Dr. Flavia Lamberghini, Pediatric dentist in Chicago, spoke with Dr, Suham Alexander about silver diamine fluoride and its use in caries management.
Silver diamine fluoride (SDF), although not currently available in Canada, is a safe and effective topical agent which helps to arrest tooth decay in patients with high caries risk who are unable to tolerate conventional care from the very young to the elderly. It is currently being used in the United States and has been used in Japan for more than 80 years. SDF, a colourless solution with a pH of 10, is composed of silver, fluoride and ammonia.
Mechanism of Action
- Dentin sensitivity is decreased as a squamous layer of dentin forms after application and partially plugs dentinal tubules
- Silver and fluoride ions penetrate ~25 microns into enamel and ~50-200 microns into dentin
- The silver ions form a layer of silver protein increasing resistance to acid dissolution and antimicrobial activity is exerted via inhibition of DNA replication and disruption of bacterial membranes
- Fluoride ions promote remineralization
When the caries process has been arrested, the lesion is hardened and darker in appearance. The application of potassium iodide immediately after SDF application can minimize the dark staining. Eventually, the area may be covered with an esthetic restoration such as a glass ionomer, composite resin or crown. SDF is contraindicated in patients with a known allergy to silver. Relative contraindications include gingivitis or mucositis that disrupts the epithelium. Patients may complain of a transient metallic or bitter taste in their mouths. Additionally, there may be temporary staining of the skin which will resolve with natural exfoliation within 2 weeks, but long-term mucosal staining is observed when SDF is applied to intraoral wound, which is not recommended.