Use Of Silver Diamine Fluoride Research Articles

Parental Acceptance for the Use of Silver Diamine Fluoride on Their Special Health Care-Needs Child's Primary and Permanent Teeth.

PurposeThe effectiveness and simplicity of the procedure and the low expense are the main advantages of silver diamine fluoride (SDF). It is useful for controlling caries in challenging patients such as those with special health care needs (SHCN). First aim of this study was to assess parents’ acceptance towards using SDF in SHCN children in their primary and permanent teeth. Second aim was to determine the factors that influence parents’ decisions toward dental treatment options.Patients and MethodsThis descriptive cross-sectional study included the parents of SHCN children aged 12 years old and younger who were actively seen in pediatric dentistry clinic at King Fahad Medical City (KFMC) and were receiving dental treatment. A previously developed and tested questionnaire was used. The surveyors received training about the questionnaire and participants’ consent was obtained before enrolling in the survey. The statistical significance level was set at P<0.05.ResultsTwo hundred twelve participants completed the study questionnaire. Parents had a higher acceptance of SDF use regardless of the tooth location and type when their child had a positive history of pain and/or inflammation (P=0.019). In addition, parents had higher acceptance of SDF staining in primary teeth compared to permanent teeth (P=0.006). Moreover, the acceptance of SDF staining was higher in posterior teeth compared to anterior teeth in both primary and permanent dentition (P<0.001).ConclusionParental acceptance of SDF was higher for primary compared to permanent teeth and posterior compared to anterior teeth in both dentitions, as well as for those with a positive history of dental pain and/or inflammation.

Evidence-Based Caries Management for All Ages-Practical Guidelines.

Introduction: The purpose of the present paper is to provide step-by-step guidelines for dental healthcare providers to manage dental caries based upon caries risk assessment (CRA) for ages 0–6 years and 6 years through adult. The manuscript reviews and updates the CAMBRA (caries management by risk assessment) system which includes CRA and caries management recommendations that are guided by the assessed risk level.Caries Risk Assessment: CAMBRA CRA tools (CRAs) have been evaluated in several clinical outcomes studies and clinical trials. Updated CAMBRA CRAs for ages 0–6 years and 6 years through adult are provided. These CRAs have been refined by the addition of a quantitative method that will aid the health care provider in determining the caries risk of individuals.Caries Management Based Upon Risk Assessment: Guidelines for individualized patient care are provided based upon the caries risk status, results of clinical exams and responses of the patient to questions in the CRA. These guidelines are based upon successful outcomes documented in several clinical outcomes studies and clinical trials. The paper includes a review of successful caries management procedures for children and adults as previously published, with additional emphasis on correct use of silver diamine fluoride (SDF) for children. The caries management plan for each individual is based upon reducing the caries risk factors and enhancing the protective factors with the additional aid of behavior modification. Beneficially altering the caries balance is coupled with minimal intervention restorative dentistry, if appropriate. These methods are appropriate for the management of dental caries in all patients.

Acidity, fluoride and silver ion concentrations in silver diamine fluoride solutions: a pilot study.

There has been renewed interest in the use of silver diamine fluoride (SDF) for the management of carious lesions in high-risk groups. Previous studies have found a difference in clinical efficacy among different concentrations of SDF and discrepancies between ionic concentrations of fluoride (F) and silver (Ag) in SDF preparations. The aim of this study was to measure the free F, Ag ion concentrations and pH of a variety of commercially available SDF preparations. Seven SDF products used globally were evaluated for F and Ag ion concentrations using a calibrated ion-selective electrode and optical emission spectrometry respectively. Acidity was determined with a pH electrode. The 30% SDF solution contained almost half the F concentration and a much higher Ag concentration than expected (16343ppmF and 246000ppmAg). Comparatively, the mean F concentration of the remaining six 38% solutions was 74802ppm (expected mean 44800ppm) ranging from 36457ppm to 120760ppm. The mean Ag concentration was 326000ppm (expected mean 253870ppm) and ranged from 246000ppm to 425451ppm. All solutions were found to be neutral or mildly alkaline in nature (pH 7-10.3). Wide variations between claimed and measured F and Ag ion concentrations exist among the different brands of commercially available SDF products.

AN INNOVATIVE APPROACH TO TREAT EARLY CHILDHOOD CARIES (ECC) USING SILVER DIAMINE FLOURIDE – A CASE REPORT

Dental decay affects 4-86% of preschoolers (temporary dentition), and regarding mixed and permanent dentition, the percentage of affected children is between 27-86%. Caries lesions of the temporary teeth is the main dental problem that the preschooler encounters, a problem that affects to some extent the permanent dentition, with repercussions on the development of the stomatognathic system. The use of silver diamine fluoride (SDF), in dental treatment of Early Chilhood Caries (ECC) has been drawing increasing attention cause to its antimicrobial effect on the species Streptococcus Mutans, Actinomyces Naeslundii and Lactobacillus Acidophilus, which are the pathogens most commonly associated with both the onset and the progression of caries, being usually discovered on the surface and in the depth of the lesion. A case report of a 4 years-old female patient suffering of SECC is presented with the application of SDF and glass-ionomer cement restauration showing advantages as carious lesions arrest, improved esthetic appearance avoiding early teeth loss

Awareness Regarding the use of Silver Diamine Fluoride in Dentistry- A Survey

Dental caries is a complex progression due to dietary sugars, bacterial metabolism involving demineralization, and organic degradation. Caries are more prevalent among young children which are mostly untreated due to dental anxiety, behavioural changes, and mainly due to expensive treatment. So innovative approaches are needed to treat caries, especially in children. Arresting caries without restoration is possible by silver diamine fluoride (SDF) which is inexpensive topical medication. Silver diamine fluoride (SDF) is used to treat caries and also prevents future caries development. Silver diamine fluoride (SDF) is also used to treat sensitivity. Before silver diamine fluoride (SDF) silver nitrate and silver varnish were used to treat dental caries. Silver diamine fluoride (SDF) consists of silver, fluoride, ammonia, and water. Silver acts as an antimicrobial agent, fluoride as remineralization, and ammonia stabilizes high concentration. The study setting was an online survey. The number of participants involved was 129. A pre-tested questionnaire was circulated. The data was collected and analyzed using SPSS software. 41.9% of the population participated have heard of silver diamine fluoride (SDF), but 34% of the population are not aware of what it is used to treat. 37.2% of the population is also not aware of the method of application. From the studies, the participants are not aware of silver diamine fluoride (SDF), its uses, and its effectiveness. Oral education should be conducted to create awareness among people.

A survey of cariology education in U.S. dental hygiene programs: The need for a core curriculum framework.

Dental hygienists play a key role in dental caries prevention and management. As the evidence of dental caries risk, prevention, and management becomes more complex, it is essential that dental hygiene (DH) programs have a strong cariology curriculum. This project aimed to assess current cariology content in U.S. DH programs, how content is taught, and interest in development/implementation of a common/core cariology curriculum framework. Directors of 336 U.S. DH programs were invited to participate in a voluntary online survey using Qualtrics. The survey consisted of 41 items including demographics, details about the program's cariology content, and how it was delivered, and items related to a core cariology curriculum. The overall response rate used for analyses was 27.3%. Some findings include: 61.6% stated their program had a defined cariology curriculum, 35.2% did not have an individual cariology course, 61.5% had preclinical hands-on experiences in cariology, 79.7% are teaching management strategies related to salivary gland hypofunction, 68.3% are teaching use of silver diamine fluoride (SDF), and 64.2% felt cariology was adequately being taught. Only 17.7% are teaching the International Caries Detection and Assessment System (ICDAS) system. 87.3% indicated support for developing a core curriculum framework for teaching cariology in DH programs. This study indicated that, although DH programs reported that cariology concepts are being taught both didactically and clinically, discrepancies between concepts taught and the literature exist. Therefore, there is a need to create a more standardized curriculum framework for all U.S. DH programs.

Parents' Views on Silver Diamine Fluoride to Manage Early Childhood Caries.

The use of silver diamine fluoride (SDF) as a nonsurgical caries management product is growing. Evidence suggests that SDF is very successful in arresting caries. However, a common concern with SDF treatment is the unaesthetic black staining. The purpose of this qualitative study was to determine parents' views following their children's treatment with SDF to manage severe early childhood caries (ECC). Parents were interviewed as part of a mixed-method study of SDF to arrest severe ECC. Children with caries lesions in primary teeth were treated with 2 applications of 38% SDF, followed by fluoride varnish. Semistructured in-person and phone interviews were conducted with 19 parents of children in the study. Data were transcribed verbatim and manually coded and uploaded to NVivo 12 for further coding analysis. None of the parents had previously heard about SDF, and they learned about it from the study dentist. Although parents trusted the dentist's information on SDF, they welcomed additional evidence, especially relating to product safety and effectiveness. Some parents were minimally concerned with the black staining caused by SDF treatment. It was more important that SDF arrested caries progression, minimized pain and sensitivity, and prevented dental infection. However, some parents expressed concerns related to the unaesthetic black staining. Interestingly, many parents indicated that their children were not overly concerned with the black staining. A majority of parents said that they would recommend the treatment to others. This is the first qualitative study involving parents of children who were treated with SDF. Most parents were accepting of SDF as a nonsurgical treatment to arrest caries and minimize dentinal sensitivity secondary to caries, although some expressed concern about the black staining in anterior teeth. It is important to adequately inform parents of the negative aesthetic consequences and obtain informed consent before treatment. This qualitative study revealed that many parents of children with severe ECC are accepting of SDF as a nonrestorative caries management option, despite the black staining of caries lesions. Dental professionals need to be aware of these parental concerns and obtain written informed consent prior to treatment. Parents also requested more information and resources on SDF on its benefits, effectiveness, and any associated risks.

Effect of three silver diamine fluoride application protocols on the microtensile bond strength of resin-modified glass ionomer cement to carious dentin in primary teeth.

Use of silver diamine fluoride (SDF) after selective caries excavation can arrest the further progress of the carious lesion. Application of potassium iodide (KI) can reduce the staining due to SDF. The aim of the study was to evaluate the effect of the application of SDF, with and without acid etching and KI on the bond strength of resin-modified glass ionomer cement (RMGIC) to the carious dentin of primary teeth. In thisin vitro study, caries was induced on the occlusal surface by inoculating Streptococcus mutans strain in 36 extracted primary molars. The teeth were divided into four groups (n = 9), and the following treatments were done to the carious dentin prior to final restoration with RMGIC: Group I: 10% polyacrylic acid conditioner, Group II: 38% SDF, Group III: 37% phosphoric acid etchant followed by 38% SDF, and Group IV: 37% phosphoric acid etchant followed by 38% SDF and 10% potassium iodide solution. The microtensile bond strength was measured using universal testing machine. Failure modes were recorded using a scanning electron microscope. There was no significant difference in microtensile bond strengths between the groups (P = 0.665), with the highest value seen in Group III. Application of SDF with or without acid etching and KI does not affect the bond strength of RMGIC to carious dentin of primary teeth.

The use of silver diamine fluoride (SDF) in dental practice

Silver diamine fluoride (SDF) is a clear, odourless liquid indicated for desensitisation of non-carious tooth lesions and molar incisor hypomineralisation. It is also useful for arresting carious lesions in adults and children who are high caries-risk and/or have difficult-to-control, progressing carious lesions, those who are unable to tolerate invasive treatment, elderly populations, and those who are medically compromised or have additional care and support needs. SDF may be used to manage lesions that are too extensive to restore but not associated with pain and/or infection. This can be important particularly where extractions might be contra-indicated for medical or behavioural reasons. This paper summarises the global evidence for the effectiveness and safety of SDF, describes what it is, its mechanisms of action and presents recommendations on how to use it. There are details on indications/contra-indications and risks/benefits to be considered in the use of SDF also discussion of how to approach SDF's side effect of black staining of carious tooth tissue. We give an example of an information sheet (Appendix S1, see online supplementary information) that may be used when discussing SDF with patients, particularly for primary teeth in children, but adaptable for the permanent dentition and for adults.

Silver Diamine Fluoride: a critical review and treatment recommendations

Over the last decade there has been a renewed interest in the use of Silver Diamine Fluoride (SDF) as an adjunctive modality in the management of caries among high-risk populations. This review presents the current evidence behind the use of SDF and recommendations for its use in caries management dental practice. CPD/Clinical Relevance: Silver diamine fluoride is an effective, evidence-based modality that can contribute towards arresting carious lesions among high-risk children and disadvantaged populations.

Parental Expressed Concerns about Silver Diamine Fluoride (SDF) Treatment.

Background: The staining associated with its caries arrest may be a deterrent for the use of Silver Diamine Fluoride (SDF). This study aims to elucidate the concerns that inform parents' perceptions and acceptance of SDF as a treatment option for their child. Study Design: We analyzed qualitative data obtained through an investigation in which parents attending a pediatric dental appointment participated in a survey, which included an open-ended question to evaluate their opinions about SDF staining. Thematic analysis of the comments, offered by the subsample of participants who replied to this question (n=43), yielded insights about perception of SDF therapy. Results: Most parents who provided comments were mothers (83.7%), college graduates (72.1%), primarily white (48.8%) or Hispanic (27.9%). Six themes emerged from the thematic analysis of the parents' responses: Esthetic Concerns, Psychosocial Concerns, SDF Treatment Process, Risks and Side Effects, Situational Benefits, and Dental Treatment Process. While many of the parents' comments are related to appearance, other topics that merit consideration when discussing SDF treatment were mentioned. Conclusions: Although parents are concerned about the esthetic impact of SDF, they understand the risks of alternative treatments and welcome information that will allow them to make an informed decision. Location of the cavities and visibility of the staining appear to heavily influence the decision to accept or reject this therapy.

A silver renaissance in dentistry.

Recently, there has been interest in biological approaches for caries management, with techniques such as interim therapeutic restorations and Hall technique crowns showing comparative effectiveness against conventional restorative methods. One of these approaches is the use of silver diamine fluoride (SDF) as a restorative option. In this invited review, the aim was to critically appraise the currently available literature with regards to the indication, technique and outcome of SDF. A review of the literature on SDF with a focus on its use in the primary dentition was conducted. There has been a recent explosion in the literature regarding the use of SDF, from in vitro studies on the mechanism to clinical studies on the effectiveness and patient acceptance of the technique. A systematic review in 2016 concluded that SDF application resulted in caries arrest in 81% of active lesions in primary teeth over 30months. Additionally, over 60% of parents reported being satisfied with the aesthetic outcome with most children finding the procedure to be acceptable, comfortable and relatively pain-free. Silver diamine fluoride is a safe and effective alternative technique to caries management in the paediatric population. Given the ongoing worldwide debate on cost-effectiveness of biological approaches coupled with the increasing concerns and limited accessibility of treatment under general analgesia, SDF should form an important addition to every dentist's armamentarium.

Stretching new boundaries of caries prevention with silver diamine fluoride: A review of literature

Silver diamine fluoride can arrest dental caries and prevents its progression. By doing so, it provides an alternative care path for those patients in whom traditional restorative treatment cannot be done, for example, children lacking cooperating ability. Although silver diamine fluoride had been used as a caries preventive measure in 1970s in Japan, it had not become popular in the other part of the world. Now, many countries have recommend the use of 38% silver diamine fluoride solution for caries prevention as well as for caries arrest. Recently, The American Academy of Pediatric Dentistry provided the guidelines regarding the use of silver diamine fluoride for dental caries management in children and adolescent including those with special healthcare needs.

The History and Use of Silver Diamine Fluoride in Dentistry: A Review

The History and Use of Silver Diamine Fluoride in Dentistry: A Review

Use of Silver Diamine Fluoride for Dental Caries Management in Children and Adolescents, Including Those With Special Health Care Needs

This manuscript presents evidence-based guidance on the use of 38 percent silver diamine fluoride (SDF) for dental caries management in children and adolescents, including those with special health care needs. A guideline workgroup formed by the American Academy of Pediatric Dentistry developed guidance and an evidence-based recommendation regarding the application of 38 percent SDF to arrest cavitated caries lesions in primary teeth.The basis of the guideline's recommendation is evidence from an existing systematic review "Clinical trials of silver diamine fluoride in arresting caries among children: A systematic review." (JDR Clin Transl Res 2016;1[3]:201-10). A systematic search was conducted in PubMed®/MEDLINE, Embase®, Cochrane Central Register of Controlled Trials, and gray literature databases to identify randomized controlled trials and systematic reviews reporting on the effect of silver diamine fluoride and address peripheral issues such as adverse effects and cost. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess the quality of the evidence and the evidence-to-decision framework was employed to formulate a recommendation.The panel made a conditional recommendation regarding the use of 38 percent SDF for the arrest of cavitated caries lesions in primary teeth as part of a comprehensive caries management program. After taking into consideration the low cost of the treatment and the disease burden of caries, panel members were confident that the benefits of SDF application in the target populations outweigh its possible undesirable effects. Per GRADE, this is a conditional recommendation based on low-quality evidence. Conclusions and practical implications: The guideline intends to inform the clinical practices involving the application of 38 percent SDF to enhance dental caries management outcomes in children and adolescents, including those with special health care needs. These recommended practices are based upon the best available evidence to-date. A 38 percent SDF protocol is included in Appendix II.

Use of silver diamine fluoride for the maintenance of dental prostheses in a high caries-risk patient: A medical management approach

A technique for using silver diamine fluoride (SDF) as part of a regimen to help maintain dental prostheses in a patient with scleroderma and at high risk of caries is presented. Medically compromised, xerostomic, or elderly patients generally face greater risk of caries and specifically with prosthetic retainer teeth. SDF is a minimally invasive solution to this problem. A technique is described for using SDF to arrest and prevent new caries with the goal of maintaining fixed and removable prostheses and supporting teeth in a cost-effective manner.

Approaches to Arresting Dental Caries: An Update.

Dental caries is one of the most prevalent chronic oral diseases across the globe that can be both treated and prevented. Preventive management strategies can effectively arrest and even completely reverse the caries process. This article aimed to review the literature on different approaches explored towards arresting caries progression. Literature search of publications in Pubmed/Medline was carried out. Total 73 articles including clinical trials, invitro studies, case reports and review articles were reviewed. Twenty-two clinical trials and invitro studies were selected for review. Most studies suggested use of Silver Diamine Fluoride (SDF) as simple and effective caries arresting approach. Fluoride varnish treatment effectively arrests caries by inhibiting demineralization, resulting in highly significant caries reductions. Arginine with an insoluble calcium compound enhances arresting and reversing buccal, coronal and root caries. A few clinical studies have shown that sealants placed in caries fissures can arrest the caries process. Various fluoride containing agents are clinically effective in arresting progression of carious lesion. However, these materials should be used appropriately understanding their scope and limitations to arrest dental caries.

Anti-microbial efficiency of silver diamine fluoride as an endodontic medicament - An ex vivo study

Context:Antisepsis achieved through appropriate use of irrigants is essential for endodontic success. Identification of newer anti-bacterial agents gives alternatives to clean the canal as eradication of the infection prior to obturation does affect prognosis.Objective:Comparison of the anti-bacterial action of 3.8% silver diamine fluoride and 2% chlorhexidine gluconate against Enterococcus faecalis in root canals.Materials and Methods:Forty-four single-rooted teeth were decoronated, and the root section was enlarged with peeso-reamer (No: 3) to standardize length and diameter. The samples were then autoclaved and divided into two study groups and two control groups. Enterococcus faecalis ATCC 29212 was inoculated into all test samples for 72 hours. The samples were enlarged with peeso-reamer (No: 5) after placement of respective medicament for 24 hours. Shavings were collected and inoculated on Brain Heart Infusion agar for 24 hrs to measure the colony forming units.Results:Both 3.8% silver diamine fluoride and 2% chlorhexidine showed a superior capacity to sterilize the root canals than control groups.Conclusion:The use of silver diamine fluoride as an endodontic irrigant is feasible as it can effectively remove the microbes present in the canal and circumpulpal dentin.