Dr. Jessica Metcalfe prepared an Oasis presentation about the possibility of using silver diamine fluoride to arrest post-radiation caries. Silver diamine fluoride is fairly new in Canada; and to date its efficacy has only been proven with children and older adults. Through these cases, Dr. Metcalfe is exploring the possibility of helping patients who undergo radiation and experience dry mouth and subsequent caries.
Dr. Metcalfe is staff dentist in the Department of Dental Oncology and Maxillofacial Prosthetics at Princess Margaret Hospital Cancer Centre.
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- Head and neck cancer patients that receive radiation develop xerostomia (dry mouth). This is due to exposure of radiation to the salivary glands. Consistent xerostomia leads to demineralization and dental caries.
- If post radiation dental caries is unchecked and teeth need to be extracted in the radiated field, there is a higher incidence of osteoradionecrosis – a highly morbid condition that is expensive to manage.
- As of February 2017, Health Canada has approved silver diamine fluoride (SDF) which has been shown to work in pediatric patients and in the geriatric population. We know that SDF is anti-cavity and can arrest caries after application. If this holds true then stopping progression of caries in a patient with dry mouth seems plausible. The author presents a case of a patient at Princess Margaret Cancer Centre Dental Clinic using the conventional management of amalgam restorations as well as SDF.
- It is understandable that esthetics can be an issue. Although, when both dentist and patient are well-informed about the use of SDF, then it does not become disconcerting. Patients who neglect to comply with daily fluoride application may eventually require extractions potentially leading to osteoradionecrosis (ORN). In this case SDF prevented the progression of caries at an early stage – preventing a potential cascade of radiation caries, multiple extraction, and elevated risk of osteoradionecrosis. Esthetics can be dealt with after oral hygiene and fluoride compliance is re-established at which point esthetic restorations can be planned.
Full Case Presentation (12.39″)