The Good, The Bad, and The Ugly About Silver Diamine Fluoride

Dr. Sharat Pani
Assistant Professor of Pediatric Dentistry
Schulich School of Dentistry, London ON

Silver diamine fluoride has been around for a long time, with early uses of silver in stopping microbial spread dating back to the 1940s. Yet it continues to be a topic of hot debate as practitioners continue argue the pros and cons of its use in daily practice.

In this episode of CDA Oasis Live, Dr. John O’Keefe, Director of Knowledge Networks CDA, invites Dr. Sharat Pani, an assistant professor of pediatric dentistry from London ON, to take an objective look back at the literature and consider the benefits and drawbacks of this much talked about treatment option.

Here are some of the key takeaways from the conversation…

• Everybody knows that SDF works, the question is what is it good for?
• SDF is not better than Sodium fluoride if you want to prevent disease, but it is better than Sodium fluoride if you want to treat a cavitated lesion.
• Traditionally, dentists are taught that fluoride is a preventative agent. SDF changes this notion in that the silver molecules go inside the tooth and block tubules, alleviate sensitivity, and have an antimicrobial effect.
• While SDF is effective at arresting caries, for some the treatment outcome is less acceptable because it is not aesthetically pleasing.
• SDF can be very useful in cases where the patient is unable to sit in the dental chair.
• SDF is an excellent tool to have, but you have to consider it in the context of alternatives. It is good compared with doing nothing and sending a patient home in pain.
• There is not enough evidence to say whether SDF acts differently on primary and permanent teeth.
• Literature shows that bond strengths are not that affected when placing restorations over SDF, though many testimonies from clinicians claim that a restoration over SDF will fail.
• Questions remain as to how safe SDF is in deep cavities.

We hope you find the conversation useful. We welcome your thoughts, questions and/or suggestions about this post and other topics. Leave a comment in the box below or send us your feedback by email.

Until next time!
CDA Oasis Team