The dos and don’ts of silver diamine fluoride
The New York Times recently published an article discussing the use of silver diamine fluoride as a minimally invasive treatment option for dental caries in children. (1) The article discussed many benefits of silver diamine fluoride including treating carious teeth without burs at a lower cost for patients, fewer pediatric hospital visits for dental emergencies, and improved oral health for nursing home residents. (1) They only cited one negative: silver diamine fluoride causes the carious tooth structure to turn black. (1)
Commercially available as a benefit arrest through Elevate Oral Care (i), 38% silver diamine fluoride is approved by the Food and Drug Administration (FDA) for reducing hypersensitivity to dentin, but has also been shown to reduce bacteria and matrix metalloproteinases (MMPs) responsible for the breakdown of dentin and suspected to stop carious lesions. (2-6) Dentists not only use it to treat dentinal hypersensitivity, but also use it off-label to stop carious lesions and as a diagnostic indicator. (7) Silver diamine fluoride only stains defects in the tooth structure such as B. Carious lesions and restorative margins; A healthy tooth structure is not colored by silver diamine fluoride. In addition, silver diamine fluoride is very inexpensive because one drop can be used for multiple teeth.
While this sounds like the magical product we’ve all been waiting for, we still need to be practical and careful when using silver diamine fluoride (or any product surrounded by sensationalism). No doctor should use dental supplies without understanding what to do and what not to do – and this clear liquid is no different.
The dosage of silver diamine fluoride
- Read the instructions.
- Let your patients know. Silver diamine fluoride colors the carious tooth structure dark brown or black. Care should be taken with other tooth surfaces and around the edges of composite restorations or crowns. Explain the risk of discoloration of the tooth structure before use. If a restoration is stained, the stain should be buffed away, but stains around the edges may remain.
- Protect your patients. Have your patients wear safety glasses and cover exposed clothing around the head and neck area.
- Danger. This product is colorless and odorless (Figure 1). Although it looks like water, it can stain skin, clothing (Figure 2), countertops, floors, and instruments. If silver diamine fluoride comes into contact with the skin, absorb as much as possible with gauze. Don’t wipe it off. Wiping can spread it and result in a larger stain. Instead, dab the area with excess material and wash the area thoroughly with soap and water, 3% peroxide, or an iodine tincture. Spots on the skin fade like a henna tattoo. Wash user interfaces, instruments and dishes thoroughly.
Figure 3: Note to tooth J. This is a one-year follow-up examination after the tooth was treated with a glass ionomer containing silver diamine fluoride prior to restoration. The restoration may not be aesthetic, but it is solid.
Silver diamine fluoride 38% has been shown to be effective for on-label applications such as the treatment of dentinal hypersensitivity, as well as for some off-label applications such as tooth decay diagnosis and arrest in children and adults. Practical application is extremely encouraging as long as the material is used correctly and with its chemistry in mind. This material can be routinely applied to tooth surfaces in clinical practice. However, we believe that further research is needed before deciding whether to use this material in restorative procedures, particularly on anterior teeth.
I. For more information on Advantage Arrest Silver Diamine Fluoride 38%, visit liftateoralcare.com.
ii. Courtesy Elevate Oral Care
1. Saint Louis C. A cavity-fighting fluid helps children avoid dental practice. New York Times website. http://www.nytimes.com/2016/07/12/health/silver-diamine-fluoride-dentist-cavities.html?_r=0. Published on July 11, 2016.
2. Introduction of Advantage Arrest, the first and only silver diamine fluoride available in the US. Increase the oral care website. http://www.elevateoralcare.com/dentist/AdvantageArrest.
3. Castillo JL, Rivera S., Aparicio T. et al. The short-term effects of silver diammine fluoride on tooth sensitivity: a randomized controlled trial. J Dent Res. 2011; 90 (2): 203-208.
4. Featherstone JDB, Horst JA. New approach to caries arrest in adults. Decisions in the dentistry website. http://decisionsindentistry.com/article/fresh-approach-to-caries-arrest-in-adults/. Published October 5, 2015.
5. Mei ML, Li QL, Chu CH, Yiu CK, Lo EC. The inhibitory effects of silver diamine fluoride in various concentrations on matrix metalloproteinases. Dent Mater. 2012; 28 (8): 903-908.
6. Mei ML, Chu CH, Lo EC, Samaranayake LP. Fluoride and silver concentrations of silver diamine fluoride solutions for dental purposes. Int J Pediatr Dent. 2013; 23 (4): 279-285.
7. Horst JA, Ellenikiotis H., Milgrom PL. UCSF Caries Arrest Protocol Using Silver Diamine Fluoride: Rationale, Indications, and Consent. J Calif Dent Assoc. 2016; 44 (1): 16-28.
Pamela Maragliano-Muniz, DMD, is editor-in-chief for Pearls for your practice: the product navigator, an e-newsletter from DentistryIQ and Dental Economics. She was a dental hygienist before earning her DMD from Tufts University School of Dental Medicine and her Certificate in Advanced Prosthetics from UCLA School of Dentistry. She teaches and maintains a private practice in Salem, Massachusetts. In 2010, her practice was named Adult Prevention Practice of the Year by the American Dental Association.
Brian New, DDS, is Director of Practice Improvement at the DentaQuest Institute and Associate Professor in the General Dentistry Department at Loma Linda University. He was a member of the ADA Council of Scientific Affairs from 2010 to 2014 and chairman of the CAMBRA coalition from 2010 to 2015. In 2009 the office of Dr. Nový named Adult Prevention Practice of the Year by the American Dental Association. He practices in Westborough, Massachusetts at the DentaQuest Oral Health Center.