hellosmile Blog Update: Sliver Diamine Fluoride (SDF), the New Way of Saving Children’s Teeth with Severe Tooth Decay!

hellosmile Update Blog on Treating Children Tooth Decay with Silver Diamine Fluoride (SDF)

by Ali B. Attaie, DDS, MPH, FAAPD

The use of Silver Diamine Fluoride (SDF) was also recently covered in a New York Times article and is rapidly gaining wide acceptance. Currently hellosmile is offering Silver Diamine Fluoride treatments at all of our Park Slope, Sunnyside, Woodside, Jackson Heights, Corona and Bronx pediatric dental locations.  This article discusses the use of SDF for children with severe dental decay.

SDF can be easily applied to the affected teeth atraumatically as seen below and help eliminate acute and or chronic dental pain in children and arrest the tooth decay process altogether. Click here to see the video showing the treatment process. The blue light curing at the end is to simply accelerate the staining such that the parents are not alerted as ti would otherwise fully develop in the next 12-24 hours.

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Clockwise series of photos shows arrested caries following SDF treatment in office, followed by surgical excavation of darkened arrested decay using a high speed dental drill on the three front teeth in the next two photos; bottom right image are the restored teeth with composite bonding. Pulp therapy/ baby root canal was avoided due to earlier SDF use; Unfortunately upper left central and lateral incisors did not get SDF on time, developed abscesses and were extracted.
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Dental caries or tooth decay remains the single most common disease of early childhood that is not self-limiting (will not go away by itself!) nor is amenable to a course of antibiotics! Surprisingly to many parents, children can begin to experience tooth decay quite early in life! In the most susceptible infants and toddlers, tooth decay can advance rapidly enough to cause pain and infection long before the child has reached two years of age and in the most severe cases children begin avoiding foods and biting due to pain just as they are becoming toddlers at 12 months of age. Prevention through good home care, proper diet and early oral health assessment by a health professional are the best ways to prevent tooth decay. When these have failed and a child is experiencing early childhood decay (ECC), it can often be difficult to properly treat the disease by conventional means that involve using a drill and filling material. Use of silver diamine fluoride (SDF) has now been approved in the United States as a very promising and effective way of treating tooth decay in children that would otherwise not be able to be treated on the dental chair.

Silver Diamine Fluoride (SDF) is a topical medicine that comes in a clear liquid form that can be painted onto teeth with cavities to help stop the teeth’s breakdown by acid producing bacteria. This also can help relieve tooth pain and hypersensitivity. Silver Diamine Fluoride SDF has been available and widely used in many countries including China, Japan, New Zealand, Australia and other for many decades. Silver Diamine Fluoride (SDF) was just cleared for sale in the USA in August 2014 by the Food and Drug Administration (FDA). Silver Diamine Flouride (SDF) can be very effective in stopping tooth decay from advancing. It is not a magic potion and still requires that the teeth are brushed twice a day with a fluoridated toothpaste and that the child’s diet is controlled to reduce frequent snacks with sugar containing foods. Silver Diamine Fluoride (SDF) may have to be applied to the affected tooth (see linked video) at several visits over a period of several weeks or months. At hellosmile clinics, we generally are recommending 2-3 treatments with in 2-12 weeks depending on the severity of the tooth decay.

The application of SDF is very simple and typically will take less than five minutes. The teeth are cleaned and dried with a gauze and stream of air and less than a drop of the clear SDF liquid is applied to the affected tooth area. All of the dentition is then covered with fluoride varnish that further helps arrest the cavity and prevent other teeth from developing decay. The patient will return for a re-evaluation of the lesion in several weeks per the Dr’s recommendation at which point additional treatments may be necessary. The process is completely painless.

The procedure does have an insurance code (D1354), but it is not yet covered by most plans. The hellosmile fee is $40-60 dollars or may be waived depending on what other services are provided at the visit and the patients socioeconomic status. The only drawback is that the treatment does stain the teeth with a dark black to grey shade. Considering that the teeth that need such treatment are already stained due to cavities, this is not a big obstacle to treatment for most parents. The good thing is that these teeth may be treated with white filling or crowns at a later age once the child is able to sit and cooperate for conventional treatment and that this interim treatment dramatically increases the possibility of saving teeth that would otherwise continue to break down due to decay and need to get prematurely extracted.

Most importantly, SDF treatment is completely atraumatic to the teeth meaning it does not involve the use of any instruments, dental drills or local anesthesia. This allows for the younger children that do not yet have any coping skills to much more easily accept this treatment and or be far less traumatized from being momentarily held for a fast and painless application of  SDF. Our hope is that the parents are able to change and improve the child’s oral hygiene routine and diet intake to help make the SDF treatment work and arrest the tooth decay. Once the caries have arrested, the lesions harden and then become resistant to more decay. These lesions can then later be cleaned out and restored with white filling when the child is old enough and ready to accept such treatment typically at 3-5 years of age.

Below are some cases the we have been referring to and help demonstrate how SDF therapy works.

In this case (hyperlink here to video) we show the ease of applying SDF on a 20 months old in the office. Curing light only speeds up the staining process and without it the lesion will reach their full level of staining within 24 hours. The application of curing light allows for the full staining of the affected areas to develop right away allowing the parents to realize this immediately.  The child came to us with pain on eating and brushing. The child had fully arrested lesions in three of the four treated teeth in the 3 week follow up visit where we applied more SDF onto the remaining soft lesions.

Here we show another case where the darkened arrested SDF treated teeth are excavated and cleaned with a high speed hand piece. (Hyperlink video). This 3 year old that was treated with SDF for two visits to arrest her severe advanced tooth decay to arrest the lesions. She unfortunately developed an abscess on one of her teeth and was finally referred to our Naptime Dental team where she was treated for all of her decay under general anesthesia. In this case we demonstrate that teeth that have been darkened due to SDF may be restored aesthetically after excavation with white fillings or crowns. In this particular case, had the child not been treated with SDF to arrest her many carious lesions, many more teeth would have been extracted and or required pulp therapy (babay root canals) at the time of the definitive treatment under the general anesthesia. In her case only two teeth were taken out and all of the rest were saved with composite fillings and stainless crowns.

Before and after photos and videos may be accessible here. 

Dr. Attaie & Dr. Nasseh 2018 McGill Symposium Slides 

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