Silver Diamine Fluoride for treating children’s cavities was one of the big stories of last year. And we began 2018 with Silver Diamine Fluoride hitting the news spotlight once again, Jan. 3, on the PBS News Hour. This time AAPD member Dr. Frank Mendoza helped answer a raft of parent’s questions about the newly approved treatment.
Silver Diamine Fluoride Might Mean Less Drilling and Filling– In Certain Cases
The new method for treating tooth decay was first controversially reported as a way to abolish the pain and expense of traditional drilling and filling for cavities caused by caries. However, Dentistry for Children believes every case, like every patient, is individual. When a number of treatments exist, we must explore options, not jump on the newest trend. That being said, silver diamine fluoride is an approved option for some forms of tooth decay. Read on for the latest news about the treatment.
A Little Background for Silver Diamine Fluoride
For generations, dentists have promoted oral health with more fluoridation and less sugar. However, we still see frightening statistics about the most common chronic childhood disease, caries. It is known commonly as tooth decay.
Yes, tooth decay remains a major public health issue in 2018. And we doubt you would be surprised to know “90 percent of all adults have cavities.”
The Silver Diamine Fluoride is a painless treatment with its user-friendly lack of a dental drill. It could possibly assist in defeating those statistics in 2018.
At Dentistry for Children, we first reported on Silver Diamine Fluoride treatment fully two years ago. We realize that the SDF treatment could really help children who have grave difficulty with traditional inject, drill and fill procedures. In fact, some children must face sedation. But in 2018, we might see a big transformation in the way dentists treat some cases of tooth decay.
Silver Diamine Fluoride and the Warm Springs Indian Reservation
Dr. Frank Mendosa has been using SDF for 4 years. And he explains it succinctly. He stated, “We started in 2013 using this.” and “in 35 years, I have not seen anything that’s worked as well.”
His treatment involved using silver nitrate, with fluoride varnish. This is a widely used dental product, to stop tooth decay. His young patients featured extensive caries infections partly due to the fact the water in their area has no fluoridation.
He hastens to tell us the treatment only works for cavities which do not breach the pulp of the tooth.
He explained on the recent PBS news show, “The silver kills the bacteria, and stops new bacteria from growing. The fluoride re-mineralizes, or hardens, what’s left. That hardened material then can be used to — you can actually bond or stick a lot of filling material to that.”
A Case Study for Silver Diamine Fluoride
13-month-old Zavion Wallulatum and his siblings paid a visit to Dr. Mendoza. Zavion sports eight teeth, but he also has decay in four have of them. Dr. Mendoza treated the affected teeth with SDF several times over a course of 3 months.
The decay has stopped. However, there are visible black spots on the teeth, revealing one of the drawbacks to the treatment: staining.
His older sister, Six-year-old Sylvia has also enjoyed the benefits of SDF. However, the dental story is not so good for their older brother Frederick. His cavities started when he was a baby, long before Dr. Mendoza began using the SDF. His cavities became so debilitating that “he ended up under general anesthesia in the hospital,” just to repair his teeth.
Dr. Mendoza stated, “That’s a common story for young children in Warm Springs and in tribal communities around the country, which have high rates of dental decay.”
He added, “Over half of the kids went to the hospital, up until we started this silver nitrate project four years ago.” Then he concludes, “We have seen about half as many kids requiring O.R. treatment since then, and we have changed nothing, other than add this to our program.”
The children’s mother, Nancy Wallulatum, says she doesn’t like the stains. However, “she believes the treatment has kept her younger children from having more invasive work done.”
She said, “It’s really fast. They just come in and out, and then we’re done. I think that it’s really helping them, preventing them to not go through surgery.”
The Slightly Shady Past of SDF
The American Academy of Pediatric Dentistry approved the use of a treatment that combines silver and fluoride last year. This was long after Doctors like Frank Mendoza had already been using the treatments “off-label.” The FDA had previously cleared the formula for reducing sensitivities in teeth. Now its once off-label use for stopping cavities is now its primary purpose.
Some pediatric dentists are lauding the treatment because it is much less painful or challenging for the child. For the parents, it is less expensive than drilling and filling. In spite of these benefits, the Silver Diamine Fluoride treatment only works 80 percent of the time, and scientists do not fully understand the reason.
In 2018, Research into SDF Must Make Strides
A leader in SDF research, Dr. Jeremy Horst is studying the structural and chemical changes wrought by treatment with silver diamine fluoride.
He stated, “We completed a short-term study, which blew our minds. It didn’t look like the bacteria changed very much at all. There were just dramatically less of them. So, it decreased the infection dramatically.”
He stresses the need for more and longer-term studies. He stated, “We need to look at cavities that didn’t stop. Are there other certain bacteria that are making the infections, cavity in the tooth, still grow?” So, questions continue. Meanwhile, back in Warm Springs, Dr. Mendoza remains conservative. He states that the “prevention of cavities should always be the focus, but, when needed, silver is making a difference.”
In the PBS news program, Dr. Mendoza also stated he would not return to dentistry’s old knee-jerk reaction to the discovery of decay, the traditional drill and fill treatment.
He said, “I won’t ever go back to the same way of doing it. I don’t think parents would allow me to because they know that there’s another way to do it. It’s not a silver bullet. It’s not going to stop everything. You need follow-up. You need to start it early.”
Learn more about Silver Diamine Fluoride on our next blog as we continue this story in Part Two of the coverage of this first big news topic for little teeth in 2018.