Silver Diamine Fluoride
Recently in the news, a new topical dental medication, called silver diamine fluoride, was discussed as an effective method to arrest the progression of dental decay. It was touted as being a ‘cure-all’ solution to treat all dental cavities. With this exposure, patients in our office have been rightly curious about this new advancement.
Dental decay is the most prevalent disease worldwide. Before the distribution of preventative fluoride in community water, the only available option to treat decay was, if shallow enough, to remove the decay and restore with a dental filling, or to extract the tooth. Unfortunately, prevention options still are not widely accessible in many less developed countries, resulting in a high rate of extractions and edentulism in those population groups.
For over fifty years, fluoride has proved to be an effective method to prevent dental decay formation and progression. However, more recently, silver diamine fluoride (SDF) has gained public attention, especially after being approved for use by Health Canada in 2017. Due to its new introduction, dentists and patients should be knowledgeable with its current facts to be able to weigh the benefits and risks of this treatment option.
Silver diamine fluoride, or under the name Advantage Arrest as it is known in Canada, is an anti-caries agent. Clinical studies have shown that its fluoride component remineralizes damaged tooth structure, whereas the silver acts as an anti-bacterial. This potent combination is effective on both adult and pediatric primary teeth. With a simple topical application onto the damaged tooth structure surface, this non-invasive procedure allows for a cost-effective preventative option to arrest dental decay.
However, there are risks and still some uncertainties to using SDF. Black-coloured staining is a known side-effect. Due to the nature of the compound, when applied to teeth, SDF turns the decayed surface dark black, which remains permanently. Staining can also occur on adjacent teeth, gums, mucosa, and skin if they accidentally come into contact with the agent, typically resolving in two weeks. Currently, there still is not a widely accepted guideline for its use within the dental community, including concentration of product and frequency of applications. Currently, only about 65% of dental decayed teeth have shown a positive result.1 Furthermore, long-term studies have not been performed to show any potential hazards.
Silver diamine fluoride has shown promise in dental advancement. Its application is quick, painless and generally effective. However, due to many uncertainties, further research is still required for use in all populations. Despite this, SDF does provide a feasible option for high-caries risk patients with behavioral or medical challenges, where conventional dental care may not be easily accessible.
1. Gao, SS. Caries remineralization and arresting effect in children by professionally applied fluoride treatment-a systemic review. BMC Oral Health. 2016; 16:12-016-0171-6.