silver diamine flouride Flashcards
affected dentin
1) acid
2) demineralized
–
1) necrotic zone
2) contaminated zone
infected dentin
1) demineralized zone
2) translucent zone
caries risk assessment + therapeutic aids
1) individual assessment
2) extreme, high, moderate, low
dilver diamine fluoride
1) 25% silver
- antimicrobial
2) 8% ammonia
- solvent
3) 5% fluoride
- remineralization
SDM development
1) developed from silver nitrate
2) used in japan for over 900 years
3) for caries arrest
4) NH3+ added in 1960s
5) SDF available since 1980s
SDF function
1) decreases dentinal hypersensitivity
- why it was FDA approved in 2016
- D1354
2) arrests caries
3) prevents caries (directly and indirectly)
fluoride
1) remineralization
2) inhibited demin
3) inhibits plaque bacteria
4) also approved for dentinal hypersensitivity
silver ion
1) denatures of all proteins
2) breaks cell walls
3) inhibits DNA replication
4) coagulant
- denatures exposed dentin proteins
zombie effect
1) silver killed biofilm, continues to kill active bacteria
2) SDF has sustainable antimicrobial effects
- penetrates the tubules
SDF and enamel
1) enamel surface increases in density
2) effective in preventing caries
- arrests >90% when used 2x/year
- powerful indirect prevention
SDF safety
1) one drop 20 uL
2) up to 5+ lesions
3) safe if not allergic
SDF contraindicated
1) silver allergy
2) significant desquamative processes
3) ulcerative gingivitis or stomatitis
other considerations
1) turns lesions dark
2) if on mucosa
- white mucosal lesion may form
- temporary for 48 hours
competing manufacturers
1) riva star and advantage arrest
- riva star can cause mucosal changes
- use with rubber dam
- intended for use on posterior teeth as desensitizer and cavity cleanser
risk
1) dark stain
- temp or soft tissue
benefits
1) reduce dentinal hypersensitivity
2) anticariogenic
alternatives
1) potassium iodine
2) fluoride
evidence
1) SDF and GI provide better anticariogenic results
2(may decrease caries progression of incipient approximal lesions in permanent teeth
applications of SDF
1) pedo and adult occlusal and approximal surfaces
2) geriatric and adult root caries
- for both populations - more cost effective to pay for SDF
3) high risk caries patients
4) lesions
- ICDAS 3-5 (surgical intervention later)
- approximal E1-D1 (surgical intervention)
if tooth is deemed necrotic or irreversible
1) traditional treatment
2) SDF can be used as a tool to slow the disease
padiographic lesions
1) E1-E2 - cavitates lesions
2) D1 - microbrush technique
3) D2 - microbrush technique
assuming patient agrees to SDF
1) CAMBRA products
2) informed consent
3) if SDF is for delay of treatment, make sure patient is clear with post op
4) post op frequency is determined based on patient compliance and caries risk
SDF clinical protocol
1) place one drop into dappen dish (if using dispensing bottle)
2) open unidose
- caution not to get onto gloves
3) apply vaseline to tissue
- outer lips
4) achieve excellent isolation
- cotton isolation- ok
5) if possible, scale surface to free debris (prophy)
- pumice or air abrasion
6) air dry (bone dry)
7) dip microbrush into SDF and leave on tooth for 1 minute
8) apply fluoride varnish
- helps with taste and odor
9) DO NOT RINSE
recall frequency
1) dependent on patient caries risk levels
- extreme - 2-3 weeks
- high 4-6 weeks
- low/moderate apply 6 months
protips
1) use vaseline
2) excellent isolation
3) clean lesion / surface
4) air dry
5) leave 1 minute
–
1) clean countertops
2) do not handle with bare hands
3) do not scrub off stain from tissue
superfloss
1) clean site, floss it down
2) place SDF on the floss
3) pull it up to get the approximal surface
