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    Using silver diamine fluoride as a new caries management solution

    Exploring the advantages and disadvantages of using SDF for specific patient populations.

    Silver diamine fluoride (SDF) has been used all over the world for decades. The FDA approved its use in the U.S. in 2014 to treat hypersensitivity. However, it’s also well-known for its off-label use for dental caries management. It’s not yet in widespread use stateside; however, dental professionals are learning that with all the benefits it presents with few downsides, SDF could provide a significant new solution for conservative treatment of carries in specific patient populations.

    “It’s something you can do at a school, in a nursing home, you could do it in a doctor’s office. You could use it on a mission trip in the middle of some rural area,” says Dr. Nathaniel Lawson, DMD, Ph.D., division director of division of biomaterials at the UAB School of Dentistry.

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    While officially an off-label use, SDF handles dental decay with a more conservative approach. Per the fact sheet by the California Dental Association, silver’s antibacterial properties combined with fluoride’s ability to remineralize tooth enamel slows or stops dental decay.

    The American Academy of Pediatric Dentistry (AAPD) published a guideline in October 2017 that recommended the use of 38% SDF to treat caries. It’s ideal for patients who can’t get the dental treatment they need for various reasons (e.g., too young, too old, too sick, too remote without regular access to dental care, etc.).

    Dr. Lawson works in an HIV clinic once a month. Sometimes his patients have been in the hospital and haven’t been able to take care of their teeth. Some of them could have as many as 25 cavities when he sees them. SDF buys the patients some time.

    “I’ll stop all the cavities from getting any bigger, and I will see them every other week until all their fillings are done,” Dr. Lawson explains. 

    Dr. Lawson also says it’s easy to use if a child can’t sit still long enough for treatment. In these cases, the dentist applies SDF to all of the child’s cavities. Then, the child has time to mature or build rapport with the dentist without the cavities worsening. It can also help when the child is on a wait list for surgical procedures that require general anesthesia, which can be a lengthy wait, particularly for Medicaid patients.

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    Silver diamine fluorideSDF also helps geriatric patients who could have cavities that are difficult to treat (e.g., on the root of the tooth or under other dental appliances). The dental professional can apply SDF and, in some cases, never fix the cavities. Dr. Lawson emphasizes that follow-up application is needed every six months to maintain the effects.

    Alyssa Aberle, a dental hygienist in Colorado, explains that SDF is also ideal for mission trips when you don’t have time to do all the restorative care that’s needed.

    “If the patient in a remote area has 10 fillings, and you don’t know when the next dentist is going to be there to finish the case, SDF is a great way to get people out of pain and stop the disease from progressing as well as help with sensitivity in the meantime,” she says.

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