Silver Diamine Fluoride: A Drill-free filling (kind of).
We have had so many parents ask, call, and email us about Silver Diamine Fluoride. Questions we hear are “Is this a drill-free filling?” “Will my child feel any pain?” “What do you mean it ‘Kills the bacteria?”
So, let’s first here what the ‘higher authority’ says about SDF:
1) The American Academy of Pediatric Dentistry (AAPD) “supports the use of SDF as part of an ongoing caries management plan with the aim of optimizing individualized patient care consistent with the goals of a dental home. In 2018, the AAPD came out with a ‘Policy on the Use of Silver Diamine Fluoride for Pediatric Dental Patients.’ In it, they stated,
“The dental profession has long viewed dental caries as an acute disease condition requiring surgical debridement, cavity preparation, and mechanical restoration of the tooth, but increasingly, especially for the infant and child population, practitioners are utilizing individually tailored strategies to prevent, arrest, or ameliorate the disease process based on caries risk assessment. One of these strategies employs application of SDF as an antimicrobial and remineralization agent to arrest caries lesions after diagnosis and at the direction of a responsible dentist of record.”
2) The California Dental association reports that various “clinical studies unanimously confirm better caries arrest and/or prevention by silver diamine fluoride over control or other materials.”
3) The American Dental Association published its first ever evidence-based clinical practice guidelines on nonrestorative treatment for carious lesions in the October 2018 Journal of the American Dental Association (JADA). In it, it stated, “An expert panel convened the American Dental Association Council on Scientific Affairs and the Center for Evidence-based Dentistry conducted a systematic review and formulated evidence-based clinical recommendation for the arrest or reversal of noncavitated and cavitated dental caries using nonrestorative treatment in children and adults… Although the recommended interventions are often used for caries prevention, or in conjunction with restorative treatment options, these approaches have shown to be effective in arresting or reversing carious lesions. Clinicians are encouraged to prioritize use of these intervention based on effectiveness, safety, and feasibility.”
So… what is SDF?
Silver Diamine Fluoride is an FDA-approved liquid treatment that is applied to a tooth showing carious (cavity forming) activity to control active dental caries (cavities) and prevent future progression of caries (aka tooth disease). It is composed of two things: silver and fluoride.
The Silver acts as an anti-microbial (remember how your mother said to get your baby a silver spoon for to kill bad bacteria…ok, my mom said that) that also makes dentin strong (dentin is basically the second layer of your tooth that protects the pulp).
The Fluoride is active, puts a stop to tooth decay, and helps prevent additional decay from appearing (the reason why Fluoride has been put in water, toothpastes, mouthwashes, etc.).
When do you recommend SDF?
We have used SDF on many different cases.
- At times we use it if we see a cavity starting and we want to prevent it from getting bigger.
- We also use it on children who are having tooth sensitivity.
- It’s an amazing treatment option for young children who have full mouth dental disease (severe early childhood caries), to try to stop the dental disease from spreading, at least until they are old enough to cooperate for treatment.
- We recommend it for young children who have difficulty cooperating for treatment (like the one who hit his mother and bit the dentist the other day).
- We also use it on our special needs patients
- It can be used on elderly patients as well who are experiencing root caries and sensitivity.
How is SDF placed on my child’s tooth?
During the visit, your child’s tooth will be washed with water and cleaned without fluoridated toothpaste. The then tooth will be dried (air) and any left-over Oreos or Pirate Booty (that’s the worst for us- soooo sticky!) will be removed. Then, the clinician takes a micro brush (tiny little fuzzy brush… think for Poppy the troll), dips it in the SDF solution, and carefully places it on the affected tooth area. The tooth and the gums and tissue around the tooth are protected by cotton rolls and Vaseline. Once the solution sets (ideally around two minutes), the child can go pick a prize (I meant that’s why they agreed to come to the appointment, right?) and we advise that they don’t eat or drink for at least an hour.
Does SDF Hurt?
No, SDF is painless. Your child’s bite, however, that hurts. A lot. Just saying.
Does SDF Stain?
Yes. SDF stains the cavity black. Although it can be used on front teeth to arrest decay in the front of the mouth, we tend to place it on back cavities or on front teeth that may fall out son.
We are very careful to make sure that it does not stain the gums or the skin but if it does, a harmless, non-itchy, brown or white stain may appear in the area. It can’t be washed off and will disappear in one two three weeks.
Does SDF need to be reapplied? What comes next?
The dentist will re-evaluate the SDF covered tooth at your child’s next visit. SDF re-application is recommended. Also, recent data has showed that the lesion can then be restored with glass ionomer. We can provide you with research articles on this topic.
So, SDF: it’s non-invasive, it’s painless, it’s quick, and it may stop tooth sensitivity and tooth decay (DECAY). Pretty cool, right?
Please feel free to call or email us with any questions!
Hugs and High Fives,
Team Pediatric Dental Center (PDC)