AAPD issues guidelines for using silver diamine fluoride

The American Academy of Pediatric Dentistry issued new guidelines last week that "conditionally recommend" the use of silver diamine fluoride (SDF) to treat cavities. With this guidance, it's likely that more parents and caregivers will start to hear about SDF—a minimally invasive, painless, and low-cost treatment for cavities.

Used in Japan and other countries for decades, SDF has only been available in the United States more recently. The U.S. Food and Drug Administration first cleared its usage as a tooth desensitizer for adults 21 and older. Some dentists began using it off label for pediatric patients once studies began to show it could prevent cavities and slow their progression.

Cavities are one of the most widespread chronic infectious diseases among children in the U.S. Six in 10 children experience a cavity by age 8. Untreated cavities in baby teeth can spread and cause decay in other teeth, including permanent teeth.

We spoke with James Nickman, DDS, MS, president of the AAPD and practicing pediatric dentist, about the new guidelines.

What did the findings in the review tell you about SDF?
Simply stated, SDF works really well when it's used in the right cases and the benefits of using SDF outweigh the negatives associated with the treatment.

The panel gave SDF a conditional recommendation meaning they recommend using it based on published data that met their stringent standards. As the research grows, I suspect that the recommendation will move to a strong recommendation and become more of a standard of care in some situations.

Are there any downsides of treatment?
The most significant downside is from an esthetic standpoint: SDF will turn the cavity and other early decay black, but it won't affect the healthy part of the tooth. There also may be temporary discoloration of the gum tissues, but that will go away within a couple of days. In the systematic review of research on which the guideline was based, no significant adverse effects were reported.

Comparatively, treating cavities in young children, especially those with special needs often involves sedation or general anesthesia, both of which have additional health risks for the patient.

How will this help close the gap of disparities in pediatric dental care?
It is a painless solution that requires limited cooperation on the child's part. Some pediatric patients, especially those with special needs, may need to have their teeth treated in a hospital setting. Because of funding in some programs, that can be delayed for 3-6 months. SDF is a very cost effective way to halt the disease process before it creates an emergency.

It also opens the doors for dentists to halt tooth decay early in the process and give patients treatment to get them back on track. Silver diamine gives the dentist and the families an option to halt the disease and defer final treatment until the child matures and is capable of receiving treatment in a normal setting without extraordinary measures. We want to make sure that children have a good experience at the dentist, and if they have cavities, this is a painless way to treat them, and make sure they are willing to come back. SDF treated teeth may require definitive treatment at some point in the future to restore function and esthetics.

What are the circumstances that you recommend this treatment option?
SDF is a good treatment option for children who are unable to cope with getting traditional fillings, such as young children and children with special needs, as part of a comprehensive plan. Especially if you catch decay early on, you may be able to maintain the lesion for years to come without giving them a filling. SDF is also useful in halting early decay in the areas in between teeth. In some patients, eventually the tooth will need to be repaired with a traditional filling. In the past, if a family wanted to delay treatment for any reason, all we could do is work with them on diet and home care. SDF is another tool to aid families in preventing the cavity from progressing.

The AAPD recommends every child over age 1 visits the dentist every six months for regular cleanings and checkups and this is no different for those who have cavities treated with SDF. SDF needs to be monitored and re-applied twice a year to have a sustained effect. As the child gets older, their pediatric dentist can share other more esthetic and lasting options for keeping a tooth treated with SDF healthy.

It's also important to note that SDF is not a silver bullet that will fix all cavities in all patients. If the cavity is deep, the nerve is exposed, or the tooth is dying or abscessed, the dentist will need to treat it with traditional methods. According to the review of research, the success rate was 76 percent, which is very positive.

To learn more about SDF, talk to your child's pediatric dentist or visit the AAPD website.