ingredients
- silver (25%)
- fluoride (5%)
- diamine ~ammonia (8%)
- deionized water (62%)
purpose of silver
antimicrobial. ..
1. denatures proteins
2. breaks cell walls and membranes
3. inhibits DNA replication
fluoride promotes what?
remineralization
purpose of diamine ~ammonia
- stabilizer
2. vaporizes at body temperature
how many mg of silver per drop?
9.5 mg
lethal dose of silver?
380 mg/kg
how many mg of fluoride per drop?
2.24 mg
potential toxic dose of fluoride?
5 mg/kg
lethal dose of fluoride?
~50 mg/kg
how many drops is lethal dose of silver for 10-kg child?
400 drops
how many drops is PTD of fluoride for 10-kg child?
- without 5% varnish: 22 drops
2. with 5% varnish: 17 drops
goals of SDF
- caries control and arrest
2. decrease dentin hypersensitivity
T/F: SDF is more effective than F varnish and interim therapeutic restorations
true
SDF stops and prevents what percent of lesions?
80%
T/F: diet and hygiene must also improve simultaneously with use of SDF
true
contraindications for SDF
- silver allergy
- irreversible pulpitis or pulpal necrosis
- (relative) ulcerative gingivitis
what does SDF taste like?
transient metallic or bitter taste so use fluoride varnish to cover up taste
how much would a drop cost per pt?
$0.60 cents per drop
indications for SDF
- rampant caries/caries control
- difficulty receiving tx
- difficult teeth
- teeth w/ limited time left in mouth
- savvy parents
- SDF results in less need for local anesthesia at restorative visit
SDF can be used on what type of teeth?
- ones w/ dentinal hypersensitivity
- active lesions
- posterior and anterior
- primary and permanent
T/F: SDF requires numbing and/or drilling
false, doesn’t require either
the black color indicates what?
that SDF is working
if accidentally stained by SDF elsewhere, how long before it disappears?
within 1-3 wks
how long should SDF be allowed to dry for?
~1 minute
T/F: smooth and “open” surfaces are better when applying SDF than proximal or occlusal surfaces
true
current guideline for number of SDF applications
apply every 6 months until lesion stable, restored or tooth exfoliates
T/F: SDF needs to be cured with curing light
FALSE!!
why should you not cure SDF?
- increases precipitation of silver out of solution at surface
- inhibits deep penetration of SDF into dentin
when should SDF be done during the appt?
at the end
clinical evaluation of SDF success
- “matte black”
2. lesion hard to Dycal instrument or perio probe
radiographic evaluation of SDF success
- no progression of lesion
2. may have secondary dentin formation
patient evaluation of SDF success
- absence of syms
2. decreased sensitivity
waiting to rinse, eat, drink after application of SDF allows what?
formation of calcium fluoride in saliva
short-term effect on gingiva after SDF application
transient inflammation (24 hr)
long-term effect on gingiva after SDF application
reduces plaque and gingival inflammation where it is applied (antimicrobial)
post-op effect on teeth after SDF application
- functional indicator of effectiveness
2. staining or radiolucency under restoration does not indicate active decay
T/F: composite and glass ionomer bond strength is affected by SDF
false, unaffected
if it is not necessary to remove stain from SDF, why might you need to slightly prep axial walls and/or place opaquer on pulpal floor?
for esthetics
T/F: if there are no symptoms, you still need to excavate pulpally or do pulpotomy
FALSE, do NOT
why would you not need to excavate pulpally or do pulpotomy post-SDF?
SDF causes dentin to lay down a protective layer, like an indirect pulp cap
T/F: it is okay if there is some soft dentin below the SDF hard layer
true
silver modified atraumatic restorative technique (SMART)
SDF + self-curing GIC
SDF’s role in SMART
to arrest and remineralize
GI’s role in SMART
to restore and remineralize
T/F: etch should be used before applying GI or RMGI when using SMART
false, not etch but polyacrylic acid
SDF pros
- quick and painless (non-invasive)
- safe
- affordable
- stops tooth decay and sensitivity, can help prevent recurrent decay
- may help improve trust, compliance, cooperation
- teeth can ALWAYS be restored later
- less need for LA = more volume
SDF cons
- permanently stains cavities black
- does not restore form or fxn (but SMART filling does!)
- requires repeat applicatiosn for max effectiveness
- doesn’t tx teeth w/ infected pulp - dx is important
- not a silver bullet - SDF cannot work alone!
who else can benefit from SDF?
- frail elderly
- immunocompromised
- Sjogren’s syndrome, polypharmacy, xerostomia
- methamphetamine abuse
- dental phobias
- cognitive disabilities
- recurrent decay at crown margins
- root caries
- or nay patient who needs a caries control phase