Silver Diamine Fluoride
Silver topical products, e.g., silver nitrate and silver diamine fluoride (SDF) have been utilized in Japan for over 40 years to arrest dental caries and reduce hypersensitivity in deciduous and permanent teeth. Over the last decade it has been introduced in other countries internationally. SDF has been marketed in the U.S. as a 38% product, equivalent to a 5% fluoride and a pH of 10. At this time, SDF is not fully understood. One theories with SDF is that silver ions, like other heavy metals, are antimicrobial. Another theory is that SDF reacts with hydroxyapatite in an alkaline environment to form calcium fluoride. One side effect with SDF is the discoloration of demineralized or cavitated surfaces. The FDA approved its use as a desensitizing agent and over-label as an anticaries agent. There are many research studies on SDF indicating it is more effective in arresting dental caries than sodium fluoride varnish. Therefore, the AAPD supports the use of SDF as part of a caries management plan. However, the AAPD recommends a consultation with the patient/parent with an informed consent recognizing SDF is a valuable therapy and informing them of the dark discoloration. Prior to the placement of SDF, the AAPD recommends patients receive a comprehensive dental exam, diagnoses, and a plan for ongoing disease management.