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Silver Diamine Fluoride: A Clinical Perspective From a Pediatric Dentist

Many articles have been written to describe how SDF works and the protocols for using it, including “Back to the Future: The Medical Management of Caries Introduction: by Steve Duffin, DDS, and “UCSF Protocol for Caries Arrest Using Silver Diamine Fluoride: Rationale, Indications and Consent” by Jeremy A. Horst, DDS, PhD, et al. in the Journal of the California Dental Association. In this article, Gary D. Sabbadini, DDS explains the decision-making process for the use of silver diamine fluoride (SDF) in his pediatric dental office. Sabbadini takes into account of the patients’ age, cooperation level, health, access to care and/or financial constraints. SDF has gained interest as an alternative to traditional dental treatment from factors such as parents’ concerns over sedation injuries, and the high financial cost of sedation and restorative procedures.

Sabbadini also discusses his experience with using SDF. Sabbadini has had the most success treating teeth with direct access to the carious lesion, such as pit and fissure and smooth surface lesions. He also finds SDF to work best on carious teeth that are asymptomatic. SDF can be used on teeth with reversible pulpitis, though it does not guarantee to prevent odontogenic infection. In his 2 years of using SDF, SDF applications have arrested or slowed down caries progression. SDF did not seem to affect restoring the teeth later on. However, restoring the teeth immediately after SDF application may darken the resin or glass ionomer restoration. Other than staining the teeth, SDF has no adverse reports in more than 80 years of use in Japan. SDF is not recommended in individuals with silver allergy and desquamative processes.

Sadly, many parents choose not to treat caries because most insurance companies don’t reimburse for SDF treatment, and some are concerned about SDF staining their child’s teeth. And many patients have not gone back for recall appointments after SDF application because parents think the cavities won’t get worse or the child isn’t in pain. While SDF is not a remedy for all dental caries, it is a good low-cost, safe, and nonsurgical option for children and other uncooperative patients.

GD Sabbadini. Silver Diamine Fluoride: A Clinical Perspective From a Pediatric Dentist. CDA Journal 2018 Feb; 46(2):83-91.


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