Silver Diamine Fluoride: The Evolving Management of Primary Tooth Carious Lesions
SDF is formulated as a clear, topical liquid to non-invasively and painlessly apply by brushing on to a carious deciduous tooth to halt the progression of dental caries and to prevent the development of new carious disease. It is also effective in controlling dentine hypersensitivity.
As its name suggests it is composed of silver and fluoride chemically combined in ammonia, and the silver and fluoride ions both are effective antimicrobial agents. It has considerable advantages for management of decay in the deciduous dentition. It can be used as a simple method of treating caries in children who are unco-operative and may assist in the development of the patient relationship allowing children to accept dental care. In particular it is effective as a technique for managing severe early childhood caries for which standard operative treatment is not successful or indicated. It is also very valuable in young patients with phobias or physical or cognitive disabilities where standard dental procedures are not indicated.
SDF is licensed in the United Kingdom for the management of dental hypersensitivity and can be used ‘off-label’ for the arrest of dental caries. The term ‘off-label’ means using a medical product at a dosage or in a manner which is not explicitly approved by a regulator such as the MHRA. The practice is legal and regularly used but should be based on strong clinical judgement and must adhere to professional guidelines.
After valid consent has been obtained, the area should be isolated and dried using cotton wool roll or gauze. The solution can then be applied, following which the area can be blotted with cotton wool or gauze. The treatment does require the child’s co-operation. The treated area can be reviewed after 2-4 weeks and the presence of a hard dark area on the tooth confirms the arrest of the caries. It can be reapplied after six months for continuing caries control or the tooth can be restored using standard conservative procedures.
SDF should be used with care and the child’s parents or guardians should be advised that it causes permanent discolouration of the carious area on the tooth, which becomes dark brown or black. It should also be noted that the agent can cause temporary staining of the soft tissues of the cheek adjacent to the location of the application, and occasionally can cause a gingival burn.
Where it is clinically appropriate the use of SDF provides an effective and simple way of treating caries in young children with little risk and significant benefits, particularly as part of the process of retaining the deciduous dentition until exfoliated naturally in anticipation of the adult dentition. In such circumstances Densura supports dentists using this conservative approach to caries management as a recognised and successful treatment which would be supported should the need arise.
Please let us know if you would like this to be added to your policy at no additional cost.
Dr Paul Lambden
