January/February 2017 | Page 29

The End of Treating Tooth Decay As We Know It ( Continued from pg . 15 )

The End of Treating Tooth Decay As We Know It ( Continued from pg . 15 )

By Steven M . Parrett , DDS Communications and Public Relations Advisory Group
After reading Dr . Jeremy Horst ’ s fine explanations on the science of how silver diamine fluoride ( SDF ) works and why , it allowed my mind to come up with different ways to put this amazing product to use fighting caries almost every day . I did supplement my knowledge by reading many of the reports and studies coming from China , Australia , Brazil and other countries throughout the world who have been using SDF for 80 years or more and have thoroughly proven this therapy is effective and safe .
I will briefly recount some of the various ways I have used SDF . Of course in younger patients , especially three and younger or suffering from Early Childhood Caries , it can be a lifesaver . For elderly patients who may be home bound but suffering from unrestorable root caries that are asymptomatic , SDF can alleviate a potential major problem for a medically compromised individual . SDF can buy time by arresting decay and rehardening carious dentin . I also use SDF on deep caries lesions and place IRM over it to give the pulp a chance to heal and build reparative dentin before I try to restore . For hypersensitive root areas , we apply SDF for three minutes then cover with a fluoride varnish to seal it into the dentin . Around orthodontic brackets , when there is extensive decalcification , we apply it to help control the bacterial invasion and harden the decal . Then , once arrested and brackets removed , we only need to remove the stained former decayed areas then restore . This preserves more tooth structure in the long term . In those sometimes impossible to treat buccal lesions on upper 3rd molars , restore the occlusal if possible and apply periodic SDF treatments to the buccal lesions . It worked incredibly on a Mesial-Distal cracked lower molar that had a temporary crown on it but was impossible to anesthetize due to the long term pulpitis . After placing SDF on the tooth and cementing the temporary crown with a ZOE based cement , after a few days , we were able to complete the necessary treatment on the tooth with sufficient anesthesia . I can see in the future that as this treatment evolves , it will make sense to treat the lesions with SDF , to begin to control the infection , before prepping and restoring ANY teeth . Oh , and one of the most important aspects of this treatment , is stressing Oral Health Education ( OHE ) every time SDF is used . I am amazed how patients respond when you take the time to explain to them … it is the frequency , not the quantity , of carbs or sugars that you consume that contribute to feeding the bacteria and allowing the infection to persist .
This is truly an infection that Dr . Prime , in 1937 , referred to as “ invisible .” One modern innovation that we put to good use for clues at our follow-up appointments is comparing original readings we got from the Diagnodent to subsequent readings we get after several treatments of lesions with SDF . We almost always see dramatic decreases in the digital readings that indicate little or no bacterial activity . If those numbers do not decrease , we step up our emphasis on OHE with that patient .
The many wonderful treatments this product can do effectively and efficiently is greatly overshadowed by its one outstanding and not so obvious feature . Silver Diamine Fluoride has the ability to relieve human suffering and easily work as a standalone treatment for arresting and controlling dental decay in populations that , before now , had no possibility or even hope of ever having access to such a solution to their dental decay problems . This treatment can be taken anywhere and delivered with little more than some cotton for isolation and a small applicator to use to apply to any obvious or suspected decayed lesions . Consider just how many additional patients can be treated in the Give Kids A Smile and Mission of Mercy events around the country . By at least stopping progression of the caries infection , it gives each person at least another chance at eventually having their teeth restored someday , instead of just removing them to prevent infections . And maybe best of all , SDF gives each and every dentist an opportunity to do something to help someone , either in their own office , down the street at a Head Start program or some other community gathering place where there are people in need of this valuable service . We are only limited by our imaginations as to what wonderful things we can do to help others .
JANUARY / FEBRUARY 2017 | PENNSYLVANIA DENTAL JOURNAL 27