Silver diamine fluoride SDF

SDF black back teeth

What is silver diamine fluoride SDF?

Silver diamine fluoride (SDF) is a product dentists use to treat dental caries. It is new to the US but has been in use elsewhere for decades. SDF application is around 80% effective but teeth with “holes” still need to have a filling and we often use the SMART. It is a great new treatment tool for pediatric dentists.

What does silver diamine fluoride staining on back molars look like?

SDF staining looks black. It is not pretty but it does work. On back teeth it is not a big deal for most patients, however this depends on big of an area is black.

Photo of silver diamine fluoride staining on back molars

What does SDF staining on front teeth look like?

SDF staining on front teeth looks pretty bad IMHO. It looks worse than decay does to me but there may be few options until the child is old enough or mentally ready enough to fix properly.

Photo of silver diamine fluoride staining on front teeth

Silver diamine fluoride cost is usually very cheap in comparison to other dentistry.

Our fee for SDF application is $80 per visit. Some offices charge per tooth and some charge per tooth surface. The silver diamine fluoride ADA code description was not specific on this until recently, therefore how offices charge is still hard to compare office to office. I image offices also charge on how difficult it is to place the SDF, which I think is the most fair.

What is silver diamine fluoride ADA code?

The SDF ADA dental code is D1354, which is currently per tooth. Other dental codes that you can also use are D1999, D9910, and D1208. Those are not the most accurate and my guess is the only people still using them are those that are trying to get more money out of the insurance plan.

What is silver diamine fluoride FDA approval status?

The FDA clearance is for hypersensitivity only. However, dentist in the US typically use it off label for caries treatment. This is exactly how dentists use fluoride varnish.

Where can one purchase silver diamine fluoride?

Most dental vendors sell Advantage Arrest which treats around 250 teeth if you are using one drop per tooth. One drop can theoretically treat up to 5 teeth.

Silver diamine fluoride staining will occur on most surfaces.

Keep it off clothing and all clinic surfaces since it will stain almost everything. However, if SDF touches anything quickly wash with water, ammonia, and or ethanol. It will stain permanently. It will stain skin for few days without harm.

Do we use a silver diamine fluoride staining consent form?

No, rather than more paperwork we simply tell parents the issues of staining and what it is and why we use it. That is good enough in my opinion, but you do need to find if there is a silver allergy. The most likely “bad” thing to occur would be black staining of the skin of the face for a few days, therefore try to be careful with it around skin! It may also sting intraoral tissue and may leave a metallic taste for awhile.

Silver diamine fluoride application steps

  1. Protect patient lips and cheeks with vaseline to help prevent staining
  2. Dry and apply SDF with a mircobrush, however be very careful what it touches!
  3. Should be for 1-3 minutes but in my experience will work in even shorter amount of time.
  4. Wash with water.
  5. Repeat twice a year
  6. Apply glass ionomer over if can or want to. This is the known SMART, which is simple addition to ART.
ART = Alternative restorative treatment, formerly known as atraumatic restorative treatment, is “a dental caries treatment procedure involving the removal of soft, demineralized tooth tissue using hand instrument alone, followed by restoration of the tooth with an adhesive restorative material, routinely glass ionomer”
SMART simply adds the SDF application into the ART.

More information on SDF

AAPD guidelines for SDF to treat cavities in pediatric and special needs patients. AACDP presentation on SDF. Research on decay and all the SDF research.