Interview with Dr. Debbie Wilson
Dr. Debbie Wilson is a general dentist in the north Toronto area. She
has been practicing dentistry for 34 years. Dr. Wilson is one of the most
preventative focused dentists I have had the pleasure of meeting. She
generously offered to share her insight on treatment with Silver Diamine
Fluoride based on a one-year observation.
1. To start
I would like you to tell me what might be some of the ways silver diamine
fluoride (SDF) has changed your assessment and treatment planning process?
I always have a patient
sign the consent form and encourage the patients to watch the YouTube
video on the application and outcome so they are fully informed on the dark
colouration of the carious lesion. I am using Silver Diamine Fluoride on
accessible root caries and large carious lesions on adults. With
children, I will also use Silver Diamine Fluoride under large caries (provided
there is no pupal involvement) when I have the consent of the parents. I am
able to be more conservative in my treatment planning. When I explain the
advantages/disadvantages to the patients who will benefit from SDF treatment.
2. On a
scale of 0-10 please rank how effective you would consider SDF at arresting
decay? (0 being not effective and 10 being extremely effective)
I rank SDF a 7 on
arresting cavities for the first application, and an 8 for the second
application for lesions I am able to gain access to. If the lesion was covered
by a restoration I am only able to check by taking an x-ray for recurrent decay
and an explorer around the filling.
a)
What types of
cavities do you find the SDF most effective at arresting (surfaces, location)?
I find
SDF is most effective in treating accessible root caries on the mandibular
posterior buccal aspects of the teeth.
b)
What age of
clients have you experienced the effectiveness or non-effectiveness of
treatment with SDF?
The best results are on
patients over 50 years with buccal root caries. It is also important to
place the patients on home fluoride (if over 5 years of age) and review oral hygiene.
3. What ways
do you determine if a cavity is arrested after treatment with SDF?
To confirm a cavity is
arrested after an application of SDF I test hardness with an instrument called
a dental explorer. The lesion would be entirely hard to the touch of
the explorer.
4. How
frequently do you see clients for follow-up appointments to assess the
effectiveness of SDF on cavities?
I encourage patients to return after two weeks after
the first application of SDF. I assess the lesion (again providing I have
access to the area), retreat with SDF and place a restoration. If not, I would recommend re-application every 6
months.
5. Are
dental caries typically appearing arrested at follow-up appointments or are you starting to see signs of
active dental caries?
Approximately, 20% of the
time I am seeing recurrent active lesions on the follow up appointment that
have ranged from 2 weeks to 1 year. I emphasize, these are on lesions
with no restorations.
6. What might be some of the ways this option of
treating dental caries with SDF has impacted the clients and families in your
office?
Patients appreciate the
conservative approach to treating dental caries where possible.
7. Has there
been a specific impact of SDF treatment on a client that may have made you feel
like this option is changing the direction of future outcomes in dentistry?
A 60-year-old gentleman
experienced root caries on the distal of his upper second right premolar.
I applied the SDF prior to restoring the filling with a glass ionomer resin.
After one year, he reports no sensitivity and there is no detectable
decay. The root surface on the distal aspect of the premolar is hard to
examination with the dental explorer and on the x-ray, there is no indication
of decay. I call this success given the alternatives of potentially
losing the tooth or needing crown lengthening. I will be following this case
closely over the next ten years. The patient is also on daily
home fluoride toothpaste and four month recalls.
Please note: Oral Science SDF – Advantage Arrest Protocol
Recommendation for re-application.
After initial SDF application, re-apply SDF again in 1-3 weeks for highest
chance of arresting the lesion hard. To optimize caries arrest, reapply at intervals
of every 6 months OR apply a Glass Ionomer over top to seal out the nutrient
source for any bacteria to survive under the restoration.