Silver Diamine Fluoride (SDF) Application: Evidence-Based Recommendations

By Adem Lewis / in , , , , , , , , , , , , , , , , , /

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

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