Dentaltown August 2017 - 91

2.

Your patients will
reject it because of
its poor aesthetics

I attended a 2015 pediatric lecture in
which the speaker, a very well-respected
pediatric dentist, took a completely dismissive stance on SDF and said that parents
would reject it because of the cosmetic
factor-they wouldn't want black teeth.
I beg to differ. When given the option,
plenty of parents choose SDF for their
children-I see such patients daily. The
parents' reasons vary considerably-no
insurance coverage or lack of funds; fear
of sedation; behavioral or special-needs

3.It's only for children

Patients of all ages can benefit
from SDF. The University of California San
Francisco School of Dentistry identified
five indications15 for SDF use:
1. Extreme caries risk, such as those
with salivary dysfunction secondary
to cancer treatment, Sjögren's
syndrome, polypharmacy, aging
or methamphetamine abuse, when
prevention visits and traditional
restorations fail to stop the disease
progression.
2. Treatment challenged by behavioral or medical management,
such as the frail elderly or immunocompromised, those with severe
cognitive or physical disabilities,
and patients with dental phobias
who may not be good candidates
for anesthesia because of medical
complexity.
3. Patients with carious lesions that
may not all be treated in one visit,
such as in the slow-moving pace of
a dental-school setting or county
clinics that could be booked out
for several months, or those unable
to complete treatment in a timely
manner because of insurance or
financial issues.

medical issues; eruption timing; and so on.
SDF advocate Dr. Jason Hirsch of
Royal Palm Beach, Florida, shares a similar
sentiment: "Perception leads to barriers, but
barriers are often overcome with discussion,
education and resourcefulness," says my
fellow Townie. Some parents will still
choose a more cosmetic treatment option,
of course, but giving them all the options
and empowering them to make the decision
is what will set you apart as a practitioner.
The No. 1 reason I see patients for a
second opinion is that they hadn't been
given treatment options-they had been
told it was GA or the highway. Often the

parent's concerns about sedation or general
anesthesia had been entirely dismissed,
but parents who don't want or can't afford
treatment for their children end up hopping
from office to office ... or just disappearing
altogether. In my mind, SDF treatment is
better than no treatment at all.
When it comes to black stains, fillings
or crowns, we shouldn't be the ones to
decide what parents want. We should give
them all the options, review the pros and
cons, and let them decide for themselves.
You might be surprised how many opt for
the less-invasive, less-cosmetic, but highly
effective choice.

4. Difficult-to-treat dental carious
lesions, such as partially erupted
molars, recurrent caries at a crown
margin or root caries in a furcation.
5. Patients without access to dental
care.
SDF has huge potential in our overburdened public health system-it has an
unprecedented ability to help treat decay
in the most vulnerable patients, such as
the elderly and Medicaid population.
Thanks to forward-thinking dentists,
the state of Oregon helped put SDF back
on the map; in January 2016, it became
the first state to reimburse Medicaid
providers for treating cavities with SDF.
Last October, the FDA granted Advantage
Arrest Silver Diamine Fluoride 38% the
"Breakthrough Therapy" designation for
caries arrest, making it the only oral medicine to receive this prestigious recognition.
Adults can also benefit from SDF
treatment to target the disease process
first, and restorative and cosmetic dentistry

second. Because fi llings and crowns are
not cariostatic, much of the dentistry
performed on adults is "redo dentistry"
for margins that are decayed or simply
discolored. Why not use SDF to arrest
marginal decay, then seal the margins?
This has been advocated by evidence-based
meta-analysis, but too many restorations
are being removed, and the death spiral
of redo dentistry is alive and well.16,17 We
must break this pattern of not treating
the disease fi rst.
Why not give your patients the option
of treating incipient lesions at a crown or
fi lling margin in a conservative manner?
Your patients will love you for it, and
they'll tell all their friends.
Also, SDF was cleared by the FDA to
treat dentin sensitivity-just like fluoride
varnish, which holds the same classification
and is also used off-label to prevent decay.
Using SDF can decrease the odds of
recurrent decay and/or postoperative
sensitivity with your restorations.

Learn more about SDF for additional CE credit
Dr. Jeanette MacLean's next online CE course for Dentaltown will discuss the
history and science behind SDF and SMART and will share clinical protocols you
can immediately incorporate into your practice. The course, titled "Silver Is the
New Black: Improving Your Practice with Silver Diamine Fluoride," will be loaded
and promoted on dentaltown.com before year's end.

dentaltown.com \\ AUGUST 2017

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