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Journal Bites

Journal Bites: Arrest caries with SDF

Silver diamine fluoride (SDF) has been shown, in select cases and circumstances, to be beneficial in arresting cavitated carious lesions.

The fluoride inhibits enamel demineralization and promotes remineralization. Arresting and preventing caries in dentin is related to the deposition of silver salts and the antibacterial effect of silver ions.

When SDF is applied, silver salts will form and precipitate on the surface. Tooth surface  permeability will be decreased due to the blocking effect of the insoluble silver apatite, and formation of sclerotic dentin will be stimulated. This increases the hardness and arrests the carious lesion.

The disadvantage of SDF is the black staining that occurs on the lesion being treated. There are also some contraindications which include silver allergy and significant ulcerative gingivitis and stomatitis.

A recent randomized controlled trial involved nursing home residents with a total of 188 active carious lesions.1 The test group received a single application of 38% SDF; the control group received no treatment. Clinical evidence after just three weeks revealed:

  • Eighty-one percent of the teeth in the test group demonstrated caries arrest, compared with zero in the control group.
  • Given the dramatic nature of the results, the trial was halted and the control group was treated with SDF.

Community public oral health programs in the United States, Australia and Hong Kong have all shown measurable effectiveness for the biannual application of SDF in school settings.2 The findings include:

  • SDF applications reduced caries treatment costs and time by 33 percent, when compared with glass ionomer, for roughly 25,000 children in schools in New York and New Hampshire.
  • The routine use of SDF in Australia significantly reduced the number of children needing general anesthesia for caries treatment.
  • The Preschool Oral Health Program implemented by the Faculty of Dentistry at the University of Hong Kong enrolled 200,000 children over a 6-month period. The program proved to be so successful in caries management that the university was encouraged to provide SDF treatment to the entire island.

1 Shakir, H. et al. J Public Health Dent 2023 Jul;83(3):292-298 doi: 10.1111/jphd 12578. Epub 2023 Jun 12

2Dental Abstracts  67(5);September–October 2022, 325-326 https://doi.org/10.1016/j.denabs.2022.05.049

 

Clinical Significance: The authors of these papers suggest SDF’s efficacy at arresting caries should prove a valuable treatment option to improve community access to care and caries prevention/reduction on a wide scale.

However, dentists are strongly advised to ensure patients and parents clearly understand, as part of the informed consent discussion, that SDF causes visible black staining when applied to the teeth.