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