WHAT'S WITH THIS SILVER FLUORIDE STUFF ANYWAY?

There has been a lot of time and energy placed into developing new dental treatment modalities for children that are safe, effective and pain free. The new buzz around pediatric dentistry is a product called Advantage Arrest, or Silver Diamine Fluoride. Cleared by the FDA to be sold in the USA as of August, 2014, this product is quickly becoming a must-have for any Pediatric Dentist.

The incidence of childhood cavities is as high as it’s ever been. Children are presenting to Pediatric Dentists under the age of 2 already having multiple cavities. Fixing a tooth is the easiest part of your Pediatric Dentist’s day. Treating your child as a whole is the challenge. For some children, traditional restorative dental treatment (fillings, crowns) may be the best option. Perhaps Nitrous Oxide (happy air) would be effective in helping ensure that these children have a successful, positive dental experience.  For very young and/or apprehensive children who are not candidates for in-office treatment, sedation dentistry may be the answer. When surrounded by the right anesthesia professionals, sedation dentistry is statistically safer than driving in your car. What happens when a child doesn’t fall into either of the above mentioned categories? Perhaps they are too young for sedation. Maybe you as a family simply do not want to have your child sedated for the dental procedure. Aside from simply watching the cavity get bigger, you may have another option.

Silver Diamine Fluoride is a clear, odorless, tasteless liquid. It is applied directly to a cavity with a miniature paint brush after the area is dried completely with air. There is no numbing and no “drilling”. The material kills the bacteria causing the decay and stops the lesion from progressing any further. Does this sound too good to be true? I have personally used this product in my practice and I will tell you that it works. However, as a consumer, you need to know all of the fine print.

• Any cavity that this product is used on will turn BLACK
  • The positive here is that the black color indicates that the product has worked.
    • Consider this: A cavity, no matter large or small, is a bacterial infection of the tooth. Although there may be multiple viable options, emphasis should be on eliminating this infectious process.
  • The negative here is that it does not deliver an esthetically-pleasing outcome.
  • Sometimes, this treatment is used in order to buy time for the child to be able to tolerate traditional restorative dental treatment, such as white fillings, in lieu of sedation. When ready, the black areas can be removed and replaced with more esthetic white fillings.
• Thus far, this product works on cavities located on the biting surfaces of the molars as well as the front/back smooth surfaces of all teeth. More research is being done on its effectiveness on cavities located in between two teeth but for now, the use of this product may be limited to certain specific areas.
• If a cavity is deep enough that it is causing sensitivity pain and/or abscess (infection), Silver Diamine Fluoride is NOT a treatment option for these areas and other treatment options should be discussed with your Pediatric Dentist.
• Silver Diamine Fluoride will stain soft tissue (tongue, cheeks, and lips) black if contact is made, although all areas will return to normal color in 2-3 days. It will permanently stain any clothing material that it comes into contact with.
• This treatment typically takes a minimum of 2 applications, spaced 4-6 weeks apart. The cavity may not be “stopped” after just one visit.
• Similar to traditional dental treatment, a minimum level of cooperation from the child is necessary. If a child is upset or struggling, controlled application cannot be achieved and the desired treatment outcome will likely not occur.
• Insurance may or may not include this as a covered benefit. There is an ADA code meant for billing this particular procedure. However, coverage will be dependent on your specific insurance plan.
  • This is a very cost-effective treatment modality if having to pay out of pocket. Cost is typically around $40/tooth in comparison to $150-$200 filling for the same area.

In conclusion, Silver Diamine Fluoride is a revolutionary product in the world of Pediatric Dentistry, but it’s no magic bullet for cavities! I’ve used it in my practice and have seen it work as advertised. It certainly has its benefits but it also comes with shortfalls. It is a wonderful, conservative form of treatment for early childhood cavities, but it may not be the best treatment option for everyone. It ultimately comes down to patient selection based on age, treatment needs, level of cooperation and provider/family treatment philosophy. Remember to keep in mind that the teeth do not have to stay black for the life of that particular tooth. It can be restored anytime that is appropriate for your child with a white filling or a white crown. The ability to arrive at these conclusions for your child is why a good parent/doctor relationship with your child’s Pediatric Dentist is so important. If anyone has any questions at all about this or any other pediatric dental topic, please do not hesitate to contact me.

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