This video contains some of the latest recommendations from the 2018 ADA
clinical practice guideline on non restorative treatments for carious lesions
Silver Diamine Fluoride or SDF has been used in other countries for decades.
SDF is safe for tooth decay across the
age spectrum and is a non-invasive way to treat carious lesions without the
need to drill and fill.
In 2014 the United States Food and Drug Administration
cleared SDF for use as a desensitizing agent and that makes the treatment
available for use off-label for caries arrest, this has led to a call for national guidance.
An expert panel convened by the ADA reviewed the
scientific evidence to provide recommendations on the use of non
restorative treatments for carious lesions. The panel recommends the use of
38% SDF to arrest advanced cavitating carious lesions on any coronal surface
of primary teeth and suggest the use of 38% SDF to arrest advanced cavitating
carious lesions on any coronal surface of permanent teeth.
additionally, to arrest or reverse non cavitated and cavitated carious root lesions on
permanent teeth in patients for whom the use of once a day 5,000 parts per
million fluoride toothpaste or gel is not feasible the expert panel also
suggests the use of 38% SDF. Let's begin the exam by asking your patient if any
new dental or medical issues have emerged since their last exam.
Next perform a full clinical exam and consider the use of a caries risk
assessment approach while conducting your clinical exam you may identify one
or more tooth surfaces exhibiting cavitated lesions. A cavitated lesion
is denoted by a carious lesion with a surface that is not macroscopically
intact and with a distinct discontinuity or break in the surface integrity.
upon identification of a cavitate lesion SDF can be considered as an intervention
to arrest carious lesions.
Make sure to discuss the effects of SDF
with patients, patients receiving SDF will want to know how their teeth may
feel after its application whether there will be a need for reapplication or
subsequent appointments and why black stains may appear in the sites where SDF is applied
These black stains may not be acceptable to some patients, parents or
caregivers therefore, clinicians should explain all non restorative and
restorative options along with their potential adverse effects, clinicians
should also request oral or written informed consent from all patients
before treatment. Once SDF application is agreed upon it's important to follow the
proper four-step process. Step one, carefully set up your workstation
clinician and patient should protect their eyes and only a drop or two of SDF
solution is needed for treatment.
Step 2 check the cavitated lesion for food
residue or gross plaque if present remove it with a micro brush or cotton
pellet till expose dentin is visible, dry the side of the lesion by patting down
the area with gauze or cotton.
Step 3 with the site now clean and dry brush
SDF onto the exposed dentin move the tongue and lips as necessary and use
careful strokes if needed remove excess solution with gauze.
Step 4 allow SDF to
dry on the lesion for one minute if possible making sure that the lesion
site does not come in contact with the gums tongue or lips. As the SDF dries, you
will likely see the lesion darken the patient should be monitored short-term
and reapplication of SDF should occur within six months to a year.
Treatment can be concluded when the treatment surface is hard upon probing, this
indicates that the lesion is arrested and not progressing.
let's review the key
takeaways, practice informed consent, prior to SDF application explain
potential side-effects such as the blackening of tooth surfaces treated
with SDF, ensure that patients and their caregivers are aware of all non restorative
and restorative treatment options available. Minimize future caries risk
talk with patients about how home care such as routine brushing with fluoride
toothpaste and interdental cleaning can help minimize the need for future
treatment. Follow-up after initial SDF application carious lesions should be
retreated with SDF every six months or annually, patients should be monitored
periodically throughout the course of treatment so that changes in lesion
hardness texture and color can be observed, lesion hardness is the
definitive outcome and hardness upon probing should be clearly observed
for more information on the ADA's clinical recommendations visit ADA.Org/caries