Silver Diamine Fluoride

SDF properties

38% colorless liquid 25% silver: antimicrobial agent 8% ammonia: stabilizer 5% fluoride: remineralization (remaining is water)

SDF's ppm

44,800 ppm fluoride highest concentration of all fluorides 253,870 ppm silver

SDF code for desensitizing

D9910

T or F SDF eliminates need for fillings

F - does not repair fxn or aesthetics of tooth

SDF in USA

FDA clearance for hypersensitivity off label use for caries tx code D1354

what is xerostomia caused by

aging medications diabetes, Alzheimers, HIV/AIDS, Sjogren's, stroke, autoimmune disorders radiation tx meth use tobacco & alcohol use

SDF contraindications

allergy to silver or other heavy-metal ions pt experiencing consistent, throbbing type pain or pain to heat pulp exposure

explain zombie effect of silver

bacteria killed by silver continues to kill living bacteria

SDF SE

cavity will turn that part of tooth dark (arresting decay) white lesions (demineralization) may cause discoloration may discolor tooth color restoration around margins permanent staining on clothing/clinic surfaces temporary staining of skin (rinse w/water)

silver properties

crystal of low solubility in oral cavity, yellowish in color; darkened by sunlight or reducing agents

antimicrobial use of silver

denatures proteins breaks cell walls & membranes inhibits DNA replication

questions to ask prior to applications: bump on gum

don't apply w/tooth that has fistula

results of xerostomia

dry mouth by lack of saliva dryness or feeling of stickiness in mouth saliva seems thick & stringy difficult chewing, speaking & swallowing dry or sore throat & hoarseness dry or grooved tongue changed sense of taste halitosis

SDF indications

extreme caries risk (xerostomia or SECC) tx challenged by behavioral or medical mgmt pts w/carious lesions that may not all be tx in one visit difficult to tx dental carious lesions (distal of 3rd molar) pts w/o/limited access to restorative pts w/sensitivity due to recession

explain process of SDF

fluoride reacts w/hydroxyapatite producing calcium fluoride & silver phosphate - CaFl2 acts as reservoir of fl2 which neutralizes imbalance in demineralization/remineralization - SDF inhibits dentin demineralization, preserves collagen by inhibiting breakdown & increases dentin hardness silver protein conjugates decayed dentin, increasing resistance to acid & enzymatic digestion hydroxyapatite & fluorapatite form on exposed matrix & inhibit proteins break down

questions to ask prior to applications: pain

how long does it last? - >5 minutes don't apply type & severity? - throbbing or steady pain indicate pulp involvement, don't use cause? - sensitivity to heat means irreversible pulpitis, don't use take meds? if meds needed for pain, don't apply

how safe is SDF

no adverse reports in >60 years of use in Japan no risk of developing fluorosis

SDF relative contraindications

oral ulcerations stomatitis ulcerative gingivitis can use vaseline to protect

fluorides MOA

prevents & inhibits caries progression by; enhancing remineralization (fluorapatite) inhibition of demineralization inhibition of bacterial activity

SDF MOA

remineralizes hydroxyapatite to fluroapatite increases lesion hardness prevents demineralization occludes dentinal tubules (reducing sensitivity) penetrates far into dentin (200-300 microns)

SDF follow-up

reschedule pt at one week intervals for 2 additional applications then for 6 month recall application until tooth restored/exfoliated inform pt to not eat or drink for one hour & don't brush for 24 hours (zombie effect), don't floss for 10 days

application protocol

use plastic cover over counter, bib for pt need; plastin dappen dish, mirror, explorer, cotton rolls, 2x2 gauze, microbrush, saliva ejector, air water syringe tip place one drop of SDF into deep end of plastic dappen dish generously apply vaseline over soft tissue (lips, gingiva, restorations too) remove bulk saliva w/ejector clean tooth of debri isolate tongue & cheek w/gauze dry tooth thoroughly immerse brush in SDF, remove excess on dish apply directly onto affected area if inter proximal - place superfloss IP & then apply SDF to floss & pull through allow to absorb for up to 1 min, then remove excess w/cotton roll rinse take all products contains SDF and fold into glove throwing away

how much does one drop tx?

~5 teeth one bottle = ~250 drops