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