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Course Number: 4

Silver Diamine Fluoride

Traditional restorative treatment is sometimes not feasible or possible. This could be due to a patient’s young age, temperament or behavior, inability to cooperate for treatment (children with special health care needs, for example), poor access to dental care, or need for advanced pharmacological management (general anesthesia or sedation) for traditional treatment that is not accessible or medically advisable. As part of the caries management plans for these patients, an inexpensive, topical medicament called silver diamine fluoride (SDF) can be applied to carious lesions to slow or arrest caries progression, prevent further loss of tooth structure, reduce tooth sensitivity, and defer dental treatment until patient is older, more cooperative, or medically stable for treatment.

SDF is a 38% silver diamine fluoride alkaline liquid approved for use in the US in 2014 but has been used for a half century in other countries to arrest caries in primary and permanent teeth. It has antibacterial properties on dentin, reduces formation of biofilm, and forms fluorapatite when reacting with hydroxyapatite to make the tooth surface more resistant and less soluble in an acidic environment. SDF is easily applied with a small brush or special type of floss (if treating interproximal caries, caries between the teeth) and only needs one minute of application time.

An important consideration when discussing SDF as a treatment option, is the fact that it heavily stains treated areas black due to the deposit of silver phosphate over the affected dentin. This staining can be a deterrent for parents and patients to accept treatment with SDF and needs to be thoroughly discussed as part of the informed consent process. Case selection of teeth for treatment with SDF is very important. Teeth to be treated with SDF need to show lack of pulpal involvement and need to be free irreversible pulpitis symptoms such as nocturnal or spontaneous pain. Continued monitoring of the lesions and SDF re-application by a dental professional as well as dietary changes for the patient are important to the success of the treatment.