SDF- Black magic for your child's teeth?
- Rachaita Chhabra
- Jul 2, 2023
- 3 min read
Maintaining optimal oral health is crucial for children's overall well-being and development. In pediatric dentistry, preventive and minimally invasive treatments play a vital role in ensuring children have a positive dental experience.
Dental treatment has traditionally been associated with high levels of pre-operative anxiety, not only in children, but also in adults. The use of an injection to administer local anesthesia and the use of a dental "drill" are among the most anxiety causing experiences in dentistry. Most parents also express apprehension about their child's coping ability on the dental chair.
Here, the use of the magic medicine - Silver Diamine Fluoride (SDF) - will help us tide over these anxiety inducing triggers. SDF application is quick, painless and cost effective.
As pediatric dental specialists, we often see kids struggling with multiple decayed teeth, sometimes as many as 20 out of 20 teeth may be decayed. In this scenario, while doing conventional treatment, we would treat each tooth one by one. The major disadvantage of this, is that decay keeps progressing in the untreated teeth due to the long duration of treatment. SDF helps us to stabilize the oral hygiene status and gain time to improve the diet, oral hygiene and other risk factors that cause caries.
What is SDF?
SDF is a colourless, odourless solution of silver, fluoride and ammonia. It has been used for decades in Japan, China, New Zealand, Brazil and a few other countries, however it was not widely adopted as a treatment modality. Since the past few years, the knowledge and evidence regarding this treatment has increased exponentially, and it is now routinely recommended in the management of severe early childhood caries.
How it works
When SDF is applied on the decayed tooth surface, it interacts with the carious lesion and arrests it.
The Silver ions are antimicrobial in nature and have a bactericidal effect. This means that silver kills the microorganisms it comes in contact with. These dead microorganisms then have a "zombie" effect - they kill the other organisms that come in contact with them. Hence, the bacterial load of the lesion is reduced.
The Fluoride ions help to remineralize the carious lesion. As the fluoride content in the area is increased, the tooth surface becomes harder and more resistant to decay. Calcium fluoride - formed as a result of the interaction between the tooth surface and SDF - acts as a reservoir of fluoride and increases the resistance of the tooth to demineralization.
Thus SDF helps to arrest active lesions and prevents further destruction of the tooth.
Indications
Children needing dental treatment over multiple visits. SDF arrests the decay and prevents further damage to the tooth.
Children in the pre cooperative age group - below 4 years of age - as a way to avoid advanced behavior management techniques.
Children with special healthcare needs.
Children who cannot cope with traditional dental treatment.
Contra indications
High aesthetic demand. The patient should be informed of the discoloration prior to starting treatment. The discoloration will NOT fade with time.
Children with allergy to silver or other heavy metals.
Side effects
SDF stains the decayed part of the tooth black. This colour change is irreversible, and might be unacceptable to parents who have high aesthetic expectations.
Patient instructions
Avoid eating or drinking anything for 30 minutes after the procedure. This will help the SDF to penetrate into the carious lesion.
The tooth will continue to darken for 24 hours after application. This is normal and to be expected.
Routine oral hygiene maintenance - brushing, flossing and use of a mouthwash - will help increase the effectivity of SDF application.
Need for follow up
It is recommended to apply SDF twice a year for maximum benefits.
You will need to follow up with your child's dentist every 3 to 6 months depending on the caries risk of your child, as recommended by the dentist.
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