In August 2014, the FDA reclassified Silver Diamine Fluoride (SDF) as a fluoride, but does that mean dental auxiliaries such as dental hygienists who are authorized to administer fluoride can utilize this product in Texas? The state of Oregon’s Board of Dentistry followed the FDA’s announcement with a resolution to allow dental auxiliaries to apply SDF.

SDF and Silver Nitrate are liquid silver solutions that have both shown great success in treating decay. SDF works by reducing the demineralization process and inhibiting the growth of bacteria and “cariogenic biofilms”. An adverse reaction to some silver solutions is tooth discoloration where the solution blackens the tooth’s dentin and enamel.

In a press release dated May 6, 2015, Advantage Silver Dental Arrest and Elevate Oral Care launched Advantage Arrest silver diamine fluoride (SDF), which:

• “Provides immediate relief from dentinal hypersensitivity.
• Kills pathogenic organisms.
• Hardens softened dentin, making it more acid- and abrasion-resistant.
• Will not stain sound dentin or enamel.”

Silver’s antimicrobial properties have been known for centuries and dentists have used silver to arrest dental decay for over one hundred years. The use of silver in dentistry greatly declined in the 1950‘s and was replaced with surgical means of treating tooth decay. In recent years, silver solutions have made a comeback in use on both adults and children.

Research shows that Silver Nitrate and Silver Diamine Fluoride (SDF) are both safe and effective in treating dental caries, even showing SDF is more effective than fluoride varnish in treating dental caries. Fluoride varnish helps to prevent dental cavities and silver solutions may be the answer to stop active decay. Compared to costly surgical treatments brushing on SDF to arrest decay is comparatively easier, less painful and less expensive.

R. Mike Shirtcliff, DMD, the CEO of Advantage Dental of Oregon, a Medicaid dental insurer, sees SDF as an investment to help those on Medicaid. “Dr. Shirtcliff estimated it would cost $1 billion to provide needed dental care to Oregon’s Medicaid population with the available technology for restorations. [ However,] SDF has great potential as a treatment option, [. . .] you can finally get the disease under control [and] it has the potential to last longer and not re-decay.”

One Oregon family dentist, Dr. Randy Morgan, discusses on his website using silver nitrate on children’s cavities instead of filling them or pulling teeth. “The technique is simple: We use a small brush to paint on the silver nitrate, then immediately seal the area with a fluoride varnish. Once applied, the silver nitrate disinfects and hardens the cavity, which stops the decay process. [. . .] This treatment is fast and easy, and all present cavities can be treated in a matter of minutes. Here’s the best part: no shots and no tears.”

Share with us what you think of Silver Solutions. Could they prove to be the future of caries treatment and reduce the burden of tooth decay for our vulnerable populations? Is the issue of tooth discoloration a marked downside, or do new silver solutions such as Elevate Oral Care’s Advantage Arrest silver diamine fluoride, alleviate that concern? Are silver solutions the future of dental caries treatment or part of the past?

Resources

FDA’s reclassification of SDF as a fluoride could mean new treatment options
Dr. Bicuspid, December 26, 2014
http://www.drbicuspid.com/index.aspx?sec=sup&sub=bai&pag=dis&ItemID=317026\

Silver compounds used in dentistry for caries management: a review
PubMed, July 2012
http://www.ncbi.nlm.nih.gov/pubmed/22484380

How does silver diamine fluoride stop dental caries?
Dr. Bicuspid, March 19, 2013
http://www.drbicuspid.com/index.aspx?sec=sup&sub=hyg&pag=dis&ItemID=312918

Advantage Silver, Elevate Oral Care launch Advantage Arrest SDF
Dr. Bicuspid, May 6, 2015
http://www.drbicuspid.com/index.aspx?sec=sup&sub=bai&pag=dis&ItemID=317807

Silver diamine fluoride: a caries “silver-fluoride bullet”
PubMed, February 2009
http://www.ncbi.nlm.nih.gov/pubmed/19278981

Black diamonds: The case for silver nitrate and silver fluoride
Dr. Bicuspid, February 18, 2015
http://www.drbicuspid.com/index.aspx?sec=wom&pag=dis&ItemID=317334

Cavity Treatment with Silver Nitrate
Newberg Family Dental, August 13, 2012
http://www.newbergcommunitydental.com/cavity-treatment-with-silver-nitrate/

Black diamonds: The case for silver nitrate and silver fluoride — Part 2
Dr. Bicuspid, February 25, 2015
http://www.drbicuspid.com/index.aspx?sec=wom&pag=dis&ItemID=317388