What is silver diamine fluoride (SDF)?
SDF is an antimicrobial liquid that is able to treat cavities in a non-invasive, fast, affordable, and painless manner. FDA cleared in August of 2014, SDF became commercially available to dental professionals in April of 2015 as Advantage Arrest by Elevate Oral Care. Compared to a traditional filling that requires the administration of local anesthetic and excavation of decay and tooth structure, this treatment is non-invasive and comfortable for the patient. It is simply a liquid that is brushed on to the cavity that can stop current decay and also prevent new decay in the future.
What’s more interesting, is the fact that the use of silver to treat cavities is nothing new. Reports of its use date back to the 1800s. It has been widely used to treat decay in Japan for nearly 50 years. G.V. Black, revered as the ‘Father of Modern Dentistry,’ regularly used silver nitrate to treat cavities in children. It wasn’t until the 1950’s that this method seemingly vanished from popular use in the US, which coincides with the development of better anesthesia options to make dentistry “painless” and the addition of fluoride toothpastes and tap water with the promise of eradicating tooth decay. Unfortunately, tooth decay remains the number one most common disease of childhood, five times more common than asthma. This technique is very exciting for young, fearful or pre-cooperative children, special needs patients, and medically compromised individuals who may otherwise require sedation for traditional dental restorations such as fillings or crowns. It is also a great option for nursing homebound elderly patients, those that lack access to care, and those individuals without dental insurance or the funds to afford traditional dental restorations.
What can SDF be used for and how does it work?
SDF is used for treatment of dentin hypersensitivity and caries arrest. In treatment of exposed sensitive dentin surfaces, topical application results in development of a silver-protein layer on the exposed dentin, partially plugging the dentinal tubules. Decreased sensitivity in treated patients is consistent with the hydrodynamic theory of dentin hypersensitivity. As we know, dental caries is a complex progression involving dietary sugars, bacterial metabolism, demineralization, and degradation of tooth structure. Upon application of silver diamine fluoride to a decayed surface, the layer of silver-protein forms, increasing resistance to acid dissolution and enzymatic digestion. Hydroxyapatite and fluorapatite form on the exposed matrix. The treated lesion increases in mineral density and hardness while the lesion depth decreases. Meanwhile, silver diamine fluoride specifically inhibits the proteins that break down the exposed dentin matrix. Silver and fluoride ions penetrate ~25 microns into enamel and 50-200 microns into dentin. The application of SDF also helps to prevent new decay in the future. Artificial lesions treated with SDF are resistant to biofilm formation and further cavity formation, presumably due to remnant ionic silver.
What are the advantages and disadvantages of SDF?
SDF has very low toxicity, it is quick, painless, non-invasive, affordable, and can stop tooth decay and help prevent recurrent decay.
SDF permanently stains cavities black. It does not restore tooth form or function, so large holes that trap food may still eventually require traditional restorations. It may require repeat application for maximum efficacy. SDF cannot be used in the presence of infection or decay into the nerve.
SDF is a safe, effective treatment for dental caries across the age spectrum. It is indicated for patients with extreme caries risk, those who cannot tolerate conventional care, patients who must be stabilized so they can be restored over time, patients who are medically compromised or too frail to be treated conventionally, and those in disparity populations with little access to care. Traditional approaches often provide only temporary benefit, given the highest rates of recurrent caries are in patients with the worst disease burden. The advent of a treatment for non-symptomatic caries not requiring general anesthesia or sedation addresses long-standing concerns about the expense, danger, and practical complexity of these services.