Caries Arrest with Silver Diamine Fluoride, your questions answered.
Caries is a progressive disease. Left untreated it will endanger the pulp (nerve). If we had a magic bullet that could stop caries in its tracks , freeze it in time as it were, would you let your child take it? Before you say yes, here’s the trade off - the decayed part of the tooth turns black permanently.
Silver Diamine Fluoride - What is it?
The “magic bullet” in question is a complex of Silver, Ammonia and Fluoride, known as silver diamine fluoride. (SDF) , a colourless liquid. When applied on the cavity for 1 min it causes caries arrest indicated by an immediate blackening of the caries. The high concentration of fluoride (44,000ppm) and silver ions (260,000ppm) are antibacterial and penetrate into the decayed dentine where bacteria are hiding. The decayed dentine is sterilised and hardened by deposition of silver ions thus walling off further decay.
Is it safe for my child?
SDF is safe and effective. In the 80 years it has been used on children in Japan, no adverse effects were reported. Currently it is the most effective form of caries arrest compared to conventional professional fluorides. In my experience some parents I offered this treatment to, declined especially if front teeth are involved because of the discolouration. Patients who accepted were satisfied with the caries arrest.
1.How many applications does it take?
There are many protocols the most common being 6 monthly application for 2 years
2.Why is there black discolouration? Can it be polished away?
Oxidation of the Silver ion produces the blackness. It cannot be removed by polishing.
3. How effective is this treatment?
SDF when combined with a programme of diet control and good oral hygiene is effective in 80% of cases.
4.What would influence me to choose this for my child ?
Your decision matrix could be influenced by the following
1. Your child is very young or has special needs and has early childhood caries but is not cooperative for fillings.
2. You are uncomfortable putting your child under general anaesthesia for dental treatment.
3. Your child has cavities which have not involved the pulp (your paediatric dentist will be able to advise)
4. Your child is young and you wish to "buy time" for your child, before deciding on general anaesthesia
5. You do not mind the black discolouration because in any case the open cavities are already unaesthetic.
5. My child has started SDF treatment, what next?
The aim of caries arrest is to preserve the tooth without any symptoms so that it will exfoliate (fall out) normally without any further invasive treatment. Periodic reapplication may be required after 2 years. However after caries has arrested, if parents find the discolouration objectionable we can camouflage it with a white filling.
By Dr Tan Wee Kiat, Paediatric Dentist
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