Is Silver Diamine Fluoride the Silver Bullet in the Fight Against Dental Decay?

The progressive staff of ADT Dental practices prevention in the most practical ways:
diet counseling, fluoride treatments and the monitoring of risk and disease factors that contribute to tooth decay.

We are very excited about a new product now available to dentists in the USA which some have dubbed the Silver Bullet. It is technically an aqueous solution of 38% Silver Diamine Fluoride (SDF). The oral product company, Elevate Oral Care, has released this product as Advantage Arrest. Although the Food and Drug Administration has approved it as a desensitizer, this product has been used by dentists globally to arrest decay, especially in children’s primary teeth. A multitude of international studies have shown that it works to both prevent and arrest dental decay. The FDA has not approved its use to arrest decay, but interestingly, they have created a dental code for its off-label use as an arresting agent. This dental code can be uses beginning January 1st of 2016.

ADT Dental staff has been using the product since January of 2015. We are able to offer this additional treatment to our patients to minimize their rate of decay.

How does it work?
Silver compounds have been used as an antimicrobial agent for over 100 years. Without toxicity and in concentrations of less than 50 parts per million (ppm), silver ions kill pathogenic organisms. Fluoride remineralizes and hardens tooth structure. By simply painting this combined suspension over an area of decay, silver ions incorporate into the tooth structure to resist bacteria while the fluoride remineralizes or hardens it. Tooth structure that absorbs the product is transformed.

How is it being used at ADT Dental?

1. For seniors we are using the product as an annual fluoride treatment on exposed roots. Exposed roots are more prone to decay because they are not covered by enamel.
2. Sometimes we use the product for diagnostic purposes. Does this patient have decay on a root? We don’t want to poke it with our explorer to see if it is soft and create a pit in the root for bacteria to colonize. If we apply SDF the decaying area turns black, and better yet, now it may be arrested. We follow this area closely.
3. For young children who cannot tolerate treatment due to their behavioral maturity, SDF allows us to buy time. Without getting the child numb, we scoop out as much decay as possible from the tooth. We treat the remaining decays with SDF and then place the appropriate restoration. Once the child is mature enough, we can return to this tooth for more definitive treatment without traumatizing the child.
4. For permanent teeth with decay so deep it could lead to a root canal and if the patient has no symptoms or signs of abscess, we remove as much decay as possible without uncovering the nerve. If decay remains, it is treated with SDF. This prevents the nerve from being exposed which would dictate root canal treatment. Especially in young children, teens and young adults, the tooth has great capacity to recover. Once treated with the SDF, we close off the prepared cavity with the appropriate filling materials. The tooth needs to be followed over its lifetime.
5. Finally we are trying something completely our own. We are not sure of the results but will follow these patients very closely. For early lesions identified on x-rays in between teeth, we are attempting to see if we can achieve remineralization through SDF application. Here is the process: Anesthetize the tooth or teeth to be treated, wedge the teeth to create a space between the teeth, place a band to retain the SDF and slowly brush the product on to the early decay area. We allow SDF to sit for 2 minutes. We are hoping to follow these areas for remineralization on x-ray in one year. We have not seen this described in the literature, but we feel it is a better option than placing a filling for an incipient carious lesion. We are hopeful.

A Drawback of Silver Diamine Fluoride

There is one drawback. SDF turns the decayed area black. That’s how we know it worked. But for the most part, treated areas are not visible. The healthy portions of teeth remain unchanged. We would never use this product without proper consent, so everyone is aware of this issue prior its application.

Is Silver Diamine Fluoride the Silver Bullet?

The jury is still out, but personally, I haven’t seen any silver bullets come about in my lifetime. I am hopeful that this will be a great tool in the USA’s armamentarium of dentistry which is always improving. Our goal should be to prevent first and treat when necessary. Patients and their teeth will be much happier.