Research Assessment #7

Date: ​November 13, 2019

Subject: ​Dentistry
MLA Citation (article):
Jewell, Tim. “Silver Diamine Fluoride .” ​Health Line,
https://www.healthline.com/health/silver-diamine-fluoride.

Analysis:
One point I have made throughout my journey in ISM is that I have always loved and
anticipated my annual trip to the dentist. However, every so often when I would slack on my
brushing and flossing I would have to go in for a cavity filling. These trips were not as exciting
as my typical cleanings and were actually quite treaded. I vividly remember walking up to the
dental office and waiting patiently in the waiting room, with my anxiety growing as every second
passed. My fears would only be suppressed once I got a dosage of the laughing gas, but I could
still hear and feel the tools drilling into my mouth. Cavity fillings are known to be one of the
scariest, most terrifying moments in a child’s life, just as it was for me. However, recent
discoveries in the field of dentistry have shown that there are possible alternative methods to the
typical filling. One product, silver diamine fluoride, also known as SDF, is arising as one of the
fastest and most convenient solutions to early tooth decay. Therefore, I will be investigating what
SDF is, and how it as impacted dentistry, with its implications more specific in pediatrics.
SDF is a liquid substance that helps prevent the spreading of already present caries or
bacteria in the mouth. The three main components of the product are silver, ammonia, and
fluoride. The silver helps kill the bacteria, the ammonia helps the solution remain concentrated
so that it’s effective against cavity resonance, and the fluoride helps your teeth rebuild the
materials they’re made of. What is so revolutionary about this product is that it is non-invasive,
and its application is rather simple. SDF is spread upon the affected area, and then the procedure
is complete. While this process is exceedingly simpler than the traditional method of cavity
prevention, there are some downsides. To begin with, it only is useful in situations where the
caries is not widespread. It works best when the cavity is in its beginning stages and is contained.
Once it begins to spread, SDF is not guaranteed to be effective. Additionally, the more serious
downside is that after the application, it leaves a permanent black stain on the tooth. For cosmetic
purposes, SDF is widely avoided by the dental community.
This new discovery has been extremely groundbreaking and important ever since its
approval by the FDA in 2014. One reason it is extremely important is that it provides a painless
and innovative approach to cavities, a condition oftentimes corresponds with fear and pain. In the
world of pediatric dentistry, cavity fillings are extremely time-consuming a cost-ineffective
process. Additionally, the nerves and anxiety of the children apply extra stress on the dentist,
making the traditional cavity filling not the most ideal method of care. SDF, on the other hand, is
a painless and safe alternative that is, on average, $175 more affordable than fillings. In addition
to it being used to treat already formed cavities, SDF can also be used on healthy teeth to prevent
the growth of bacteria. Because a lot of children have not yet had a solid and stable brushing and
flossing schedule reinforced into their lives, any treatment that prevents the formation of cavities
is seen as beneficial and crucial in pediatric dentistry. While SDF comes across as almost the
perfect substitute, the downsides of it have prevented its use on a wider scale and have caused
many patients to reject going that route of treatment.
In every career field, advancements and developments are constantly occurring. It is
necessary to stay up to date and not fall behind on what is happening in the industry. Silver
diamine fluoride, one of the most relevant and recent improvements in dentistry, is something
that I will need to be familiar with before entering a mentorship with any professional working in
pediatric dentistry for many different reasons. For starters, because it is on the rise, I will need to
know about SDF just in case it gets brought up when with patients, or in any other conversation.
While it may sound strange for a dentist to randomly bring up SDF, during a previous interview I
had SDF was mentioned, and after that, I felt as if I should become more educated on the topic.
Besides the possibility of it being mentioned in a conversation, as an aspiring pediatric dentist, I
feel as if it is important for me to stay updated on the most recent advancements in the field.
While some may say it is a bit early for me to start staying updated, I believe that it is better for
me to start now, so I do not get behind later.
 As I was once a child who feared the pain fillings, hearing about the new silver diamine
fluoride product that would remove all the pain from the process excited me. While it does have
its downsides, it has high prospects for the future, and I am even more excited to see where this
product goes in the future. In addition to SDF, the field of dentistry is constantly advancing and
progressing. Watching the field that I am very passionate about developing is something that I
am so glad I can do, and I cannot wait to see where dentistry goes in the future.
What is silver diamine fluoride? 
Silver diamine fluoride (SDF) is a​ liquid substance used to help prevent tooth 
cavities (or caries) from forming, growing, or spreading to other teeth. 

SDF is made of: 

● silver:​ helps kill bacteria 

● water:​ provides a liquid base for the mixture 
● fluoride:​ helps your teeth rebuild the materials they’re made of (known as 
remineralization 
● ammonia:​ helps the solution remain concentrated so that it’s maximally 
effective against cavity resonance 

SDF was first approved for use in Japan for more than 80 years ago. SDF was 
approved by the U.S. Food and Drug Administration (FDA) in 2014 for use in the 
United States.​ SDF is considered a ​class II medical device.​ This means that it 
only carries​ slight risks​ (for reference, condoms and pregnancy tests are also 
class II medical devices). It’s sold in some stores for home use, but it’s most 
commonly and safely used in dental clinics. 

How is it used? 
Most dentists use a liquid form of SDF containing at least​ 38 percent of the 
SDF solution​. It’s applied topically, meaning that it’s applied directly to the 
surface of your teeth. 
Many dentists use the following steps: 

1. Cotton or gauze is placed near the affected teeth to​ prevent saliva from 
moistening the teeth. 
2. Moisture is removed ​from the surface of the teeth using a vacuum 
suction tool. 
3. SDF is applied to the area affected by a cavity. 

Your dentist may also use the following to mask the areas affected by cavities: 

● glass ionomer 
● opaquer 
● crowns 

SDF is most commonly used on areas affected by cavities. Research shows 

that SDF can be just as helpful​ when used as a preventive measure by being 
applied to healthy tooth surfaces.​ Research also suggests that dentists don’t 
need to treat cavities with fillings or tooth surface modification before using 
SDF. 

Traditionally, many dentists have used a fluoride varnish to help stop cavity 
development.​ SDF has proven to be much more successful at reducing cavity 
growth than varnish. SDF also requires fewer treatments over time. 

There’s no set number of applications required for SDF to work. ​Most dentists 
only apply SDF once per year.​ Varnishes often need to be applied four or more 
times per year. 
How does it benefit your oral 
hygiene? 
● SDF has widely been shown to be ​effective to help stop cavity 
development after a cavity has formed​. Dentists call this process​ caries 
resonance. 
● SDF helps kill the bacteria that break down tooth surfaces while also 
keeping them from spreading to other teeth. 
● SDF is often suggested as a more​ comfortable alternative to drilling 
cavities​. This can be​ helpful for children or adults who have anxiety about 
the dentist or may not be able to fully engage in dental procedures, such 
as those with special healthcare needs. 
● SDF can be​ helpful as a cavity treatment if you’re overly sensitive to the 
instruments​ and substances used during cavity treatments. 
● SDF can help ​keep cavities to a minimum or prevent them entirely​ if you 
feel that it’s difficult to make time for regular dental check-ups or feel 
uncomfortable about cavity procedures. It’s quick, requires no special 
equipment, and generally only needs to be done ​once per year. 

Are there any side effects? 

Few harmful or negative side effects have been found with use of SDF. ​SDF is 
widely considered by dentists to be safe, even on young children. 
You shouldn’t use SDF if you have a ​silver allergy,​ oral ulcerations or ​canker 
sores​, ​advanced gum disease​, or ​major tooth decay​ that’s exposed to the soft 
tissue of your tooth beneath the enamel. These conditions can have painful 
reactions with acid or ammonia in SDF. 

The only common side effect of SDF noted in hundreds of studies is​ black 
staining around the area where SDF is applied.​ SDF can also ​stain​ surfaces that 
it comes into contact with when being applied, such as clothing or nearby 
tissues in the mouth. 

Some research recommends the use of ​potassium iodide along with SDF to 
keep staining to a minimum.​ This mixture may also turn ​black when exposed to 
light​. One study found that a similar treatment using ​nano-silver fluoride (NSF) 
limits SDF’s black staining​. But more research needs to be done to make sure 
that NSF is just as effective as SDF in stopping cavities over a longer period. 
NSF may need to be applied more often than SDF to have the same level of 
success. 

How much does it cost? 

According to a presentation by the Association of State & Territorial Dental 
Directors, the average cost of an SDF application is ​$75 for a single treatment. 
This cost usually equals about $20–$25 per tooth. 
SDF may be covered by certain health insurance plans or be eligible for flexible 
spending accounts (FSAs) available from some healthcare providers because 
it’s a class II medical device. 

Many states now offer Medicaid plans that cover SDF treatments​. A growing 
number of state legislatures have either proposed or are currently considering 
adding SDF to Medicaid and other government-sponsored healthcare plans. 

Takeaway 
SDF is a safe, painless alternative to traditional cavity drilling procedures. 

Your dentist may not recommend SDF in every case of cavities. It’s also not yet 
as widely available as similar treatments, such as fluoride varnish. 

But SDF has been proven to be ​highly successful in stopping the development 
and spread of cavities​. Even more effective forms that leave fewer black stains 
continue to be tested.