Silver diammine fluoride
Silver diammine fluoride (SDF) is a topical dental medication designed primarily to prevent dental caries (cavities) and alleviate tooth sensitivity. Composed of approximately 25% silver, 8% ammonia, 5% fluoride, and 62% water, SDF functions by combining the antibacterial properties of silver with the remineralizing effects of fluoride. Although its medicinal use dates back thousands of years, SDF gained FDA approval in the United States in 2014, where it is classified as a "cavity varnish" primarily for sensitivity relief, rather than for cavity prevention. Despite this classification, many dental professionals apply SDF off-label to halt cavity progression.
Historically, SDF has been widely utilized in various countries, including Japan, China, Brazil, and Australia, often regarded as an effective alternative to traditional cavity treatments. The application involves cleaning the tooth surface and then applying the solution directly to the affected area. It is considered safe with a low risk of side effects, although individuals with silver allergies or gum disease should avoid its use. Studies indicate that SDF is more effective at reducing cavity growth compared to standard fluoride varnishes and necessitates fewer treatments over time, making it an appealing option in pediatric dental care and beyond.
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Silver diammine fluoride
Silver diammine fluoride is a topical medication used in dentistry to prevent dental caries, or cavities, and relieve hypersensitivity in the dentin of the tooth. The substance contains about 25 percent silver, 8 percent ammonia, 5 percent fluoride, and 62 percent water. At a pH of about 10, the colorless substance has not only shown to prevent cavities from forming, but also keep them from spreading to other teeth. Although the product has been in use in many countries for several decades, silver diamine fluoride was only approved for use as a “cavity varnish” in the United States in 2014, not as a cavity preventer. The Food and Drug Administration limits the product’s classification as a “varnish” applied to tooth enamel “to block dentinal tubules for the purpose of reducing tooth sensitivity.” Many dentists use the product off-label for halting the progression of cavities and to prevent them, however.
Overview
Historical records have shown that silver was used for medicinal purposes as far back as 1000 BCE. The use of silver nitrate for dental purposes dates back to about 1000 CE in Japan, where people used it to cosmetically blacken teeth. Prior to the invention of silver diammine fluorine, early dentists applied fluoride varnish to teeth after silver nitrate application to treat cavities. Silver diammine fluoride was developed when ammonia was added to silver nitrate to stabilize the substance. Later, fluoride was added. The addition of ammonia also gave the substance antibacterial properties that helped with dental lesions and infected root canals. The use of silver diammine fluoride spread across many countries from the twentieth century onward. It has been widely used throughout countries such as Japan, China, Australia, and Brazil for decades. In the United States, silver diammine fluoride was only approved as a treatment for dental hypersensitivity in 2014, but many dentists use the medication to treat and prevent cavities as well.
Silver diammine fluoride is made of silver, fluoride, ammonia, and water. The silver helps kill bacteria, while the fluoride helps with the process of teeth remineralization—the rebuilding of minerals that are a part of healthy teeth. Ammonia serves to keep the solution concentrated to ensure maximum effectiveness. The water is the liquid base in which the components are mixed. Silver diammine fluoride is labeled a class II medical device, which means it only carries a slight risk of side effects. The product can be found in stores, but it is most safely administered when used in a dentist’s office. It is considered a potential alternative to having to drill cavities, but those with major tooth decay may not be able to benefit from the treatment. Individuals with silver allergies or gum disease should also not use the solution.
Silver diammine fluoride is usually mixed at a 38 percent concentration. When applied to the teeth, dentists first remove moisture from the tooth with a suction tool and then apply the solution to the part of the tooth containing the cavity. Sometimes, dentists may use the solution to prevent cavities. Studies have shown that silver diammine fluoride is much more effective at preventing and reducing cavity growth than the traditional fluoride varnish used by many dentists. Research also shows that silver diammine fluoride requires fewer treatments over time.
Bibliography
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“Silver Diamine Fluoride (SDF) Fact Sheet.” July 2017, Association of State & Territorial Dental Directors, www.astdd.org/www/docs/sdf-fact-sheet-09-07-2017.pdf. Accessed 5 Mar. 2020.
Subbiah, Gireesh Kumar, and Nithin Manchery Gopinathan. “Is Silver Diamine Fluoride Effective in Preventing and Arresting Caries in Elderly Adults? A Systematic Review.” Journal of International Society of Preventative and Community Dentistry, vol. 8, no. 3, 2018, pp. 191-199.
“What You Should Know About Silver Diamine Fluoride.” Northwest Bulletin, April 2019, depts.washington.edu/nwbfch/silver-diamine-fluoride-SDF-for-children-cavities. Accessed 5 Mar. 2020.