Hani Mostafa looks at the benefits that silver diamine fluoride can bring.
The chemistry of caries and the use of silver diamine fluoride (SDF) in dentistry to treat dentine hypersensitivity and for caries arrest have always been of great interest to me. Silver compounds have long been used for a variety of medical purposes, acting as an anti-microbial agent and in dentistry for caries management, while fluoride promotes remineralisation of tooth structure.
The potential of SDF
Silver diamine fluoride has come into its own recently and clinicians like myself are realising the important role SDF has to play in minimally invasive dentistry, treating hypersensitivity, and in my opinion, for caries control and prevention.
One main concern of using SDF is that it can turn carious lesions black as a result of the reduction of silver ions to metallic silver and silver oxide over time. To counteract this it is possible to bind free silver ions with an application of potassium oxide (KI).
A new generation of ammoniated silver fluoride, developed in Australia, has addressed the staining problem. Riva Star (SDI) offers a simple chairside procedure whereby applying the KI solution over the silver fluoride, a silver iodide precipitate is formed which then turns clear, resulting in an aesthetically acceptable tooth coloured appearance for the patient.
Rising to the challenges
Since dental practices have reopened after lockdown, clinicians are facing the problem of a significant backlog of patients requiring treatment, and the challenge is to treat those patients using minimal AGPs while following strict safety guidelines.
It is really important that both clinicians and patients are made aware of SDF and KI as a treatment option and what this could do to stabilise our patients’ dentition in a sensible, ethical and conservative way. While Riva Star is only currently licenced for treating hypersensitivity in the UK, I believe its potential is far-reaching in other ways.
With nominal enamel occlusal surface access, I can clean to the protected contact point (matrix band), leave caries of significance towards the pulp and use a glass ionomer composite to restore the cavity. I’ve been preforming this treatment since lockdown, without the ability to use rotary instruments, with no complications and every case had significant caries that would otherwise have resulted in carious exposure of the pulp complex.
At the same time, the desensitising element of SDF literally hardens the dentinal tubules and chemically changes the structure of the caries at the surface, reducing pressure on the pulp complex. This provisional stabilisation work can be left in place until further treatment can commence, while potentially saving the tooth from more complicated treatment in the long-term.
Moving forward
The Covid-19 situation has heightened clinicians’ awareness for the need to stabilise a large number of patients needing essential dental treatment and it has created a massive challenge for us as a professional body. I believe that Riva Star will be instrumental in saving a significant number of teeth within the limitations of the current system and is already doing so in my clinic.