IST and SDF

Question 1

what is ist

Answer 1

• interim stabilization therapy
• the materials usually employed are zinc-oxide eugenol, glass ionomer or other medicated/non-medicated temporary cements

Question 2

when should you use ist

Answer 2

• access to a permanent restoration is not immediate or practical
• there is a reasonable risk of further damage to the tooth structure
• the pulp is not exposed
• the client is in discomfort or is experiencing difficulty in eating
• the discomfort is due to recent trauma, fracture or lost dental restoration
• the client has not received any medical/dental advice that would contraindicated placing a temporary restoration

Question 3

what is consent and record keeping

Answer 3

• the client consents to the treatment and it is in the client’s best interest to proceed ->
• the client record must indicated the tooth restored, the material used and the notification to the client that the restoration is temporary ->
• the referral to a dds must be noted

Question 4

what is sdf

Answer 4

• silver diamine fluoride
• in 2017 canada approved the use of silver diamine fluoride as a preventative measure for stopping caries
• it has been used in Europe and Asia for up to 80 yrs

Question 5

what are the parts of sdf

Answer 5

• silver nitrate: antimicrobial
• fluoride: hardens enamel
• ammonia: stabilizer

Question 6

how does sdf work

Answer 6

• it is thought that pdf reacts with hydroxyapatite crystals to form calcium fluoride and silver phosphate
• it is 2-3x more effective than fluoride varnish

Question 7

what is the ‘zombie effect’

Answer 7

• silver ions bind to bacteria then the dead bacteria are added to the living bacteria thus killing more bacteria

Question 8

what are the pros to sdf

Answer 8

• cheap
• effective
• decreases sensitivity

Question 9

what are the cons to sdf

Answer 9

• stains

- may need to be reapplied over time

Question 10

when is it good to use sdf

Answer 10

• clients who are increased risk for caries (sticky pits)
• root caries
• to secure leaking margins of posterior restorations
• to use a liner under restorations

Question 11

what are the procedural steps of sdf

Answer 11

• isolate area
• dry well
• dispense 1 drop into happen dish
• using micro brush, apply sdf to lesion for minimum of 60 seconds
• remove excess with cotton pellet or roll
• apply fl varnish to create barrier (not necessary). if no varnish is applied, let dry for 60 secs
• may need to repeat procedure every 6 months to optimize caries arrest

Question 12

what are risks to sdf

Answer 12

• if silver diamine fluoride comes in contact with skin it will cause a small dark spot that will go away on its ow in 1-2 weeks. if it comes into contact withe existing white fillings it might stain

Question 13

information to tell ptes

Answer 13

• fluoride with silver looks like water but is very powerful and stops cavities that are hard to see. it is painted on the teeth with a tiny brush and can heal early tooth decay
• it goes on quickly, doesn’t hurt or smell. cavities that are stopped or healed with sdf will turn dark brown or black. teeth without cavities will not change colour. if the colour shows a lot, a dental provider can cover it with white filling material
• fillings may not be needed for cavities that are healed with silver fluoride, especially in baby teeth because those will be lost anyway when the permanent teeth come in

Question 14

what are some alternatives to sdf

Answer 14

• choose not to have the silver fluoride applied. this could leave harmful bacteria on your teeth and increase the chance of tooth decay
• another alternative would be to use fluoride toothpaste regularly and have fluoride varnish and sealants applied at the dental office