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

Non-restorative Cavity Control Using Silver Diamine Fluoride (SDF)  Learning Outcome Indications and contraindications for SDF Procedure of SDF Recall and follow up 03/11/2024 Non-restorative Cavity Control Using Silver Diamine Fluoride (SDF) sil...

Non-restorative Cavity Control Using Silver Diamine Fluoride (SDF)  Learning Outcome Indications and contraindications for SDF Procedure of SDF Recall and follow up 03/11/2024 Non-restorative Cavity Control Using Silver Diamine Fluoride (SDF) silver diamine fluoride (SDF) (approximately 44,800 ppm) colourless fluoride delivery solution with the ability to arrest active dentinal carious lesions (frank lesions in dentine) In carious lesions treated with SDF, the remnant ionic silver inhibits further biofilm formation and makes the treated dentin more resistant to cariogenic bacteria thereby preventing further cavity formation Paediatric Dentistry 3  While the silver in SDF solution plays the role of an antimicrobial, remineralization of the lesion is stimulated by fluoride. The solution is stabilized by ammonia SDF is an economical and a non-invasive mode of carious lesion management.  it discolours the arrested carious tissue black. SDF is an invaluable tool in the management of carious lesions in pre-cooperative children and in children where delivery of operative care is limited by disabilities. It is also a beneficial alternative when restorative options are not affordable or accessible  Indications Primary tooth surfaces that exhibit areas of active cavitated dentinal lesions (frank soft carious lesions in dentin) with no signs or symptoms of pulp involvement. Children where cooperation is limited by age or disabilities and performing conventional operative dentistry becomes a challenge Deep active carious lesion where the clinician may want to scrub the lesion with SDF to arrest lesion progress predictably prior to restoring it with an intra-coronal or an extra-coronal restoration. To arrest inaccessible proximal lesions where placing a restoration would involve extensive tooth preparation. In multi-surface dentinal lesions or difficult to treat cavitated carious lesions lower anterior primary teeth where longevity of the restoration is questionable. In children with limited access to dental care, SDF is the preferred choice of treatment given the evidence-based outcomes of predictable carious lesion arrest.  MoA Increased resistance to acid dissolution and enzymatic digestions through formation of silver protein conjugates. Increase in mineral density and hardness through hydroxyapatite and flourapatite formation. Anti-protease activity preventing the breakdown of the dentinal organic matrix. A direct antibacterial action killing cariogenic bacteria. Lesions treated with SDF are also resistant to biofilm formation.  The expected concentrations of fluoride ions and silver ions in a 38% SDF solution are 44,800 ppm and 255,000 ppm, respectively The most commonly adopted protocols are reapplication every 12 months (annual application) and reapplication every 6 months (semi-annual application)  Application One drop of SDF dispensed in a plastic dish is sufficient to treat roughly 6 teeth Isolation with cotton rolls is adequate. When required, superficial loose debris can be removed to enable better contact of the SDF with carious dentin The lesion is air-dried, SDF scrubbed on for a minute, and gently dried. The site of application should be isolated for up to 3 min when possible post application. Fluoride varnish can be applied on the lesion post SDF application to keep the SDF in contact with the lesion and to mask the taste of SDF. Patients are advised against eating or drinking for 30 min. Proximal Preparation  Most Important informed consent from the patient or the child’s parent/guardian is essential before the use of SDF