This post is presented by Dr. Natasha Cormier of Brookside Dental Clinic

Silver diamine fluoride: A cavity fighting liquid that lets kids avoid the dentist drill.

When I first heard about using a silver product to treat a cavity rather than getting a filling I thought it sounded crazy. I almost dismissed it. Surely if there was a product out there that could stop cavities and avoid needing a filling I would have learned about that in dental school. 

I was surprised to learn that silver products have been used internationally for decades to treat both tooth hypersensitivity and tooth decay. In 2016, Health Canada approved the use of 38% silver diamine fluoride (SFD) for treating dental caries. SDF had been approved by the US Food and Drug Administration for treating tooth hypersensitivity 21 years earlier and over time they realized it also stopped the progression of cavities.

SDF is an effective and inexpensive way to stop cavities from spreading in patients who have behavioural challenges and would need sedation to complete the treatment, patients who have a lot of dental treatment to complete at one time, rapidly spreading cavities, those who are medically compromised or those who cannot afford dental treatment. 

The silver component of SDF has an antimicrobial effect by interacting with decay-causing bacteria while the fluoride component protects the tooth. It is a liquid varnish (similar to a fluoride varnish but with a lower concentration of fluoride). It is applied to the cavity by the dentist with a small brush. The application time is often only a couple of minutes and the patient leaves the office without dental freezing or experiencing the use of the dental drill. A single application costs less than a filling and the treatment is usually covered by dental insurance. 

So if this miracle substance exists…why do I still have a job?

The main disadvantage of SDF is its esthetic result. It permanently blackens the enamel and dentin layers of the tooth affected by the cavity. It can be covered with a white filling but often the tooth still appears to have a grey hue.

For some parents and patients the esthetic result is not a concern. SDF use can allow a child to avoid having to undergo more invasive dental treatment at a young age, including fillings and the use of sedation in cases where the child is not cooperative. 

While SDF will stop a cavity by turning it black and hard, it will not restore the form and function to teeth that are broken down. Fillings and crowns are often still needed to prevent food impaction and space loss. But the use of SDF can buy you some time if your child is not cooperative, medically compromised or you simply don’t have the finances to complete the treatment. 

SDF does requires reapplication. There is some uncertainty about best practice protocols because of the lack of long-term data. However, applications twice a year for the first two years has shown to arrest 70-90% of the caries.

The only contraindication to SDF use is a silver allergy. Immediately after its application some patients may notice a transient metallic or bitter taste. If SDF accidentally contacts the gingival tissue it will cause temporary staining that will resolve in 2-14 days. 

Statistics show that one out of four children aged 2-5 years have cavities. SDF can be a valuable therapy for many of these patients. This agent is not a miracle drug and does not work all of the time, nothing does. However, it is a minimally invasive option for all patients — and, for some, perhaps the best and only option. 

I am glad to be able to offer this therapy to my patients. If you would like to know more I have included some great references at the end of this article. Feel free to contact our office or reach out to your dentist to see if they offer it too. 

Until next month,

 

 

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Hi, I’m Dr. Natasha Cormier, a general dentist at Brookside Dental. I began practicing in my hometown of Fredericton in 2012 after completing my Doctorate of Dental Surgery at Dalhousie University.

I enjoy all aspects of dentistry and a major part of my practice involves treating children! I have additional certification in dental implant placement, oral conscious sedation and maintain my hospital privileges at the Dr. Everett Chalmers Hospital to be able to treat special cases that cannot be handled in an office setting.

Outside of work, my husband Shawn and I keep busy with our 1.5 year old daughter Madison and 6 month old son Elliott. I believe that laughter is the best medicine and that we should never stop trying to learn new things.

 References: AAPD Guidelines. Use of SDF for dental caries management in children and adolescents, including those with special healthcare needs. 2017.  | CDA Essentials 2017. Volume 4. Issue 3.  | Silver Diamine Fluoride (SDF) current evidence for the management of dental caries

 

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