So you may have recently heard of this new miracle liquid out there that stops cavities from growing… but does it work? The short answer is yes, it does work. But the more complicated aspect of this trending treatment is that case selection is critical.
Silver diamine fluoride is a liquid combination of silver and fluoride that, when applied to cavities, has the ability to inhibit the cavity causing bacteria effectively stopping a cavity from growing. The addition of the fluoride component can help to promote remineralization of the tooth to a certain degree. In other words, SDF aims to harden the soft decay and inactivate the bacteria to prevent the cavity from getting bigger.
While there are many stories of great success, there are also instances where cavities can continue to grow despite multiple rounds of SDF treatment. In these instances, one of two things is typically present.
The first predictor of a poor outcome from SDF treatment is if the cavity is already too large to begin with. When a cavity is already large this usually means that the bacteria has gotten too close to the nerve. This can be detected by either a child having symptoms with the cavity and/or by taking an xray to see how close the cavity is to the nerve of the tooth.
Therefore, if a cavity is already large and close to the nerve of the tooth to begin with, or if the cavity is symptomatic, then SDF is likely not the best treatment solution.
The second predictor of a poor outcome from SDF treatment is if the patient maintains a high carbohydrate/sugar diet and poor oral hygiene habits. In these situations, the plaque and bacteria continue to flourish and attack the already weakened spots on the teeth leading to new cavity progression. In this instance, it is not that the SDF treatment is not effective, it is more so that the oral environment is highly conducive to decay formation and thus the cycle continues to repeat itself.
Therefore, SDF treatment will likely not be successful if a patient continues to have a high carbohydrate diet combined with less than ideal brushing and flossing habits.
When SDF does work, one should expect the area of the decay to become hard, be symptom free, and take on a dark appearance. SDF treatment is ideally done every 6 months until cavity progression has been verified to be stopped or when an alternative treatment method is chosen.
Overall, Silver Diamine Fluoride has shown great success when applied to cavities at an early stage. It can be a great alternative to treatment for those children who would otherwise have a difficult time getting traditional dental treatment done. If you want to know if SDF is right for your child, schedule a dental visit so that your child’s dentist can do a full evaluation to see if it would be a good treatment option. And remember, no matter what treatment is decided on, always be sure that a low sugar diet and good brushing and flossing is part of the long term plan!
Dr. Mikaeya Kalantari has been a practicing pediatric dentist for over 7 years working in both the children's hospital setting and private practice. She has had a wealth of experience treating children of all ages, and medical conditions. When it comes to serving children, she feels the importance of communication between the dentist and parent can not be emphasized enough. Dr. Kalantari practices in her family owned dental office in Mission Viejo, California