Silver Diamine Fluoride
- Topical silver diamine fluoride (SDF) is a liquid that is painted on a tooth surface with an active caries lesion and arrests the lesion. SDF was cleared by the Food and Drug Administration in 2014 as a treatment for sensitive teeth and has been used off-label to treat tooth decay in the United States since 2015. 1
- Topical 38 percent SDF arrests tooth decay and is effective for the short-term treatment of tooth decay in preschool-age children. The effect is rapid and safe. 1
- The American Academy of Pediatric Dentistry’s SDF panel supports the use of 38 percent SDF for the arrest of cavitated caries lesions in primary teeth as part of a comprehensive caries management program. 2
- The American Dental Association’s expert panel strongly recommends the use of 38 percent SDF solution to arrest advanced cavitated carious lesions on any coronal surface of primary teeth and to arrest or reverse non-cavitated carious lesions on occlusal surfaces of primary teeth using sealants and a 5 percent solution of sodium fluoride varnish or sealants alone. 3
- The effectiveness of SDF for treating tooth decay in children has implication for pediatric dentistry. The cost of SDF treatment is lower than the cost of conventional treatment. Also, because SDF is easy to apply, its use could result in more children with untreated tooth decay receiving treatment. 4,5
- To arrest advanced cavitated carious lesions on any coronal surface of primary teeth, clinicians should consider the use of 38 percent SDF solution biannually. 6
- SDF is more effective than fluoride varnish in arresting advanced cavitated carious lesions on any tooth surface. 7
- Estimations of SDF effectiveness in arresting dental caries lesions range from 47 to 90 percent with one-time application depending on size of the cavity and tooth location. 3 Anterior teeth have higher rates of arrest than posterior teeth. 8 Therefore, follow-up for evaluation of caries arrest is advised, including reapplication. Reapplication shows increased caries arrest rate versus a single application. 3
- Parents are more likely to accept SDF-associated black staining on their child’s posterior teeth than on anterior teeth. Although staining on anterior teeth is undesirable, most parents prefer this option to advanced behavioral techniques such as general anesthesia or sedation. 9
- Milgrom P, Horst JA, Ludwig S, Rothen M, Chaffeee BW, Lyalina S, Pollard KF, DeRisib JL, Mancla L. 2018. Topical silver diamine fluoride for dental caries arrest in preschool children: A randomized controlled trial and microbiological analysis of caries associated microbes and resistance gene expression. Journal of Dentistry 68:72–78.
- American Academy of Pediatric Dentistry, Council on Clinical Affairs. 2017. Use of Silver Diamine Fluoride for Dental Caries Management in Children and Adolescents, Including Those with Special Health Care Needs.
- American Dental Association. 2018. Evidence-Based Clinical Practice Guideline on Nonrestorative Treatments for Carious Lesions: Summary of Clinical Recommendations for the Nonrestorative Treatment of Caries on Primary Teeth. Chicago, IL: American Dental Association.
- Hansen RN, Shirtcliff RM, Dysert J, Milgrom PM. 2017. Costs and resource use among child patients receiving silver nitrate/fluoride varnish caries arrest. Pediatric Dentistry 39(4):304–307.
- Trieu A, Mohamed A, Lynch E. 2019. Silver diamine fluoride versus sodium fluoride for arresting dentine caries in children: a systematic review and metaanalysis. Scientific Reports 9(1):2115.
- Slayton RL, Urquhart O, Araujo MWB, Fontana M, Guzmán-Armstrong S, Nascimento MN, Nový BB, Tinanoff N, Weyant RJ, Wolff MS, Young DA, Zero DT, Tampi MP, Pilcher L, Banfi L, Carrasco-Labra A. 2018. Evidence-based clinical practice guideline on nonrestorative treatments for carious lesions: A report from the American Dental Association. Journal of the American Dental Association 149(10):837–849.
- Urquhart O, Tampi1 MP, Pilcher L, Slayton RL, Araujo MWB, Fontana M, Guzmán-Armstrong S, Nascimento MM, Nový BB, Tinanoff N, Weyant RJ, Wolff MS, Young DA, Zero DT, Brignardello-Petersen R, Banfield L, Parikh A, Joshi G, and Carrasco-Labra A. 2019. Nonrestorative treatments for caries: Systematic review and network meta-analysis. Journal of Dental Research 98(1):14–26.
- Fung M, Duangthip D, Wong M, Lo E, Chu C. 2018. Randomized clinical trial of 12% and 38% silver diamine fluoride treatment. Journal of Dental Research 97(2):171–178.
- Crystal YO, Janai MN, Hamilton DS, Niederman R. 2017. Parental perceptions and acceptance of silver diamine fluoride staining. Journal of the American Dental Association 138(7):510–518.
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