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Silver Diamine Fluoride in Caries Management



A recent article in the New York Times highlighted use of silver diamine fluoride (SDF) as an alternative approach to treatment of cavities in children.1 The article highlighted that SDF was faster and cheaper than drilling and filling; and it mentioned the downside that when applied, SDF blackens the tooth.

Silver diamine fluoride (SDF) is a colorless liquid that at pH 10 is 24.4% to 28.8% (weight/volume) silver and 5.0% to 5.9% fluoride.2 Just as 5% sodium fluoride varnish has FDA clearance as a Class II medical device for the treatment of tooth hypersensitivity, FDA classified SDF as a fluoride and cleared its use as a Class II medical device for the same indication. A number of products are currently available in other countries, but at this time, Advantage Arrestâ„¢ (Elevate Oral Care, L.L.C.) is the only commercially available SDF product for dental treatment in the U.S.3

Although FDA-cleared for use in the management of hypersensitivity, SDF received coverage in the Times for its use in treating cavities in children, although this might be more accurately described as caries control and management. Likely a result of its fluoride content, when applied to a carious lesion, SDF has also been shown to lower caries risk of the adjacent tooth surface.4 While the Times article focused on the use of SDF in young children, it has also been shown to be effective in management of root caries in the elderly.5, 6 It likely has additional applicability as an interim approach for managing problematic caries in individuals currently unable to tolerate more involved dental treatment.

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