silver diamine flouride

Question 1

affected dentin

Answer 1

1) acid
2) demineralized
–
1) necrotic zone
2) contaminated zone

Question 2

infected dentin

Answer 2

1) demineralized zone
2) translucent zone

Question 3

caries risk assessment + therapeutic aids

Answer 3

1) individual assessment
2) extreme, high, moderate, low

Question 4

dilver diamine fluoride

Answer 4

1) 25% silver
- antimicrobial
2) 8% ammonia
- solvent
3) 5% fluoride
- remineralization

Question 5

SDM development

Answer 5

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

Question 6

SDF function

Answer 6

1) decreases dentinal hypersensitivity
- why it was FDA approved in 2016
- D1354
2) arrests caries
3) prevents caries (directly and indirectly)

Question 7

fluoride

Answer 7

1) remineralization
2) inhibited demin
3) inhibits plaque bacteria
4) also approved for dentinal hypersensitivity

Question 8

silver ion

Answer 8

1) denatures of all proteins
2) breaks cell walls
3) inhibits DNA replication
4) coagulant
- denatures exposed dentin proteins

Question 9

zombie effect

Answer 9

1) silver killed biofilm, continues to kill active bacteria
2) SDF has sustainable antimicrobial effects
- penetrates the tubules

Question 10

SDF and enamel

Answer 10

1) enamel surface increases in density
2) effective in preventing caries
- arrests >90% when used 2x/year
- powerful indirect prevention

Question 11

SDF safety

Answer 11

1) one drop 20 uL
2) up to 5+ lesions
3) safe if not allergic

Question 12

SDF contraindicated

Answer 12

1) silver allergy
2) significant desquamative processes
3) ulcerative gingivitis or stomatitis

Question 13

other considerations

Answer 13

1) turns lesions dark
2) if on mucosa
- white mucosal lesion may form
- temporary for 48 hours

Question 14

competing manufacturers

Answer 14

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

Question 15

risk

Answer 15

1) dark stain
- temp or soft tissue

Question 16

benefits

Answer 16

1) reduce dentinal hypersensitivity
2) anticariogenic

Question 17

alternatives

Answer 17

1) potassium iodine
2) fluoride

Question 18

evidence

Answer 18

1) SDF and GI provide better anticariogenic results
2(may decrease caries progression of incipient approximal lesions in permanent teeth

Question 19

applications of SDF

Answer 19

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)

Question 20

if tooth is deemed necrotic or irreversible

Answer 20

1) traditional treatment
2) SDF can be used as a tool to slow the disease

Question 21

padiographic lesions

Answer 21

1) E1-E2 - cavitates lesions
2) D1 - microbrush technique
3) D2 - microbrush technique

Question 22

assuming patient agrees to SDF

Answer 22

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

Question 23

SDF clinical protocol

Answer 23

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

Question 24

recall frequency

Answer 24

1) dependent on patient caries risk levels
- extreme - 2-3 weeks
- high 4-6 weeks
- low/moderate apply 6 months

Question 25

protips

Answer 25

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

Question 26

superfloss

Answer 26

1) clean site, floss it down
2) place SDF on the floss
3) pull it up to get the approximal surface