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Dr. Elliott A. Schwartz
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Be warned of the media hype ? SDF (Silver diamine fluoride) is not an answer to avoid the drill.

By Dr. Elliott A. Schwartz B.Sc DDS Dip. Paedo.

Articles published in The Globe and Mail, New York Times and other media outlets suggest that (SDF) Silver diamine fluoride can be used as a much less expensive alternative to fixing teeth especially in children. It is stated that this treatment also saves the child from undergoing multiple painful filling appointments or having a general anesthetic.

So what is SDF and why isn't it a solution for my child's tooth problems?

Silver diamine fluoride (SDF) is a topical drug used to treat and prevent dental caries (cavities) and relieve hypersensitivity of the teeth. Silver diamine fluoride has been available in many countries including China, Japan, New Zealand, Australia and others for many decades. This product was recently cleared for sale in Canada in January 2017 for treatment of tooth decay and teeth sensitivity.

Silver diamine fluoride is a metal ammine complex of silver fluoride. It is a light-sensitive liquid with a strong ammonia smell. Silver diamine fluoride (SDF) is a colorless liquid that at pH 10 is 24.4% to 28.8% (weight/volume) silver and 5.0% to 5.9% fluoride. Silver diamine fluoride stains cavities black. A completely darkened cavity is a strong indicator of success.

In my opinion, based on treating children teeth for 47 years, I do not think that SDF is the right solution for children's cavities in Ontario, more specifically in a city with easily accessible dental care. There are articles published by the CDA (Canadian Dental Association) which are contrary to my opinion, however based on my own research and experience this is why I believe this isn't a solution for your child.

When one finds a cavity in a child's baby teeth, most parents want to ensure their children are not in pain from the decay or the treatment and that the child will have a long lasting healthy, beautiful smile. While SDF promises a no drill solution, I found most parents are not pleased with the end results: black teeth. The downside of this product are that it: doesn't treat pain from tooth decay; an unpleasant metallic taste; potential to irritate gingival and mucosal surfaces; and the characteristic black staining of the tooth surfaces to which it is applied. Additionally, a single application has been reported to be insufficient for sustained benefit.

In countries such as China, Japan, New Zealand, and Australia where it has been used for decades, there was limited access to professional dental care or there were limited financial resources to having the child's teeth fixed. The rationale behind using SDF was better to have the child not suffer from dental pain even though the child's teeth are stained black. This solution can be useful in Canada for remote regions where getting your child to a dentist can involve days of travel or a year long wait times to get dental care.

Many parents have asked about using SDF treatments for children which lead me to write this article and heavily research the academic literature. From my interpretation of the American Academy of Pediatric Dentists literature: SDF has limited use for most urban populations. In our practice, the parents' of our patients have a very high expectation that we will restore the beautiful smile of their child. Very few parents would be satisfied that their child's teeth would be stained black until the baby teeth fell out between 6 to 12 years of age. Financial restraints for children to receive dental care in Ontario are minimized since a majority of Ontarians have private dental insurance or can qualify for the Healthy Smiles Ontario dental program.

In our opinion SDF can be considered as treatment for children in the far north with limited access to dental care or as a stop gap procedure till a general anesthetic can be arranged. In Toronto, SDF disfigures the child by staining their teeth black and it does not treat the child who is experiencing dental pain.