PEARLS FOR YOUR PRACTICE
Few things have taken the world
of dentistry by storm. Silver
diamine fluoride is one of those
things. This product was propelled
into the spotlight by a New York
Times article that spread through
social media like wildfire. While
I don’t think that silver diamine
fluoride is a miracle cure, I do think
it has a place on the shelf of every
dental office in the United States.
The key is knowing when and how
to use it.
I have heard all sorts of things
about it from other dental professionals. “I heard it stains all teeth
black!” one hygienist told me. A
dental student e-mailed, “I read
that this stuff cures decay!” Just
like anything else, the buzz is partially true, partially inaccurate.
This product has several great
applications. One underrated use
is treating dentinal hypersensitivity.
Because it hardens dentin,
making it more acid- and abrasion-resistant, silver diamine fluoride
is beneficial in areas with gingival
recession and root exposure.
From a decay perspective,
silver diamine fluoride has the
potential to be a game changer. It
has been shown to arrest decay
after multiple applications, especially when used with traditional
fluoride varnish. Once the decay
is arrested, we can decide if the
area needs a restoration.
As I mentioned above, there
has been a lot of confusion
about silver diamine fluoride and
esthetics. The truth is that silver
diamine fluoride will stain teeth
black—but not all teeth. It will not
stain healthy, sound enamel and
dentin. It will only stain demineralized or decayed tooth structure.
The staining occurs because
decay causes precipitation of the
silver as the fluoride disassociates
from it and associates with the
This is excellent news for us
because we can use the staining
as a diagnostic tool. If we stain a
lesion and see black, we will know
that decay is present. We then
have clinical choices to make.
If we are to restore the tooth in
question, we can remove the
layer of silver precipitate with a
handpiece and place a restoration. If we are just going to watch
the area (presuming the lesion
in question isn’t an esthetic
concern), we can reapply silver
diamine fluoride in a year and
keep the decay arrested.
Silver diamine fluoride is an
excellent tool, especially for treat-
ing pediatric or geriatric patients.
We can use it on primary teeth
that have some decay but are
within a year or two of exfoliation, which could save many kids
from frightening dental experiences while stopping the spread
of decay. On geriatric patients, it
could help us through many tough
situations—for instance, if root
decay is present on a tooth with
a crown or bridge, but we want to
avoid large expenses.
Silver diamine fluoride is only
available from Elevate Oral Care
under the brand name Advantage
Arrest. Advantage Arrest is available in unit-dose ampules and
8-mL bottles for many applications. Unit-dose applications run
around $4 per application. The
larger bottle is a more economic
choice, keeping application costs
under $1 for one to three teeth.
I have just begun using silver
diamine fluoride in my practice. As
time goes on, I think it will be an
important tool for me in many situations. Ground-rule double to center
field for Elevate Oral Care!
Advantage Arrest silver diamine fluoride 38%
by Elevate Oral Care
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