CSL 8 SDF (easy)

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

• Silver diamine fluoride (SDF) is a colorless fluoride delivery solution used to arrest tooth decay.
• SDF contains approximately 44,800 ppm of fluoride and 255,000 ppm of silver.
• SDF arrests active carious lesions in dentin.
• The silver in SDF has antimicrobial properties, inhibiting further biofilm formation.
• Fluoride in SDF stimulates remineralization of the affected tooth.
• SDF is an economical and non-invasive way to manage tooth decay.
• SDF is an invaluable tool for treating children who lack cooperation or have disabilities, limiting the options for managing their caries.
• SDF is also a beneficial alternative when restorative options are not affordable or accessible.
• SDF discolors the affected areas of the tooth dark.
• Informed consent from the patient or guardian is crucial.

Indications for SDF Use

• Active carious lesions (frank soft carious lesions in dentin) in primary teeth without pulp involvement.
• Children with limited cooperation or disabilities.
• Deep active carious lesions that need predictable arrest before restorative procedures.
• Difficult to treat cavitated carious lesions where extensive tooth preparation is required.
• Proximal lesions which are inaccessible for restorations.
• Lower anterior primary teeth where restoration longevity is questionable.
• Children with limited access to dental care.

Mechanism of Action (MoA)

• SDF increases resistance to acid dissolution and enzymatic digestion through the formation of silver protein conjugates.
• SDF increases the mineral density and hardness of the affected dentin by increasing hydroxyapatite and fluorapatite formation.
• SDF has anti-protease activity, halting the breakdown of the dentinal organic matrix.
• SDF directly kills cariogenic bacteria.
• SDF-treated lesions are resistant to biofilm formation.

Application of SDF

• One drop of SDF is sufficient for roughly 6 teeth.
• Isolation with cotton rolls is adequate.
• Superficial loose debris should be removed.
• The lesion should be air-dried.
• SDF is scrubbed onto the lesion for one minute.
• The lesion should be gently dried.
• The site should be isolated for up to 3 minutes post-application.
• Post application of SDF, a fluoride varnish may be applied to keep the SDF in contact with the lesion and mask the taste.
• Patients should avoid eating or drinking for 30 minutes after SDF application.

Protocols for SDF Application

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