Silver Diamine Fluoride Flashcards
Dysbiosis
A disturbance of the normal microbiome population
Caries is a _____ disease
multifactorial
When it comes to treating children ->
Still see relapse rates 6 months later with new lesions with minced invasive treatments
Be a fire fighter first- Control the biofilm and arrest and regionalize lesions
Want remineralization exceeds dimeralization, silver diatomic fluoride can help do that
Be a carpenter second
Restore teeth as time, money and behavior allow.
Silver Nitrate is old
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.
30-38% SDF has the ____ efficacy.
Most
SDF Ag(NH3)2F
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
Mechanism of action
Occludes dentinal tubules, produces fluorohydroxyapatite, and inhibits biofilm adhesion on the surface of the lesion. It does penetrate deep on tooth structures.
Is SDF safe and effective?
yes, more effective than fluoride varnish, more effective than interim therapeutic restoration (ITR) alone, most effective applied 2x/year, arrests 80% of lesions.
SDF satisfies the “triple aim of care”
- 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)
What is the components of quadruple aim of care?
patient experience, population health, reducing cost, care team well-being
Aging population on root surface caries can be difficult to manage, good option for
that.
They might have decreased saliva production, SDF could help, maybe
even do it a couple more months in frequency.
SDF is used for high caries risk or if pt is _____
phobic
The only irreversible thing is pulpitis
it is abscessed SDF cannot resurrect a tooth from the dead.
Can SDF be used in deep lesions?
The used of SDF can be used in deep lesions it just cant have irreversible pulpitis.
Need to have informed consent before use
- 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.
SMART
Silver Modified Atraumatic Restorative Treatment
SDF is not a cure-all
needs follow up, needs reapplication, and needs at some point
Toxicity
- 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.
Basic Protocol
- 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.
“Rack of lamb”
doing super floss technique and doing different sites at one. Used silk floss to apply SDF.
If doing varnish after as well
add it to other teeth when the SDF is sitting and then do that tooth last so it doesn’t get contaminated.
