Dental Materials Exam 2: Silver Diamine Fluoride

What are clinical uses of Silver Diamine Flouride?

- Desensitizing agent - dentinal hypersensitivity - Remineralizing agent - caries arrest

Advantages Of SDF*** - _______ of application - Effectiveness in treating ______________ - Effectiveness in _______ _____ - Low ________ - No need for local anesthetic, ___________ application - No need for _________ or _______ of very young or special needs patients

- Ease - hypersensitivity - arresting caries - cost - painless application - sedation or restraint

Disadvantages of SDF*** - ________ carious tooth structure ______ - caused by formation of ______ _______ - Temporarily stains _____ and _____ ________, like a henna tattoo - Permanently stains _________, __________, etc..... - Unpleasant _______ taste - _________ of soft tissue - Does not restore _________ lesion, only stops __________ - Black stain caused by formation of ______ ________

- Stains; black; silver phsophate - skin and mucosal tissue, - clothing, furniture, etc..... - metallic - Irritation - cavitated; progression - silver phosphate!

Contraindications to SDF** - Silver _______ - Presence of mouth ______ - Irreversible ________ - Pulpal ________ - Deep ________ _______ that HAVE been _________ - ammonia and high ___ could affect _______ tissues

- allergy - ulcers - pulpitis - necrosis - carious lesions; excavated; pH; pulpal

Informed Consent for SDF Treatment The fee for SDF treatment is $___ per tooth. It will be billed to your _______ ________ carrier as code D1354: Interim caries arresting medicament application. Most insurance companies are not providing _______ for this service yet.

- dental insurance; coverage

Success Rates SDF - They don't have an exact ________ due to lack of standardized treatment protocol - Most studies show around ____% efficacy in arresting caries. - More successful at arresting caries than ________ _________ or ________ ________ - Only one application of SDF is comparable to ____ applications of _____ ________

- number; - 80% - glass ionomer or fluoride varnish - 4; NaF varnish

Restoring SDF-Treated Teeth - Large cavitated lesions must be ________ to prevent ____ impaction. - Can restore immediately if patient is _______ - _________ if patient not cooperative - Restore with _____ ________ or ________

- restored; food - cooperative - Reappoint - glass ionomer; composite

Five Indications for Treatment of Dental Caries with SDF 1. Extreme ______ _____ (_________ or Severe Early Childhood ______). 2. Treatment challenged by _________ or _______ management. 3. Patients with _______ ______ that may not all be treated in _____ visit. 4.________ to _______ dental carious lesions. 5. Minimal/No access to _______ ______

1. caries risk; Xerostomia; Caries 2.behavioral; medical 3. carious lesions; one 4. Difficult; treat 5. dental care

Treatment Protocol for Caries Arrest 1. Remove ______ and ____ _____ from the carious lesion. 2. Isolate _________ tooth with ______ ____, ______ and/or _____ ______. 3. ___-___ the treatment site. 4. Apply ____ to caries with ______ (superfloss for noncavitated interproximal lesions). 5. Allow to soak in for __-___ minutes. 6. Remove SDF _____ with _______ ____ 7. Rinse patient's mouth to remove ___________ _______ 8. Reapply ___-__ times each _____ for highest success rate.

1. plaque and food debris 2. carious; cotton rolls, gauze and/or dry angles. 3. Air-dry 4. SDF; microbrush 5. 1-3 6. excess; cotton roll. 7. unpleasant taste. 8. 1-2; year

Treatment Protocol for Hypersensitivity 1. Isolate _________ tooth with _____ _____, ______ and/or _______ _______ 2. If treating _____ exposure, cover ______ with ________ to minimize _____ ______ staining. 3. ___-___ the treatment site. Warn patient! 4. Apply ____ to exposed _____ with microbrush. 5. Allow to soak in for __-___ minutes. 6. Remove SDF _____ with ______ ___. 7. Rinse patient's mouth to remove ______ _____ 8. Re-apply __-___ times at ____ ______ intervals as needed.

1. sensitive; cotton rolls, gauze and/or dry angles. 2. root; gingiva; Vaseline; soft tissue 3. Air-dry 4. SDF; dentin 5.1-3 6. excess; cotton roll 7. unpleasant taste. 8. 1-2; one week

silver Diamine Fluoride (SDF) alkaline solution pH of _____

10

Remineralization of Carious Dentin and Enamel Silver diamine fluoride arrested lesions are ______ microns thick.

150

Indications for SDF Treatment - Early childhood caries treated with ____% silver diamine fluoride to arrest caries progression. Parents and caregivers need to be aware of ________ and provide ______ consent for this treatment

38%; staining; written

silver Diamine Fluoride (SDF) is available only as

Advantage Arrest™ by Elevate Oral Care, LLC.

What is silver Diamine Fluoride (SDF)?

Colorless liquid, same consistency as water

History of Silver Diamine Flouride Dr. ____ _______, often referred as the "Father of __________ ____________," described the use of ________ compounds to treat teeth as far back as the late 1800s.

G. V. Black; Modern Dentistry; silver compounds to treat teeth as far back as the late 1800s.

Where was silver diamine fluoride used and since when?

Used in Japan since the 1970's Used in China since the 1980s Also used in Australia and Brazil

Silver diamine fluoride is a ____ solution containing ______ and _____ ions

ammonia; silver and fluoride

Remineralization of Carious Dentin and Enamel SDF enhances deposition of _______ and _______ ions, remineralization of tooth structure and reversal of the _______ process.

calcium and phosphate; disease

Informed Consent for SDF Treatment - SDF causes a ______ _____ or ______ discoloration of the decayed tooth structure. - This staining is (permanent or temporary) and can also affect small enamel defects in the teeth. - If SDF contacts skin or gum tissue, it will stain _______ and fade slowly, like a _____ _______.

dark brown or black permanent brown; henna tattoo

Remineralization of Carious Dentin and Enamel SDF prevents collagen ___________ in dentin by inhibiting the activity of ____________ (enzymes that degrade collagen) and cysteine cathepsins (enzymes that degrade proteins).

degradation; collagenases

Remineralization of Carious Dentin and Enamel The _______ collagens are protected by the remineralized ________ materials.

dentine; mineral

The U.S. Food and Drug Administration (FDA) approved the use of SDF as a _________ _________ in 2014.

desensitizing agent

Remineralization of Carious Dentin and Enamel Silver ions act (directly or indirectly) against bacteria in lesions by _________ membranes, denaturing ________, and inhibiting ______ replication.

directly; breaking, proteins; DNA

Nano Silver Fluoride is ____-friendly and (high or low) cost

eco; low

Remineralization of Carious Dentin and Enamel Silver and fluoride ions penetrate ~25 microns into ________ and 50-200 microns into _________

enamel; dentin

Remineralization of Carious Dentin and Enamel SDF's antibacterial properties inhibit the _________ of cariogenic biofilms.

growth

silver Diamine Fluoride (SDF) is low or high cost?

low

Also, unlike SDF, the NSF solution has no ________ taste.

metallic

In January 2016, a new Code on Dental Procedures and Nomenclature (CDT) D1354 allowed billing claims for ____-________ use of SDF as an interim _______ _______ medicament.

off-label; caries arresting

Indications for SDF Treatment - Silver diamine fluoride was used to arrest ________ and ________ root caries in this older adult. The balding of the tongue and caries resulted from __________. The black, discolored surfaces do not show when ________ or _______

primary and secondary; xerostomia; speaking or smiling.

Remineralization of Carious Dentin and Enamel Fluoride has proven to be effective in enhancing the _________ of dental hard tissue. Silver ion acts as an __________ agent in SDF.

remineralization; antibacterial

Remineralization of Carious Dentin and Enamel After being treated with SDF, a highly _____________ surface zone rich in calcium and phosphate can be found on the arrested cavitated _______ lesion. The dentine collagens are protected by the remineralized mineral materials.

remineralized; carious

Informed Consent for SDF Treatment Best success is achieved with?

repeat applications of SDF.

Nano Silver Fluoride is _____ for humans, _______

safe; biocompatible

Informed Consent for SDF Treatment SDF is NOT to be used on patients with a _______ ________ or any active mouth _________.

silver allergy; ulcers

Nano Silver Fluoride The effectiveness of this new anticaries agent (66.7%) was similar to that of ______ _______ _______ 30% (66.9%) when applied _____ a ____, and the agent also had the advantage of not staining the dental tissue ______

silver diamine fluoride (SDF); once; year; black

Zombie Effect is when bacteria killed by _____ _____ are added to ______ bacteria, the silver is re-activated, so that effectively the ______ bacteria kill the_____ bacteria in a "zombie effect. This reservoir effect helps explain why _____ deposited on _______ and ________ proteins within a cavity has sustained ___________ effects.

silver ions; living; dead; living silver; bacteria and dentin; antimicrobial

In 1906 Dr. Black published a paper on ________ _______, the predecessor of the 2014 FDA cleared formula for silver diamine fluoride 38%.

silver nitrate

Nano Silver Fluoride (NSF) is a new experimental formulation containing _____ nanoparticles, _______ and fluoride combines preventive and antimicrobial properties and was developed to be an effective _____-______ agent without staining the porous dental tissues _______

silver, chitosan, and fluoride; anti-caries; black.

Applying silver Diamine Fluoride (SDF) does not require

sophisticated instruments or techniques required for use

Informed Consent for SDF Treatment SDF is shown to arrest most, but not all, ______ _______, so no guarantee for success is ___________.

tooth decay; promised

Neutral silver fluoride is ________; ammonia is added to form a more _______ complex ion

unstable; stable

Informed Consent for SDF Treatment - The appearance of the tooth decay on your ________ will not change. - If you transfer to another dental office, you will need to_______ them of this treatment and request a copy of your ___________ to be transferred.

x-rays; inform; x-rays

Nano Silver Fluoride is a _____ solution

yellow