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An Interview: Silver Diamine Fluoride Use in Today's Dentistry

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.

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