A systematic review. J Dent Res Dent Clin Dent Prospects 2023;17(2):63-70.
  38. Selwitz RH, Ismail AI, Pitts NB. Dental caries. The Lancet 2007;369(9555):51-59.
  39. Law V, Seow W, Townsend G. Factors influencing oral colonization of mutans streptococci in young children. Australian dental journal 2007;52(2):93-100.
  40. Kidd E. The implications of the new paradigm of dental caries. Journal of Dentistry 2011;39:S3-S8.
  41. Takahashi N, Nyvad B. Ecological hypothesis of dentin and root caries. Caries Research 2016;50(4):422-31.
  42. Slayton RL, Urquhart O, Araujo MWB, et al. Evidence-based clinical practice guideline on nonrestorative treatments for carious lesions: a report from the American Dental Association. J Am Dent Assoc 2018;149(10):837-49.e19.
  43. Fontana M, Gonzalez-Cabezas C. Evidence-based dentistry caries risk assessment and disease management. Dent Clin North Am 2019;63(1):119-28.
  44. Urquhart O, Tampi MP, Pilcher L, et al. Nonrestorative treatments for caries: systematic review and network meta-analysis. J Dent Res 2018:22034518800014.
  45. Crystal YO, Marghalani AA, Ureles SD, Wright JT, Sulyanto R, Divaris K, Fontana M, Graham L. Use of silver diamine fluoride for dental caries management in children and adolescents, including those with special health care needs. Pediatric Dentistry. 2017 Sep 15;39(5):135E-45E.
  46. Seifo N, Cassie H, Radford JR, Innes NPT. Silver diamine fluoride for managing carious lesions: an umbrella review. BMC Oral Health 2019;19(1):145.
  47. Zhang J, Sardana D, Li KY, Leung KCM, Lo ECM. Topical fluoride to prevent root caries: systematic review with network meta-analysis. J Dent Res 2020;99(5):506-13.
  48. Horst JA, Heima M. Prevention of Dental Caries by Silver Diamine Fluoride. Compend Contin Educ Dent 2019;40(3):158-63; quiz 64.
  49. Jiang M, Wong MCM, Chu CH, Dai L, Lo ECM. Effects of restoring SDF-treated and untreated dentine caries lesions on parental satisfaction and oral health related quality of life of preschool children. J Dent 2019;88:103171.
  50. Wu DI, Velamakanni S, Denisson J, et al. Effect of silver diamine fluoride (SDF) application on microtensile bonding strength of dentin in primary teeth. Pediatr Dent 2016;38(2):148-53.
  51. Jiang M, Mei ML, Wong MCM, Chu CH, Lo ECM. Effect of silver diamine fluoride solution application on the bond strength of dentine to adhesives and to glass ionomer cements: a systematic review. BMC Oral Health 2020;20(1):40.
  52. Trieu A, Mohamed A, Lynch E. Silver diamine fluoride versus sodium fluoride for arresting dentine caries in children: a systematic review and meta-analysis. Scientific Reports 2019;9(1):2115.