Silver Diamine Fluoride Treatment

Silver Diamine Fluoride, SDF, is an alternative treatment for tooth decay under certain conditions. Treatment of children’s deciduous (primary or “baby”) and permanent (“adult”) teeth with silver diamine fluoride is a rather new strategy aimed at preventing tooth decay (dental caries) and at arresting existing tooth decay. Let’s review the dynamics. Tooth decay is a bacterial infection, in which bacteria of the oral cavity, the main culprit is Streptococcus mutans, metabolize dietary sugars to sticky polymers that allow them to adhere within a biofilm to the tooth surface. In addition, bacterial metabolism of dietary sugars forms acidic end-products that demineralize (i.e., soften) the enamel, the hard tooth outer surface. If left unchecked, the bacterial infection will advance, burrowing deeper into the tooth structure, first into the dentin and thereafter to the pulp, which houses nerve endings and blood vessels. Recognizing that tooth decay is a bacterial disease, the strategy behind topical application of silver diamine fluoride to tooth surfaces is to inhibit bacterial growth in existing areas of decay and to prevent the occurrence of areas new decay.     

 Silver diamine fluoride provides a triple “punch” to promote oral health.

1. Fluoride is a proven preventative against tooth decay. Fluoridation of community waters and the usage of fluoride-containing toothpastes are widely accepted strategies against dental caries. Minerals  of tooth enamel are in flux, with demineralization and remineralization being competing processes. Demineralization, occurring by acids formed through bacterial metabolism of dietary sugars, leads to the softening of the outer tooth surface. Remineralization, occurring when minerals such as fluoride, calcium, and phosphate are redeposited into the enamel, serves to harden the tooth surface. Fluoride curtails dental caries by making the outer tooth surface more resistant to acid released from plague-forming bacteria.   

2. Silver is a strong antibacterial metal, exhibiting “oligodynamic” properties, i.e., low concentrations of this metal are biocidal. Silver ions immediately kill bacteria upon contact. Furthermore, the silver ions remain embedded in demineralized tooth structures, serving both to harden the tooth and to provide antibacterial properties to prevent reinvasion by bacteria of dental decay.

3. Diamine is the source of ammonia, which stabilizes the solution and which acts as an antiseptic to kill harmful oral bacteria.

 The Food and Drug Administration has designated silver diamine fluoride with Breakthrough Therapy Status, which is the Agency’s designation of a process designed to expedite the development and review of medications that are intended to treat a serious medical condition. Dental caries fits this criterion – childhood caries is a worldwide public health problem with untreated decay in deciduous teeth being the tenth most prevalent health risk and with untreated dental caries in permanent teeth being the most common.

 Topical application of silver diamine fluoride is a rather simple, noninvasive process. Using a microbrush, it may be used to curtail a current infection and thereby applied directly to the area of dental decay or to prevent an infection and applied to newly emerged, high-risk surfaces, such as first molars. The only known side effect of silver diamine fluoride is a black staining of the area of dental decay. The blackening is due to the tarnishing of silver and, interestingly, is used as an indicator of the effectiveness of the treatment. Black staining indicates that the treatment was successful and that the bacterial infection was halted.

Silver Diamine Fluoride has been proven to be a very useful tool in arresting dental caries in patients with special needs. It clearly is not for everyone and every condition. You may not want to have this applied for esthetic reasons. Also if there is decay extending into the pulp or if too much tooth structure is gone because of decay or trauma, SDF would not be the treatment of choice.

In summary, SDF is a very valuable in the overall armamentarium of the pediatric dentist. It is very important to trust your pediatric dentist to make the right choice.