Dentaltown August 2017 - 90

continuing
education

It's going to run
you out of business

early 1900s.1 It has been used for decades in
other countries including Japan, China and
Australia. In fact, 12 randomized clinical
trials tout its efficacy.2-13
In the U.S., the use of silver products
to treat caries seemed to have vanished in
the 1950s when we introduced "painless"
dentistry with better anesthesia and added
fluoride to toothpastes and water. Apparently,
we thought we would eradicate decay and if
an issue did arise, it wouldn't be painful to
have it fixed. Well, it's 2017 and sugar is king,
and the cavities are rampant-especially in
the Southwest, where I practice. According
to the latest Centers for Disease Control
and Prevention data, 91 percent of the
American population has caries.14 It has
become increasingly apparent that we cannot
simply drill our way out of this problem.
Unfortunately, our prevention programs
(exams, prophylaxis and fluoride varnishes)
aren't cutting the caries incidence rates in
high-risk individuals. There must be a better
way. Unlike surgical dentistry, or drill and
fill, SDF treats the decay-causing bacteria
and biofi lms. Shortly after Elevate Oral
Care's Advantage Arrest SDF 38% came
on the market in 2015, I ordered a bottle
and now use it daily for patients in a wide
array of scenarios. I hope more dentists
will open their minds and expand their
knowledge base by reading up on SDF and
introducing it to their practices. Let us start
by addressing what I consider to be the five
most common SDF misconceptions.

I thought an angry mob was going
to come for me with pitchforks and
torches after my patient's parents told
Times reporter Catherine Saint Louis
that they paid me $25 to place SDF on
their 4-year-old child's incipient carious
lesion. I thought pediatric dentists would
be in a state of panic that they'd be on
the verge of bankruptcy because someone
had helped out a child in a humane and
affordable manner.
Now, I find this misconception
laughable. The procedure takes mere
minutes-often done the same day
as the exam-with little more than a
microbrush. For a measly 50-80 cents
per drop, Advantage Arrest SDF can
treat up to five lesions.
SDF can be applied to incipient
lesions you would normally watch and
check in six months. We offer patients
same-day SDF application on noncavitated incipient lesions. Very few insurance
companies currently reimburse D1354
(caries arresting medicament), but most
parents are more than willing to pay
out of pocket for SDF. Your routine
exam and cleaning then becomes more
productive, and you've given the patient
a better chance of being caries-free at
the next checkup. It's a win-win.
As a pediatric dentist, it's frustrating
to have time blocked out for a sedation

patient only to have the person no-show,
cancel last-minute because of an illness
or violate NPO. Talk about a waste of
time and money! Simple and quick
yet effective treatments like SDF and
SMART allow you to treat more patients
in less time by eliminating the need for
local anesthetic and sedation. Because
SDF is a fluoride, often a hygienist or
expanded-function dental assistant can
apply subsequent treatments to arrested
lesions, freeing up the dentist's time to
examine and treat other patients.
Remember that SDF does not
restore form or function, nor is it cosmetic-there will still be fillings, crowns,
extractions, cosmetic dentistry, implants,
and the like. SDF isn't putting anyone
out of business; it's just another tool
in the tool kit for fighting decay. Any
notion otherwise is simply unfounded.
I now use SDF daily in my practice. We've enjoyed an increase in
new patients, improved retention of
existing patients and increased internal
marketing via word-of-mouth referrals.
I've dramatically reduced our minimal
oral conscious-sedation cases, eliminated
the use of in-office IV sedation and
rarely have the need to refer a case
out for general anesthesia-all while
maintaining a thriving, seven-fi gure
producing practice. (This financial
misconception will be explained further
when discussing Myth No. 4.)

A high-quality HV GIC such as Fuji Equia Forte may be placed as a SMART restoration over SDF-arrested
caries in an efficient, effective and noninvasive manner. Photos by Dr. Jeanette MacLean

AUGUST 2017 // dentaltown.com

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