Silver Diamine Fluoride (SDF)

[Omar Hasham]

Is anybody using Silver Diamine Fluoride (SDF) ?

We have a number of elderly patients that are seriously medically compromised with early enamel lesions and extensive gingival recession.

Has anybody had any experience with SDF?

Many thanks

Omar

[James (Jim) Lopez]

I am a pedo/ortho and use SDF and also Milgroms protocol of Povidine iodine and fluoride varnish every two months.  Interesting that the PI research was published with a high success, but only one pedo program teaches it.  More programs are beginning to teach the SDF.

SDF does work and articles by Milgrom and others and a good article by Duffin on Silver Nitrate are available for download in the California Dental Association journal.  Be careful to explain that lesions past the incipient stage cannot be whitened by SSKI. I believe that there is a tremendous reason to use SDF in medically compromised adults and use the PI on anteriors because it does not permanently stain. 

SDF might fail as a tx for kids because insurance companies will label it a cheap fluoride and it is not.  Read G V Black's text from the 1930s on treating caries with Silver Nitrate. He understood that it took 3-4 minutes per lesion and teeth needed restoration later. Interesting that Silver Nitrate greatly lessened sensitivity.  I suspect that SN fell out of favor because it is easier to restore and the doc makes more money.  We feel as though we have done more for the patient when we restore; however, we know from pedo hospital cases that we must eliminate the factors that caused the disease to begin. As an aside, SDF has great potential to eliminate the need for OR pedo cases as Duffin described and the inherent risks to the patient.

[Omar Hasham]

Many thanks for your response. We started using it yesterday on an elderly patient. I will let you know the outcome.

Kind regards.

[Hazar Jaber]

We had a pediatric dentist associate who used it .. It caused several upset parents and sometimes staff, who couldn't understand why are we doing it on anterior teeth, no reimbursement will ever be received, it is very messy and it ruined a couple of counter tops at our office.. Maybe use it on posterior teeth only ..And make sure your staff are very well trained on how to handle it.

[Byron McKnight]

There is a good review of that in the current Clinician’s Report from Gordon Christensen.