SILVER DIAMINE FLUORIDE
FIGURE 4 . UCSF special consent form .
UCSF Dental Center Informed Consent for Silver Diamine Fluoride
Facts for consideration :
• Silver Diamine Fluoride ( SDF ) is an antibiotic liquid . We use SDF on cavities to help stop tooth decay . We also use it to treat tooth sensitivity . SDF application every 6-12 months is necessary .
• The procedure : 1 ) Dry the affected area , 2 ) Place a small amount of SDF on the affected area , 3 ) Allow SDF to dry for one minute , 4 ) Rinse .
• Treatment with SDF does not eliminate the need for dental fillings or crowns to repair function or esthetics . Additional procedures will incur a separate fee .
• I should not be treated with SDF if : 1 ) I am allergic to silver 2 ) there are painful sores or raw areas on my gums ( i . e ., ulcerative gingivitis ) or anywhere in my mouth ( i . e ., stomatitis ).
Benefits of receiving SDF :
• SDF can help stop tooth decay .
• SDF can help relieve sensitivity .
Risks related to SDF include , but are not limited to :
• The affected area will stain black permanently . Healthy tooth structure will not stain . Stained tooth structure can be replaced with a filling or a crown .
• Tooth-colored fillings and crowns may discolor if SDF is applied to them . Color changes on the surface can normally be polished off . The edge between a tooth and filling may keep the color .
• If accidentally applied to the skin or gums , a brown or white stain may appear that causes no harm , cannot be washed off , and will disappear in 1-3 weeks .
• You may notice a metallic taste . This will go away rapidly .
• If tooth decay is not arrested , the decay will progress . In that case the tooth will require further treatment , such repeat SDF , a filling or crown , root canal treatment , or extraction .
• These side effects may not include all of the possible situations reported by the manufacturer . If you notice other effects , please contact your dental provider .
• Every reasonable effort will be made to ensure the success of SDF treatment . There is a risk that the procedure will not stop the decay and no guarantee of success is granted or implied .
Alternatives to SDF , not limited to the following :
• No treatment , which may lead to continued deterioration of tooth structures and cosmetic appearance . Symptoms may increase in severity .
• Depending on the location and extent of the tooth decay , other treatment may include placement of fluoride varnish , a filling or crown , extraction , or referral for advanced treatment modalities .
I certify that i have read and fully understand this document , and all my questions were answered :
SIGNATURE OF PATIENT
DATE
A saturated solution of potassium iodide ( SSKI ) is contraindicated in pregnant women and during the first six months of breastfeeding because of the concern of overloading the developing thyroid with iodide ; thyroid specialists suggested a pregnancy test prior to use in women of childbearing age uncertain of their status .
Nonmedical Side Effects Silver diamine fluoride darkens carious lesions . At least for children , many parents have seen the color changes as a positive indication that the treatment was effective . 29 Application of an SSKI immediately following silver diamine fluoride treatment is thought to decrease staining ( patent US6461161 ). This is an off-label use ; potassium iodide is approved as an over-the-counter drug to facilitate mucus release to breathe more easily with chronic lung problems and to protect the thyroid from radioactive iodine in radiation emergencies . In our clinical experience , SSKI helps but does not dramatically effect stain ; arrested lesions normally darken . Most stain remains at the dentin-enamel or cementum-enamel junction . However , SSKI maintains resistance to biofilm formation or activity in laboratory studies . 20 Also , SSKI maintained caries arrest efficacy in the early results of an ongoing clinical trial . 42 Meanwhile , silver diamine fluoride-treated lesions can also be covered with GIC or composite ( see below for discussion on bonding ).
At least for children , many parents have seen the color changes as a positive indication that the treatment was eff ective .
SIGNATURE OF WITNESS DATE
22 JANUARY / FEBRUARY 2017 | PENNSYLVANIA DENTAL JOURNAL