Theory II - SDF

What is the only Breakthrough Therapy Designation ever received for an oral care medicine?

Silver Diamine Fluoride

How does SDF work?

Silver ions act directly against bacteria in lesions by breaking membranes, denaturing proteins, and inhibiting DNA replication.

Silver and fluoride ions penetrate ______ microns into enamel, and _________ microns into dentin.

1) ~25

2) 50-200

Fluoride promotes _______________, and silver is available for ________________ upon release by re-acidification

1) remineralization

2) antimicrobial action

The ammonia __________ the ingredients in the solution

stabilizes

Uses for SDF

Dentinal sensitivity

Caries arrest with or without restoration

Prevention around high-risk sites

As a liner under restorations

Indirect Pulp Cap material

Around existing restoration margins

SMART Technique

Occlusal barrier

Application Frequency (caries arrest)

1-4 times annually based on risk

A single application arrests > 80% of caries

A second application arrests > 95% of caries

Application Frequency (prevention)

1-2 times annually based on risk

Contraindications for SDF

True silver allergy

Direct pulpal involvement/exposure

Stomatitis and/or ulcerative gingivitis

SDF and Staining

Does NOT stain sound enamel or dentin.

Does NOT stain when preventing sensitivity.

Does discolor when applied on demineralization.

What to do if stain is an issue

can be covered with Glass Ionomer or other restorative

Potassium Iodide has also been used to reduce the staining

D1354

Caries Arrest

D1355

Primary Prevention/Remineralization: Caries Preventive Medicament Application

D9910

Desensitize

D3210 Indirect Pulp Cap

Indirect Pulp Cap

0792T

Application of silver diamine fluoride 38%, by a physician or other qualified health care professional

SDF prevents _____ % of caries lesions.

61%