CSL 8 SDF (hard)

Non-restorative Cavity Control Using Silver Diamine Fluoride (SDF)

• Silver diamine fluoride (SDF) is a colorless fluoride delivery solution.
• SDF contains approximately 44,800 ppm fluoride and 255,000 ppm silver.
• SDF arrests active carious lesions, especially in dentin.
• SDF inhibits further biofilm formation.
• SDF strengthens treated dentin, making it more resistant to cariogenic bacteria.
• SDF remineralizes the lesion by stimulating fluoride activity.
• SDF stabilizes the solution with ammonia.
• SDF is economical and non-invasive for carious lesion management.
• SDF discolors the arrested carious tissue black.
• SDF is valuable for pre-cooperative children and in cases where operative care is limited by disabilities.
• SDF is a beneficial alternative when restorative options are unavailable or are unaffordable.

Indications for SDF Use

• Primary tooth surfaces with active cavitated dentinal lesions (frank soft carious lesions), no signs or symptoms of pulp involvement.
• Children with cooperation limited by age or disabilities where conventional operative dentistry is challenging.
• Deep active carious lesions, where clinicians desire to arrest lesion progression before restorative procedures.
• Inaccessible proximal lesions requiring extensive tooth preparation for restorations.
• Multi-surface dentinal lesions, or difficult to treat cavitated carious lesions.
• Lower anterior primary teeth, when the longevity of the restoration is questionable.
• Children with limited access to dental care.

Mechanism of Action (MoA)

• SDF increases resistance to acid and enzymatic digestion via silver protein conjugates.
• SDF increases the mineral density and hardness of hydroxyapatite and fluorapatite formation.
• SDF contains anti-protease activity, which prevents the breakdown of the dentinal organic matrix.
• SDF has a direct antibacterial action, killing cariogenic bacteria.
• SDF-treated lesions resist biofilm formation.

Application Procedure

• One drop of SDF is enough for roughly 6 teeth.
• Cotton rolls are sufficient for isolation.
• Superficial loose debris removal is required.
• Dry the lesion before SDF application.
• SDF application for a minute, followed by gentle drying.
• Isolate the application site for up to 3 minutes post-application.
• Apply fluoride varnish after SDF application to mask the taste and maintain contact with the lesion.
• Patients should avoid eating or drinking for 30 minutes post treatment.

Protocols

• Reapplication every 12 months (annual) or every 6 months (semi-annual).