SDF - a silver bullet…literally

May 10

Traditional dentistry has remained largely unchanged in over 100 years. This model treated dental decay by surgically removing (aka drilling) the infected part of the tooth and placing a filling to restore the original form of the tooth. This does treat the localized problem of a cavity, but research has shown that dental decay is a chronic disease, like asthma, and is due to an imbalance in the overall oral environment. As some of you may have experienced, getting a filling does not prevent you from getting future cavities and needing further fillings. That being said, placing a filling is important to prevent a tooth from getting too weak and breaking. In addition, it is important to treat the bacteria in a tooth to prevent them from going deeper into the tooth and into the nerve which can cause pain and infection. This is especially challenging in baby teeth since the outer hard enamel shell is much thinner than in permanent teeth, which makes them much more susceptible to cavities and dental infections.

Recently, however, there has been a shift in dentistry, especially in pediatric dentistry, away from a surgical model of treating dental decay and more towards a medical model. The utilization of fluoride has long been proven to strengthen enamel but it has also been controversial (a blog about the debate on fluoride will follow shortly). Newer research on the action of xylitol has also gained quite a bit of traction in its ability to prevent decay as well (a blog about xylitol will also be out soon). Another great development has been the addition of Silver Diamine Fluoride (SDF) to our toolkit.

Silver has a long proven track record of killing bacteria, whether it’s through eye drops in newborns to prevent conjunctivitis or on wound dressings of burn victims to prevent infections. Silver nitrate has been used in Japan for decades to treat dental decay. SDF is an improved formulation that combines the antibacterial properties of silver with the enamel-hardening properties of fluoride and some research even shows that it may prevent future cavities. It has been getting a bit of press recently including this New York Times article and this article in the American Academy of Pediatrics news. You can even see me talk about it on NY1 on our home page! If you’d like to read more research about it, I have included some scientific articles at the end of this blog.

The process of application is super easy, just apply a drop of the liquid directly to the tooth and wait about 30 seconds. There is no pain but it may taste a little funny (I’ve tried it on myself!). The silver does react with the infected part of the tooth and turns that area darker, so some people may not like that as an outcome. However, it is much easier than drilling and filling and often we can place a white filling over to mask the darkness of the SDF(to learn more about that please visit the blog about SMART restorations that will be coming soon). The big benefit is that in many cases we can avoid sedation in young children and children with special needs. Please feel free to reach out if you have any questions!