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Dentists adopting drill-and-fill alternative

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By Kathleen McLaughlin,

Preschoolers, elderly people and others who are ill-suited to go under a dentist’s drill have an alternative that proponents say will stop their tooth decay quickly, painlessly and cheaply.

A subsidiary of Advantage Dental of Redmond has been marketing since last spring a silver fluoride product called Advantage Arrest, which the U.S. Food and Drug Administration approved to treat dental sensitivity. Its real purpose, however, is to stop tooth decay, and it’s about to become even easier for dentists in Oregon and across the country to use it.

The American Dental Association approved a new billing code that can be used for silver fluoride treatments starting in January, said Gary Allen, dental director for Advantage, which is a statewide network of clinics that treats 340,000 Oregon Health Plan members.

Also starting Jan. 1, OHP, which is the state’s version of Medicaid, will cover silver fluoride treatment for cavities up to two times per year.

Advantage is already using silver fluoride, which the FDA approved in August 2014. Before then, Advantage used a controversial compound called silver nitrate in conjunction with fluoride varnish. Both compounds are applied in tiny drops to the decayed area to stop infection and, dentists hope, avoid the need for a filling.

“It’s new, it’s revolutionary, it changes the way dentistry is practiced,” said Mike Shirtcliff, president and founder of Advantage.

Shirtcliff acknowledges that there was not much current research to support the use of silver nitrate. That’s why he joined forces with University of Washington oral health professor Peter Milgrom to push through approval of silver fluoride.

Silver, which is the antimicrobial agent, comes at a slightly higher concentration in silver fluoride, which has been used and studied extensively in Asia and other places around the world, said Milgrom, director of the Northwest Center to Reduce Oral Health Disparities at UW.

He specializes in working with fearful or otherwise difficult-to-treat patients.

Advantage and Milgrom formed a small business, won a grant to support their own research and received FDA approval for silver fluoride as a medical device.

The next step, Milgrom said, is to conduct further research that would support FDA approval of silver fluoride as a drug, which would be marketed directly for treatment of cavities. That’s a much more expensive and rigorous process, he said.

Gaining approval for silver fluoride to this point took seven years, Milgrom said. He estimates that he donated $500,000 of his time, and Shirtcliff said Advantage invested $1 million of time and cash.

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