New York Times Report on Silver Diamine Fluoride

The New York Times ran a story on July 11 titled: A Cavity-Fighting Liquid Lets Kids Avoid Dentists’ Drills

With the increasing national attention, and the fact that in Oregon, Medicaid patients are being reimbursed for SDF treatment,  we wanted to make sure our readers were up to date on Dr. Kutsch’s thoughts. Have you noticed an increase of public awareness of Silver Diamine Fluoride by your patients? Have you been using it?

by V. Kim Kutsch, DMD

Silver Diamine Fluoride was market cleared by the FDA earlier this year as a “Cavity Varnish” for the treatment of hypersensitivity only in adults over the age of 21.  But the use of the silver ion as an anti-cavity agent dates back to GV Black.1 He described the use of a silver nitrate solution painted onto lesions to arrest the process. I have personal experience with using silver nitrate in a technique modified by Dr. Steve Duffin. He immediately covered the lesion with fluoride varnish following the silver nitrate solution.2 I have used this technique for years with excellent outcomes. There is a drawback however, the silver ion turns the yellow to dark brown dentin lesion to black. It arrests the process, but turns the lesions black. So while effective, a technique that may not work for every patient. The good news, is that it does not stain sound enamel.

Most of the cases I have treated involved young children with SECC, whose parents didn’t want them subjected to sedation or general anesthesia to have restorative dentistry done. They were willing to compromise esthetics in the short term. These patients I then restored as the parents desired after the child was developmentally capable of having dentistry done with local anesthesia, or no anesthesia. Many of the lesions were never restored, but this provided a great service in my opinion. The other patients I have used this technique on were senior citizens in the end stages of life, where neither myself, the patient, or the family members were interested in putting the patient through extensive restorative procedures. It has worked fairly well with that demographic also.

Silver Diamine Fluoride has been used extensively for years in other countries with similar outcomes to silver nitrate. There have been numerous studies published on the topic and I believe it has gained popularity as a necessity with the increasing rates of SECC in the past two decades.3 Silver Diamine Fluoride provided better outcomes than fluoride varnish and GIC.4,5,6 I am now also using Silver Diamine Fluoride for the same types of patients that I have used silver nitrate with in the past. But in my experience contrary to some reports, it too turns the dark dentin lesions black. As long as that outcome is acceptable to the patient/parents/family, it too works very well. There is even evidence that once the silver ion kills a bacterial cell, it continues to kill other bacteria in what is described as a zombie-like state.7 For the right patient, this offers another option to their care.

One final note, these silver ion solutions do stain everything they come in contact with in the operatory, clothing, countertops etc. So just be very careful in handling the solution.

References

1. Peng JJ, Botelho MG, Matinlinna JP. Silver compounds used in dentistry for caries management: a review. J Dent. 2012 Jul;40(7):531-41. 1966-2011 Sys Rev.
2. Duffin S. Back to the future: the medical management of caries introduction. J Calif Dent Assoc. 2012 Nov;40(11):852-8.
3. Chu CH, Lee AH, Zheng L, Mei ML, Chan GC. Arresting rampant dental caries with silver diamine fluoride in a young teenager suffering from chronic oral graft versus host disease post-bone marrow transplantation: a case report. BMC Res Notes. 2014 Jan 3;7:3.
4. Chu CH, Lo EC, Lin HC. Effectiveness of silver diamine fluoride and sodium fluoride varnish in arresting dentin caries in Chinese pre-school children. J Dent Res. 2002 Nov;81(11):767-70.
5. Rosenblatt A, Stamford TC, Niederman R. Silver diamine fluoride: a caries “silver-fluoride bullet”.J Dent Res. 2009 Feb;88(2):116-25.
6. Zhi QH, Lo EC, Lin HC. Randomized clinical trial on effectiveness of silver diamine fluoride and glass ionomer in arresting dentine caries in preschool children. J Dent. 2012 Nov;40(11):962-7.
7. Wakshlak R, Pedahzur R, Avnir D. Antibacterial activity of silver-killed bacteria: the “zombies” effect. Scientific Reports 5, Article number: 9555 doi:10.1038/srep09555.