What is silver diamine fluoride (SDF)?

Silver diamine fluoride (SDF) is a clear ammonia solution containing silver and fluoride ions. It has been used for arresting tooth decay and promoting tooth desensitisation.

 

Past researches showed that the effectiveness of one-time SDF application in arresting dental caries lesions ranges from 47 percent to 90 percent, depending on the lesion size and the location of the tooth and the lesion. Reapplication of SDF may be necessary that annual or semi-annual application of the solution is more effective.

 

Advantage of using SDF for arresting caries

  • Non-invasive treatment

  • As a more preferable approach to children, elderly and people with special health care needs

  • No serious adverse events, such as allergic reactions, toxicity or pulpal irritations have been reported in any of the randomised control trials so far

  • The treatment is inexpensive due to the low cost of materials and supplies and relatively short chair time required for application. It eases the economic burden of the communities, especially to the lower-income groups

 

Considerations and reminders before receiving SDF treatment:

  • The carious area will be stained black permanently. Healthy structure of the tooth will not be stained.

  • If SDF is applied to the skin or gums, a brown or white stain may appear that causes no harm. The stain on skin or gums will disappear in one to three weeks.

  • Patients may notice a metallic taste temporarily.

  • It is recommended that no eating or drinking for 30 minutes for the patient after receiving the SDF treatment.

References

  1. Crystal, Y. O., Marghalani, A. A., Ureles, S. D., Wright, J. T., Sulyanto, R., Divaris, K., ... & Graham, L. (2017). Use of silver diamine fluoride for dental caries management in children and adolescents, including those with special health care needs. Pediatric dentistry, 39(5), 135E-145E.
     

  2. Duangthip, D., Chen, K. J., Gao, S. S., Lo, E. C. M., & Chu, C. H. (2017). Managing early childhood caries with atraumatic restorative treatment and topical silver and fluoride agents. International Journal of Environmental Research and Public Health, 14(10), 1204. https://doi.org/10.3390/ijerph14101204
     

  3. Seifo, N., Robertson, M., MacLean, J., Blain, K., Grosse, S., Milne, R., ... & Innes, N. (2020). The use of silver diamine fluoride (SDF) in dental practice. British Dental Journal, 228(2), 75-81.
     

  4. Zhao, I. S., Gao, S. S., Hiraishi, N., Burrow, M. F., Duangthip, D., Mei, M. L., ... & Chu, C. H. (2018). Mechanisms of silver diamine fluoride on arresting caries: a literature review. International dental journal, 68(2), 67-76.

 

Why is SDF important for children oral health? This animation stated the studies from various renowned oral health expertise including JCCOHP In-charge Professor CH Chu who "investigated the impact of SDF use in young children and found it could significantly reduce the incidence of new cavities in kindergarten children. This study was so successful that SDF has now been implemented in community treatment programmes across Hong Kong.”

 

This animation “Silver Diamine Fluoride – Transforming Community Dental Caries Programmes” is based on a webinar hosted by Professor Raman Bedi, during the #DPHTalks webinar series led by World Federation of Public Health Associations and its Oral Health Working Group on 10 October 2019. 

 

To view the scripts of the animation, please click here.

Animation of the webinar, “Silver Diamine Fluoride – Transforming Community Dental Caries Programmes”, on 10 October 2019, lead by World Federation of Public Health Associations and its Oral Health Working Group

The consumption of free sugars and processed carbohydrates has increased around the globe in developed and developing countries alike. Lower-income groups are particularly vulnerable to high dietary intake, and this has created a disparity in caries experience across socioeconomic groups. This inequality has created a global challenge for oral health professionals and so far, few initiatives has successfully managed to address it effectively.

 

In many parts of the world, young children don’t go to the dentist. This can be extremely problematic because when caries go untreated, our research show that affected children can suffer from pain and decreased quality of life. Treatment costs can be high which puts pressure on families, and this is especially prevalent in those belonging to low-income groups.

 

Silver diamine fluoride, or SDF, is a promising new approach to improving child dental care that we argue should be implemented globally. SDF is a clear liquid that combines the antibacterial effects of silver and the re-mineralising effects of fluoride. Numerous studies support the efficacy of SDF for caries in children’s teeth and in the prevention of new root caries lesions. SDF should be used in all dental practices to prevent child dental pain and the need for general anaesthetic.

 

Dr Richard Niederman found that using SDF in community programmes can reduce inequality in oral health among children. The same study also showed that SDF delivers a better cost-benefit ratio. Dr Prathip Phantumvanit showed that a technique called silver ART which is the use of SDF in atraumatic restorative treatment could improve treatment outcomes when compared to ART restoration. Again supporting the use of SDF in dental practice. Professor Chung Hung Chu investigated the impact of SDF use in young children and found it could significantly reduce the incidence of new cavities in kindergarten children. This study was so successful that SDF has now been implemented in community treatment programmes across Hong Kong. Other countries must follow suit. And, Melbourne-based Dr Geoff Knight demonstrated that SDF usage results in a significant reduction in invasive dental treatments and general asaesthetic, as well as in pain and sepsis.

 

SDF is safe, effective, and efficient, and is transforming the community approach of dental care for children, SDF could also increase community support and engagement by helping to reduce dental issues for children whose parents have not traditionally seen dental practitioners. This is why we advocate for the inclusion of SDF in outreach dental programmes globally – especially for young children.

 

© 2020 by Jockey Club Children Oral Health Project