What is Silver Diamine Fluoride?

You mean you’ve never heard of silver diamine fluoride?  It is hot, hot, HOT, right now!  I’m surprised it is not trending on Twitter.  Silver Diamine Fluoride, known among dentists as SDF, is a liquid with a high concentration of fluoride that is applied to a cavity to prevent it from getting larger. 

You may ask, why would one apply this to a tooth instead of just getting a filling?  A filling or crown would be a more permanent fix, but what if the child is two years old and is unable to behave for a filling?  What if the child has special needs that make it dangerous to sedate or have the fillings done under general anesthesia?  What if the child is eight years old and will lose the tooth in a year or two and the parents insurance benefits have been maxed out for the year?  These are all reasons to consider SDF in a dental treatment plan.

As costs increase and dental insurance benefits stay the same, it is becoming more and more of a struggle for parents to pay for their children’s dental needs.  SDF may not be long term treatment, but if there is a need to defer treatment, it can be applied to the teeth to prevent the cavity from becoming larger.  Typically, SDF needs to be applied every six months until the final treatment can be completed, or the tooth falls out.   Some practitioners will place it once and follow up a week later to add another coat.  Some practitioners will place the SDF and add some type of temporary restoration to further protect the tooth from breakdown. 

It sounds too good to be true, right?  There is always a catch, isn’t there?  The downside to SDF is, it turns the cavity black.  When I say black, I mean black!  It not only turns cavities black, it turns anything it touches black, as well.  If it were to touch a child’s cheek, the soft tissue would be black for a week.    For some children, if they cannot follow instructions and will be fighting the treatment, they are not candidates for SDF.  For some parents, the esthetics would eliminate SDF as a treatment option completely.  Attempts have been made to make SDF more esthetically pleasing, but at this time, they do not look as natural as a traditional filling. 

If SDF is placed and a white filling is indicated later, the dark staining can be removed with a dental handpiece, but it is not always completely successful.  This is one reason why SDF is not commonly used on adult teeth.  It is great for baby teeth, because they fall out in a few years and you get a “do over.”  In the past when treatment needed to be delayed, the cavity sat exposed for six months or a year until treatment could be completed and what originally needed a filling now needs a crown or extraction.  SDF prevents cavities from getting larger, so in theory, a cavity that requires a filling should still require a filling in six months following SDF application.  SDF is not recommended on teeth that have been deemed non-restorable and need to be removed to prevent the risk of infection. 

What are the advantages of SDF?

  1. No injection is required
  2. Sedation can be prevented or delayed as the child matures
  3. Lower cost than a filling
  4. Promotes a positive dental attitude for the child

I hope you found this post informative.  I love working in this time period because we are blessed to have so many treatment options at our disposal, and we can customize it to the needs of the individual.  I am happy to have this option in my wheelhouse, but I very much hope it does not put me out of business!

References:

American Academy of Pediatrics:

https://www.aappublications.org/news/2016/08/05/SilverDiamine080516

https://www.healthline.com/health/silver-diamine-fluoride#cost

Jeanette MacLean Placement of SDF between teeth:

https://www.youtube.com/watch?v=nPyYpZYfrHQ