SILVER DIAMINE FLUORIDE
Until now , no option for the treatment of dental caries in the U . S . besides restorative dentistry has shown substantial efficacy . 1 Silver diamine fluoride is an inexpensive topical medicament used extensively in other countries to treat dental caries across the age spectrum .
No other intervention approaches the ease of application and efficacy . Multiple randomized clinical trials — with hundreds of patients each — support its use for caries treatment , thus substantiating an intervention that addresses an unmet need in American dentistry . In August 2014 , the Food and Drug Administration ( FDA ) cleared the first silver diamine fluoride product for market , and as of April 2015 , that product is available .
Since its approval in Japan more than 80 years ago , 2 more than 2 million containers have been sold . The silver acts as an antimicrobial , the fluoride promotes remineralization and the ammonia stabilizes high concentrations in solution . 3
Because silver diamine fluoride is new to American dentistry and dental education , there is a need for a standardized guideline , protocol and consent . The University of California , School of Dentistry paradigm shift committee assembled a subcommittee with the following goals :
n Use available evidence to develop a list of clinical indications .
n Define a protocol that maximized safety and efficacy and minimized inadvertent staining of clinical facilities .
n Build an informed consent document at the eighth-grade reading level .
We conducted a systematic review , inquired of authors of published clinical and in vitro studies about details and considerations in their protocols and consulted experts in cariology and materials chemistry where evidence was lacking . The work of this committee resulted in the adoption of silver diamine fluoride use in the UCSF student clinics .
METHODS A literature review was designed by a medical librarian to search PubMed and the International Association of Dental Research abstract archive with the following search terms : ” 33040-28-7 ” OR “ 1Z00ZK3E66 ” OR “ silver diamine fluoride ” OR “ silver fluoride ” OR “ silver diamine fluoride ” OR “ diammine silver fluoride ” OR “ ammonical silver fluoride ” OR “ ammoniacal silver fluoride ”. Differences in nomenclature have led to confusion around this material . Another review was completed with the terms “ dental ” OR “ caries ” AND “ silver nitrate ” AND “ clinical .”
FIGURE 1 .
Graphic summary of randomized controlled trials demonstrating caries arrest after topical treatment with 38 % silver diamine fluoride . Studies are arranged vertically by frequency of silver diamine fluoride application . Caries arrest is defined as the fraction of initially active carious lesions that became inactive and firm to a dental explorer . SDF , silver diamine fluoride ( 38 % unless noted otherwise ); q6mon , every six months ; q1year , every year ; q3mon , every three months ; GIC , glass ionomer cement ; NaF , 5 % sodium fluoride varnish ; + OHI q6mon , SDF every year and oral hygiene instructions every six months .
Arrested caries
Arrested caries
100 %
50 %
0 %
100 %
50 %
0 %
MATERIAL Silver diamine fluoride ( 38 % w / v Ag ( NH3 ) 2F , 30 % w / w ) is a colorless topical agent comprised of 24.4-28.8 % ( w / v ) silver and 5.0-5.9 % fluoride at pH 10 , 4 and marketed as Advantage Arrest by Elevate Oral Care LLC ( West Palm Beach , Fl .). Other companies may market silver diamine fluoride in the future following determination of substantial equivalence and FDA clearance .
MECHANISMS Silver diamine fluoride is used for caries arrest and treatment of dentin hypersensitivity . In the treatment of exposed sensitive dentin surfaces , topical application results in development of a squamous layer on the exposed dentin , partially plugging the dentinal tubules . 5 High concentration
373 6 year olds | 3.2 lesions at start Llodra et al ., 2005
0.5 1 1.5 2 2.5 3 Time ( years )
181 3-4 year olds | 3.4 surfaces at start Zhi et al ., 2012
0.5 1 1.5 2 2.5 3 Time ( years )
SDF q6mon control
SDF q6mon SDF q1year GIC q1year
16 JANUARY / FEBRUARY 2017 | PENNSYLVANIA DENTAL JOURNAL