very simple presentation

1. Protocol for caries arrest using Silver Diamine Fluoride

2. ILOS
Introduction
How does it
work ?
Indication
Contraindication
Side effects
Application of SDF
Follow up

3. Silver
Diamine
Fluoride
definition
• Silver diamine fluoride (SDF) is a
liquid substance used to help prevent
tooth cavities (or caries) from
forming, growing, or spreading to
other teeth.

4. Introduction
Dental practitioners have utilized
sodium fluoride varnishes,
chlorhexidine varnishes,
prescription-strength fluoride
toothpaste, and mouth rinses to
help patients prevent and arrest
decay.
Recently, however, silver diamine
fluoride (SDF), a relatively new
formulation of topical fluoride using
silver compounds, has gained global
recognition as a noninvasive,
nonrestorative treatment to arrest
or prevent caries.

5. Composition
• SDF is made of:
-1 silver(25%): helps kill bacteria.
-2 water: provides a liquid base for the
mixture.
-3 fluoride(5%): helps your teeth rebuild the
materials they’re made of (known
as remineralization Trusted Source).
-4 ammonia(8%): helps the solution remain
concentrated so that it’s maximally effective
against cavity resonance.
This results in a product with 38% SDF
medicinal ingredients.
fluoride ammonia silver water

6. How does it work?
• In the treatment of decay, it is applied
only onto carious lesions, either
cavitated or non-cavitated.
• Once applied, the silver complex forms a
squamous layer on demineralized
enamel and dentin, This layer increases
resistance to acid dissolution and
enzymatic digestion of the collagenous
organic matrix.
• The treated carious lesion increases in
mineral density with formation of
hydroxyapatite and fluorapatite.

7. How does it work?
✓ Both the silver and the fluoride ions penetrate into enamel
(up to 50 microns) and into dentine (up to 200 microns). The
fluoride stimulates remineralization and the silver remains
available for antimicrobial action.
✓ Single application loses its effectiveness over time.
✓ Suggested frequency of application is twice yearly.

8. Patients who may benefit from
SDF
• With high caries risk who have active
cavitated caries lesions in anterior or
posterior teeth.
• Presenting with behavioral or medical
limitations.
• With multiple cavitated caries lesions
that may not all be treated in one visit.
• With dental caries lesions that are
difficult to treat.
• With difficulty accessing dental care.

9. Criteria for tooth selection
• No clinical signs of pulpal inflammation
or reports of unsolicited/spontaneous
pain.
• Cavitated caries lesions that are not
encroaching on the pulp. If possible,
radiographs should be taken to assess
depth of caries lesions.
• Cavitated caries lesions on any surface as
long as they are accessible with a brush
for applying SDF.

10. Contraindication of SDF
✓ Silver allergy
✓ Tooth that is symptomatic or pulpally involved
✓ Presence of stomatitis or ulcerative gingival conditions

11. Side Effects
• For gums and tissue in the mouth, the staining is
temporary. The cells in these soft tissues shed and are
replaced quickly, so stains may persist for a few days up to a
couple of weeks. When applied by a skilled dentist, the
chances of tissue staining are fairly low.
• The child may notice a metallic taste that will go away rapidly.

12. Side Effects
• The blackening is permanent on
the teeth, however, which may be
enough to deter adults from
choosing this form of
treatment. For children with baby
teeth, however, the stains are
effectively temporary because the
teeth will fall out on their own.
Even so, some parents opt to hide
the staining with crowns, which is
why some kids have silver teeth.

13. Application of SDF
1. Cleaning the Area
All dental procedures need a
clean mouth to be safe and
effective. SDF is no different.
The dentist removes any
debris from the tooth’s
cavitation to ensure the
solution makes the best
possible contact with the
affected area. This includes
plaque, food debris, or
possibly even some of the
cavity.

14. Application
of SDF
2. Isolating the Area
Because the lips and skin are so
susceptible to staining, dentists
may apply a protective coating of
Vaseline to these areas. Dentists
will also isolate the treatment area
using cotton rolls or other
methods. The gums are usually
protected with petroleum jelly or
cocoa butter.

15. Application
of SDF
3. Applying the SDF
✓ When the mouth is properly prepped, it’s time
for the dentist to dry the tooth with compressed
air or dry gauze and apply the SDF with a
microbrush. They simply dip the brush into the
solution, remove any excess liquid and paint the
SDF directly to the affected surface. A single
drop of the solution is enough to treat up to
eight teeth at once.
✓ The application itself takes about a minute but
can be shorter for young patients who may be
less able to keep still for sustained periods. To
allow the SDF to set, the dentist may apply
gentle airflow until the solution is dry.
✓ Optimally, the affected teeth are then covered
with a fluoride varnish which acts as a top coat
and seals in the SDF over the cavity portion of
the tooth.

16. Follow up
• Estimations of SDF effectiveness in arresting
dental caries lesions range from 47 to 90
percent with one-time application
depending on size of the cavity and tooth
location.
• Follow-up at 2-4 weeks after initial
treatment to check the arrest of the lesions
treated.
• Reapplication of SDF may be indicated if
the treated lesions do not appear arrested
(dark and hard). Additional SDF can be
applied at recall appointments as needed,
based on the color and hardness of the
lesion or evidence of lesion progression.
• Caries lesions can be restored after
treatment with SDF.
• When lesions are not restored after SDF
therapy, biannual reapplication shows
increased caries arrest rate versus a single
application.

17. Reference
• https://www.aapd.org/media/Polici
es_Guidelines/R_ChairsideGuide.pdf
• https://www.sproutpediatricdentistr
y.com/blog/pediatric-
dentistry/silver-diamine-fluoride/
• https://www.rdhmag.com/patient-
care/fluoride/silver-diamine-
fluoride/article/14175344/silver-
diamine-fluoride-sdf-dental-caries-
in-older-adult-patients
• https://pixabay.com/

18. “Every child is an artist.
The problem is how to remain an
artist once we grow up”
Pablo Picasso
Thank you