Wednesday, April 20, 2016

Silver Diamine Fluoride

I don’t know how I heard of silver diamine fluoride (SDF) in the first place, but it has blown my mind ever since I have found it. You may have heard of silver nitrate — the stuff we put on ulcers to burn them up. This is also what some dentists were using to arrest caries.

Now there is something new (U.S. Food and Drug Administration-approved in 2014 and the first product on the market in 2015) that is actually made to arrest caries.

Wait? What?!

Yeah, that is what I said.

You take this SDF liquid and put it on a cavity, and it arrests the progression of decay and builds a secondary dentin layer at the same time.

Because it is so new, there is not much on it on the Internet. There are a lot of studies on rats and some research on people in China, but few have been published in the United States. (All of the studies say the same thing: The stuff works.)

Think of the implications. You rub it on a cavity, and the decay stops.

You have a 3-year-old who won’t sit still who has decay on his or her teeth. The parents don’t want to put the kid under anesthesia. All the dentist has to do is rub some SDF on all of his or her decay, and the procedure is done.

When you go back four to six weeks later, the dentin bridge is so strong that you can drill on the teeth without anesthetic.

Wait? What?! Yeah, that is what I said.

Think of the implications. For a youngster who has decay on the facial of No. C, use a little rub of SDF on the cavity at the cleaning appointment. Four weeks later, you can complete the filling in about three minutes, and the patient is done.

How about Henry, who has been coming to your practice forever? Henry is diagnosed with cancer and is in failing health. He is on tons of meds, and the chemo is drying out his mouth. He is getting decay everywhere. You try to do 10 facial fillings. You see Henry on recall, and he has 12 more spots of decay. You put SDF on and around all of his teeth. You don’t even have to do the restorations. At least you know that his decay isn’t going to progress.

How about all of us who go on mission trips and see so much decay that one week of dentistry is equivalent to throwing a piece of sand in the ocean? How about buying the third-world country clinic a case of SDF? They would wipe it on an already black spot, and that person would keep that tooth.

OK, so here is the catch. (Yes, there is always a catch.) The only side effect of this liquid is that it turns all decay black. In all the articles that I have read, this is the only drawback.

Do you think the youngster will care if his or her brown spot of decay turns to black? Do you think Henry is going to care that all of his brownish/orangeish roots become black on the distal ling surfaces? Do you think the child in rural Mexico is going to care? Maybe, but sometimes the patient will just be happy not to have to sit in your chair and spend dollar after dollar.

Look it up. It is new, so there is only one product on the market. I am sure this is going to be big — so big that someone probably is going to make some formulation that doesn’t turn the decay black.

Do you use SDF? Let me know if you find out something I am missing. I am so excited about what the future holds with this stuff and beyond.

John Gammichia, DMD, FAGD


Unknown said...

SDI make a product for this
Also check out Dr G Knight from Australia on this- he had talked about it for years

Cabrillo Family Dental Care said...

Thanks for sharing. I haven't found much online myself, so this is new to me as well. Do you have any thoughts to what the reason is that decay is blackened? Does this pose any additional problems for if/when a patient wants to go through with a full restoration at a later time?

Unknown said...

Thanks for your article! This is the first I have heard of it and have been asking around about its use. Seems like a great way to treat rampant decay. I have many cases where pts have decay everywhere, but cannot afford to treat all the teeth, leading to future larger restorations, root canals, and extractions. This seems like a good way to arrest caries to later restore in a more conservative manner. Also, what do you think about treating children? As long as the pt and pt's parents don't mind the black, you could leave deciduous teeth as is and let them exfoliate, leading to much less dental work as a child.

Radhika Wadhwa said...

Very informative blog. It helps me to understand about this new medicine which is currently in market. So thanks.

gatordmd said...

Dr. Shim,
You are right on with all your thoughts.
I just bought the product (The company is Elevate and the product is Advantage Arrest. It is a clear liquid in a drop bottle. It is about $125)
I started using it on my elderly patients with dry mouth. I use it in areas they can't see anyway. Lingual of #30, Distal of #15.
Dry the area, put it on and forget about it.

I would use it on kids, like you said, and forget about it.
The lesion is dark anyway.

Let me know if you have any other questions.

gatordmd said...


I think it turns black because of the Silver.
The liquid is clear but don't let that surprise you. It will stain everything dark. Even your counter tops and tray table.

But if it turns black, you know it is working.

Thanks for the comment.

Mobile Dentistry said...

Thanks for the very informative article. Keep us updated with the current dental medicine updates.


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