Not using silver diamine fluoride regularly? Here’s why you should be

Hygienists pleasure on their own on blocking disorder and providing reliable oral treatment training. When you’re imagining about caries avoidance, I problem you to give imagined to what we can do in different ways and greater in dentistry. The stats for caries in pediatric people are alarming. Fifty percent of clients ages 6–8 are affected by caries in their principal teeth, and 50% of young children ages 12–19 are influenced by caries in their long term tooth.¹ Little ones ages 5–19 from low earnings family members are twice as probably to have caries in their younger life.²

Early childhood caries is however the amount a single childhood condition in the globe. In 2022, The US Division of Wellbeing and Human Services claimed that more than 51 million several hours of school are missed each 12 months simply because of dental complications.¹ We need to do much better. Of the grownup individuals we treat, a person-3rd report hypersensitivity, and 1-fourth are probably to have untreated dental caries. Fifty % of older older people go through from root caries.³

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Is silver diamine fluoride the new sealant?

How and why to position silver diamine fluoride interproximally

Factors to increase SDF

The Fda accredited silver diamine fluoride (SDF) for dentinal hypersensitivity in 2014. A lot more than fifty percent the offices I’ve consulted for and labored with have procured SDF, but the proportion of sufferers benefiting from SDF is fewer than 1%. SDF is employed initially to arrest decay, next to reduce decay, and final to minimize dentinal hypersensitivity. It is a powerful resource to have in our day by day armamentarium.

Good reasons to incorporate SDF to your day-to-day plan are quite a few:

• Silver destroys bacterial cells and interrupts cell synthesis.
• SDF has a fluoride focus of 44,800 ppm. This is twice what’s in varnish.
• Fluoride generates fluorapatite, which is critical for remineralization.
• Fluoride is bacteriostatic.⁴ 

There are numerous gains to making use of SDF for:

• Those people with reasonable to large caries chance
• Individuals who are behaviorally or medically challenged
• Clients without obtain to proper dental treatment
• Young small children ready for medical center-primarily based treatment method
• Noninvasive procedure for tooth shut to exfoliation
• Dentinal hypersensitivity
• Biofilm command
• Fissure security
• Managing root caries
• Individuals with carious lesions that are unable to all be handled in a person go to⁴

The most present-day investigate supports the use of SDF, which is 89% additional effective in controlling/arresting caries than other treatments or placebos.⁴ Yearly, 38% of SDF apps to uncovered root surfaces in older adults are a simple, inexpensive, and productive way of avoiding caries initiation and progression.⁴ When chatting about minimally invasive treatments these types of as SDF, the goal is to existing the clinically suitable choices and offer schooling so that the dad or mum or affected individual can make the most effective conclusion for them.

Additional explanations to aid SDF use

When SDF was used only to carious lesions, spectacular prevention was noticed for other tooth surfaces. In both little ones and the elderly, an yearly software of SDF prevented numerous additional carious lesions than 4-moments-for each-yr fluoride varnish application.⁴ SDF has been demonstrated to cease incipient lesions from needing restorative remedy.⁵ This begs the question—why aren’t dental practices treating incipient lesions with SDF?

Clinicians suppose that mother and father will reject SDF for their small children since of inadequate esthetics. But if it indicates a boy or girl doesn’t have to be sedated or have their tooth drilled and stuffed, numerous dad and mom do pick SDF. Analysis shows that more than 90% of clinicians in a dental residency application think that parental acceptance for SDF in a pediatric placing is a problem, when in reality they uncovered fewer than 7% of parents have been anxious with the staining.⁶

When submitting insurance, the CDT code to use is D1354, and it applies to cure for each tooth, not for each software. The frequency of application is dependent on the hazard things and the measurement of the lesion. If you’re managing an incipient lesion, reapplication can be in six months. If the lesion is into the dentin, you may possibly reapply in two to 4 weeks.

In places of work that have SDF on hand but are not making use of it to its whole capacity, the preventive care opportunity is subpar. Clinicians are concerned about stained tooth, counter tops, and dental tools, and they’re anxious to implement new protocols. Intact tooth framework does not stain.²

Exploration supports many affected individual circumstances where by SDF is the greatest solution.

Illustrations for practical use of SDF

• A 90-year-previous male presents with recurrent buccal decay on selection 19 close to the present porcelain-fused-to-metal crown. He has a complicated professional medical record and a substantial plaque index. Implement SDF to arrest the lesion and preserve the life span of the crown.
• Numerous interproximal lesions are existing on the bite wing survey of an uncooperative 4-calendar year-old affected individual. Use SDF to arrest decay until eventually the affected individual can have definitive restorative perform done.
• Occlusal decay on selection 30 is present in a 20-year-old healthy client. Restorative schedules are booked out for three months. Use SDF to arrest the decay to maintain the restoration conservative.
• SDF has develop into a normal of care in minimally invasive strategies. Its use can control the biofilm, arrest the progress, and remineralize lesions 1st. Then you may perhaps restore the teeth as time, assets, and income make it possible for.⁵ When we’re contemplating of reinventing and improving upon our typical of treatment in caries avoidance strategies, assume about what we can do differently, and what we can do far better.

Editor’s notice: This posting appeared in the November-December 2023 print edition of RDH magazine. Dental hygienists in North The usa are suitable for a complimentary print membership. Signal up below.

References

1. Oral well being surveillance report, 2019. Facilities for Condition Command and Avoidance. Webpage past reviewed December 9, 2021. https://www.cdc.gov/oralhealth/publications/OHSR-2019-index.html 
2. Dye BA, Xianfen L, Beltrán-Aguilar ED. Selected oral wellness indicators in the United States 2005–2008. NCHS Knowledge Brief. 201296(5):1-8.
3. Chan AKY, Tamrakar M, Jiang CM, Lo ECM, Leung KCM, Chu CH. A systematic evaluate on caries status of more mature grown ups. Int J Environ Res General public Health and fitness. 202118(20):10662. doi:10.3390/ijerph182010662
4. Horst JA, Ellenikiotis H, Milgrom PL. UCSF protocol for caries arrest making use of silver diamine fluoride: rationale, indications and consent. J Calif Dent Assoc. 201644(1):16-28. PMID:26897901
5. Braga MM, Mendes FM, De Benedetto MS, Imparato JC. Effect of silver diamine fluoride on incipient caries lesions in erupting long-lasting initially molars: a pilot review. J Dent Youngster (Chic). 200976(1):28-33. PMID:19341576
6. Crystal YO, Janal MN, Hamilton DS, Niederman R. Parental perceptions and acceptance of silver diamine fluoride staining. J Am Dent Assoc. 2017148(7):510-518.e4. doi:10.1016/j.adaj.2017.03.013

Brooke Ackerman, MSDH, is an skilled in the dental discipline, an advocate for thriving dental procedures and substantial-high-quality, extensive affected individual care. She is a practicing medical dental hygienist and retains a master’s diploma in dental hygiene, with a target on administration by way of the University of Minnesota Carlson University of Small business. Brooke is also a practice management specialist at Advanced Follow Management. You may make contact with her at (952) 921-3360 or by way of advancedpracticemanagement.com.