Silver diamine fluoride is a product that is painted on areas of active caries (cavities) for the purpose of stopping, or arresting the caries. Products like it have been used in Japan for 80 years and in parts of Europe for decades. We are excited to add this option in to our treatment for cavities and hope that it will lead to a significant reduction in the number of cavities requiring treatment.
Absolutely not! Since treatment with SDF is non-invasive there is not typically pain. If the liquid gets on the tongue or lips there can be a temporary tingling sensation. There is no need for local anesthesia (numbing) or removal of the decay (drilling.) Food debris, if present, is cleaned out, the teeth are gently dried with air, and the SDF solution is applied with a small brush for one minute.
SDF contains two active ingredients, silver and fluoride. The silver actually kills the bacteria present in caries (cavities.) In addition, the silver ions penetrate the weak part of the tooth and plug up the microscopic holes in the enamel or dentin surface. This residual silver continues to work at killing additional bacteria resulting in tooth structure that can be immune from further decay. The fluoride then helps to remineralize the weak areas of the tooth. One study showed that applying SDF once a year was more effective in stopping cavities than four applications of fluoride varnish four times a year.
Possibly but there is no guarantee. SDF has been shown to have about an 80% success rate when applied twice per year. 20% of cavities will continue to grow. SDF has been shown to be a little less effective for cavities between the teeth compared to cavities on other surfaces. Along with changes to dietary habits, hygiene, and the use of other “anti-cavity” products, we are hopeful our success rate will exceed 80%!
SDF has been approved for use by the FDA. Silver nitrate has been successfully used by dentists since the 1800’s without reported incidence. The advent of local anesthesia possibly caused a shift away from the use of silver nitrate since teeth with cavities could be treated without pain. SDF has been used in Australia and parts of Europe for decades, and in Japan for over 80 years without any reported adverse effects. One drop of SDF is usually sufficient to treat up to five teeth. Within that one drop of SDF there is roughly the same amount of fluoride as a properly fluoridated liter of water. Another comparison is that the amount of fluoride is approximately 1/10th of the fluoride found in the topical fluoride varnish we use. The amount of silver is also well within safe limits.
We are finding that many insurance companies are not covering treatment with SDF. Hopefully these companies will soon find that this is a more cost effective treatment than traditional dental treatment. To find out if your insurance company covers SDF you can provide them with code D1354 to see if it is a benefit.
There are some downsides. SDF does permanently turn the part of the tooth with decay black. Therefore it is not indicated for front teeth except in the very young child when we want to try to avoid the need for sedation or general anesthesia. It can also discolor weak or hypomineralized enamel. SDF does not always work and will likely need to be reapplied annually. SDF does not fill in any open cavities and may not prevent the need for treatment. Additionally, not all insurance plans cover the treatment. Although it is not a “silver bullet” that works all the time, we are excited that SDF does give us a more conservative method to treat cavities.