Silver Diamine Fluoride

Question 1

Dysbiosis

Answer 1

A disturbance of the normal microbiome population

Question 2

Caries is a _____ disease

Answer 2

multifactorial

Question 3

When it comes to treating children ->

Answer 3

Still see relapse rates 6 months later with new lesions with minced invasive treatments

Question 4

Be a fire fighter first- Control the biofilm and arrest and regionalize lesions

Answer 4

Want remineralization exceeds dimeralization, silver diatomic fluoride can help do that

Question 5

Be a carpenter second

Answer 5

Restore teeth as time, money and behavior allow.

Question 6

Silver Nitrate is old

Answer 6

Used to be used a lot more in dentistry. Used as a first measure against the
disease. But it lacked the fluoride component then so it lacked the re-mineralizing of the
teeth.

Question 7

30-38% SDF has the ____ efficacy.

Answer 7

Most

Question 8

SDF Ag(NH3)2F

Answer 8

o 25% silver: antimicrobial
o 8% ammonia: solvent
o 5% Fluoride: remineralization
o They are better in used together than they are individually
o Actions: Arrest dental caries, prevent dental caries, decrease dentinal
hypersensitivity

Question 9

Mechanism of action

Answer 9

Occludes dentinal tubules, produces fluorohydroxyapatite, and inhibits biofilm adhesion on the surface of the lesion. It does penetrate deep on tooth structures.

Question 10

Is SDF safe and effective?

Answer 10

yes, more effective than fluoride varnish, more effective than interim therapeutic restoration (ITR) alone, most effective applied 2x/year, arrests 80% of lesions.

Question 11

SDF satisfies the “triple aim of care”

Answer 11

1. increase access, 2. Improves health, 3. reduces cost
   • Improves provider experience, reduces
   aerosols (important for now bc do not need proper PPE so less $, and less intimidating, would only take droplet precautions)

Question 12

What is the components of quadruple aim of care?

Answer 12

patient experience, population health, reducing cost, care team well-being

Question 13

Aging population on root surface caries can be difficult to manage, good option for
that.

Answer 13

They might have decreased saliva production, SDF could help, maybe
even do it a couple more months in frequency.

Question 14

SDF is used for high caries risk or if pt is _____

Answer 14

phobic

Question 15

The only irreversible thing is pulpitis

Answer 15

it is abscessed SDF cannot resurrect a tooth from the dead.

Question 16

Can SDF be used in deep lesions?

Answer 16

The used of SDF can be used in deep lesions it just cant have irreversible pulpitis.

Question 17

Need to have informed consent before use

Answer 17

• Talk about the risks, benefits and alternatives to treatment.
• If never heard of before, can give them a copy of New York times.
• Really important to show before and after photos of SDF because it will stain
  active caries but it will not stain good enamel. • Will stain black until you restore it.
• Parental acceptance is pretty high. If alternative is sedation or a filling there is a higher % will accept something else.

Question 18

SMART

Answer 18

Silver Modified Atraumatic Restorative Treatment

Question 19

SDF is not a cure-all

Answer 19

needs follow up, needs reapplication, and needs at some point

Question 20

Toxicity

Answer 20

• one drop can fix up to 5-6 teeth. 1 drop for 10kg body weight.
• Be conscious on how much fluoride you’re applying to children especially if
  putting varnish after too.

Question 21

Basic Protocol

Answer 21

• Protect clinic and pt, put Vaseline on lips and face, toothbrush clean, isolate with dri-aids and cotton rolls, dry dry dry!, (non-aerosol dry with gauze or cotton roll) , apply SDF onto the tooth for 1-3 mins, use caution to use on desired tooth/teeth it is site specific.
• Optional: cover with fluoride varnish. But it is not necessary for the proven efficacy of SDF done.
• If doing DIY need to add varnish for efficacy.
• Do not rinse, do not blow compressed air while it absorbs, don’t light cure.

Question 22

“Rack of lamb”

Answer 22

doing super floss technique and doing different sites at one. Used silk floss to apply SDF.

Question 23

If doing varnish after as well

Answer 23

add it to other teeth when the SDF is sitting and then do that tooth last so it doesn’t get contaminated.