Silver Diamine Fluoride

Question 1

ingredients

Answer 1

1. silver (25%)
2. fluoride (5%)
3. diamine ~ammonia (8%)
4. deionized water (62%)

Question 2

purpose of silver

Answer 2

antimicrobial. ..
1. denatures proteins
2. breaks cell walls and membranes
3. inhibits DNA replication

Question 3

fluoride promotes what?

Answer 3

remineralization

Question 4

purpose of diamine ~ammonia

Answer 4

1. stabilizer

2. vaporizes at body temperature

Question 5

how many mg of silver per drop?

Answer 5

9.5 mg

Question 6

lethal dose of silver?

Answer 6

380 mg/kg

Question 7

how many mg of fluoride per drop?

Answer 7

2.24 mg

Question 8

potential toxic dose of fluoride?

Answer 8

5 mg/kg

Question 9

lethal dose of fluoride?

Answer 9

~50 mg/kg

Question 10

how many drops is lethal dose of silver for 10-kg child?

Answer 10

400 drops

Question 11

how many drops is PTD of fluoride for 10-kg child?

Answer 11

1. without 5% varnish: 22 drops

2. with 5% varnish: 17 drops

Question 12

goals of SDF

Answer 12

1. caries control and arrest

2. decrease dentin hypersensitivity

Question 13

T/F: SDF is more effective than F varnish and interim therapeutic restorations

Answer 13

true

Question 14

SDF stops and prevents what percent of lesions?

Answer 14

80%

Question 15

T/F: diet and hygiene must also improve simultaneously with use of SDF

Answer 15

true

Question 16

contraindications for SDF

Answer 16

1. silver allergy
2. irreversible pulpitis or pulpal necrosis
3. (relative) ulcerative gingivitis

Question 17

what does SDF taste like?

Answer 17

transient metallic or bitter taste so use fluoride varnish to cover up taste

Question 18

how much would a drop cost per pt?

Answer 18

$0.60 cents per drop

Question 19

indications for SDF

Answer 19

1. rampant caries/caries control
2. difficulty receiving tx
3. difficult teeth
4. teeth w/ limited time left in mouth
5. savvy parents
6. SDF results in less need for local anesthesia at restorative visit

Question 20

SDF can be used on what type of teeth?

Answer 20

1. ones w/ dentinal hypersensitivity
2. active lesions
3. posterior and anterior
4. primary and permanent

Question 21

T/F: SDF requires numbing and/or drilling

Answer 21

false, doesn’t require either

Question 22

the black color indicates what?

Answer 22

that SDF is working

Question 23

if accidentally stained by SDF elsewhere, how long before it disappears?

Answer 23

within 1-3 wks

Question 24

how long should SDF be allowed to dry for?

Answer 24

~1 minute

Question 25

T/F: smooth and "open" surfaces are better when applying SDF than proximal or occlusal surfaces

Answer 25

true

Question 26

current guideline for number of SDF applications

Answer 26

apply every 6 months until lesion stable, restored or tooth exfoliates

Question 27

T/F: SDF needs to be cured with curing light

Answer 27

FALSE!!

Question 28

why should you not cure SDF?

Answer 28

1. increases precipitation of silver out of solution at surface 2. inhibits deep penetration of SDF into dentin

Question 29

when should SDF be done during the appt?

Answer 29

at the end

Question 30

clinical evaluation of SDF success

Answer 30

1. "matte black" | 2. lesion hard to Dycal instrument or perio probe

Question 31

radiographic evaluation of SDF success

Answer 31

1. no progression of lesion | 2. may have secondary dentin formation

Question 32

patient evaluation of SDF success

Answer 32

1. absence of syms | 2. decreased sensitivity

Question 33

waiting to rinse, eat, drink after application of SDF allows what?

Answer 33

formation of calcium fluoride in saliva

Question 34

short-term effect on gingiva after SDF application

Answer 34

transient inflammation (24 hr)

Question 35

long-term effect on gingiva after SDF application

Answer 35

reduces plaque and gingival inflammation where it is applied (antimicrobial)

Question 36

post-op effect on teeth after SDF application

Answer 36

1. functional indicator of effectiveness | 2. staining or radiolucency under restoration does not indicate active decay

Question 37

T/F: composite and glass ionomer bond strength is affected by SDF

Answer 37

false, unaffected

Question 38

if it is not necessary to remove stain from SDF, why might you need to slightly prep axial walls and/or place opaquer on pulpal floor?

Answer 38

for esthetics

Question 39

T/F: if there are no symptoms, you still need to excavate pulpally or do pulpotomy

Answer 39

FALSE, do NOT

Question 40

why would you not need to excavate pulpally or do pulpotomy post-SDF?

Answer 40

SDF causes dentin to lay down a protective layer, like an indirect pulp cap

Question 41

T/F: it is okay if there is some soft dentin below the SDF hard layer

Answer 41

true

Question 42

silver modified atraumatic restorative technique (SMART)

Answer 42

SDF + self-curing GIC

Question 43

SDF's role in SMART

Answer 43

to arrest and remineralize

Question 44

GI's role in SMART

Answer 44

to restore and remineralize

Question 45

T/F: etch should be used before applying GI or RMGI when using SMART

Answer 45

false, not etch but polyacrylic acid

Question 46

SDF pros

Answer 46

1. quick and painless (non-invasive) 2. safe 3. affordable 4. stops tooth decay and sensitivity, can help prevent recurrent decay 5. may help improve trust, compliance, cooperation 6. teeth can ALWAYS be restored later 7. less need for LA = more volume

Question 47

SDF cons

Answer 47

1. permanently stains cavities black 2. does not restore form or fxn (but SMART filling does!) 3. requires repeat applicatiosn for max effectiveness 4. doesn't tx teeth w/ infected pulp - dx is important 5. not a silver bullet - SDF cannot work alone!

Question 48

who else can benefit from SDF?

Answer 48

1. frail elderly 2. immunocompromised 3. Sjogren's syndrome, polypharmacy, xerostomia 4. methamphetamine abuse 5. dental phobias 6. cognitive disabilities 7. recurrent decay at crown margins 8. root caries 9. or nay patient who needs a caries control phase