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Silver Diamine Fluoride & No Drill, No Injection Dentistry

Dental Care without a Dental Drill?  Too good to be true?  Not really! In fact, for over 80 years Silver Diamine Fluoride, a pharmacological Cavity Arrest Therapy, has been effective in treating millions of people all over the world, including in developed countries like Japan. In fact, in 2016 FDA awarded SDF breakthrough therapy status as a commitment for its approval as a drug to treat caries lesions (otherwise known as cavities or dental decay) by killing the bacteria that cause tooth decay. SDF is a central part of drill free dentistry at Zak Dental.

 

What is Silver Diamine Fluoride?

Silver Diamine Fluoride is a liquid solution that consists of silver, water, ammonia, and fluoride and is approved by FDA since 2014. It arrests decay by killing the bacteria that cause dental decay. This means many patients who are treated with Silver Diamine Fluoride do not require drilling in order to treat a cavity!

 

Why Silver?

Remember back in the day, babies were fed from silver spoons (the rich ones at least)? Well, that wasn’t just Tiffany & Co propaganda to sell overpriced baby spoons. Silver is an extremely effective antimicrobial agent that has been used in healthcare for hundreds if not thousands of years! So when dental decay is exposed to silver, it kills all kinds of harmful bacteria. But don’t get too excited…sucking on a silver spoon or eating off a silver spoon will not get rid of your dental decay. The silver has to be in liquid form and remain stable (hence water and ammonia) so that it’s ready to do its molecular magic when applied to the decayed tooth structure.

 

Why Flouride?

Our teeth are living organs that require minerals to be strong, so they can accomplish their function of chewing and biting. Fluoride is one of the most important minerals that strengthen the hard structure of our teeth. When our teeth get infected with bacteria, the bacteria start consuming our precious teeth minerals in essence de-mineralizing our tooth structure and making it weak. Once Silver kills these bacteria, the fluoride starts to remineralize the decayed tooth structure and make it as hard as a rock!

 

Is it Safe According to the FDA?

SDF is approved by the FDA and is considered to be extremely safe. In fact, it is recommended to our most vulnerable populations like little kids, the elderly, and even pregnant women. Now, there are a few contraindications such as if you have a silver allergy (one of the rarest types of allergies) or if you happen to have an open lesion in your mouth and/or canker sore. In those cases, your dentist will either ask you to return when the wound is healed OR to protect the area with an extra barrier such as petroleum jelly or vaseline.

 

In addition, when the decay is so deep into the dentin that the soft tissue (i.e. pulp of your tooth has been exposed), it is too late to use SDF. In fact, the use of SDF is counter-indicative and can lead to hypersensitivity/pain. Luckily, dentists are equipped with lots of other traditional procedures that can still save your tooth with root canal treatment, etc.

 

What is the Downside of SDF Treatment?

So what’s the catch SDF? Ahh…yes, of course…there is always a catch. When SDF is applied to a cavity, the silver reacts with the bacteria and decayed tooth structure and it turns black. In other words, SDF transforms your decayed weak tooth area (i.e. cavity) into an antimicrobial super BLACK rock. In fact, blackness translates to efficacy! I know…I know its a bummer, especially in our society where teeth that are anything but white are stigmatized as less healthy or diseased…but if it means you can minimize or in some cases avoid the dreaded dental drill altogether, and skip getting a shot in your mouth and retain your natural tooth structure, it’s still worth your SERIOUS consideration.

But there is another, more important catch. SDF is not a one-and-done type of treatment. It is a Caries Arrest Therapy, meaning that it needs to be repeated over time to sustain its antimicrobial effect. In addition, it works over 80% of the time, but 20% of the time it doesn’t. What this means is that You, our beloved patients, should commit to visiting our practice every 6 months so we can monitor its efficacy and step in with more involved treatment when needed. Luckily, this can be done during your regular dental check-up or cleaning every 6 months.

 

Why Are So Few Dental Offices Offering SDF as the First Line of Defense Against Decay?

The short answer is aesthetics and cultural norms. Black-colored teeth have been stigmatized for Millenials. It’s true, back in the day (before SDF), the darkening of teeth implied disease. In our culture, the obsession with white teeth over the last 50 years has made the SDF blackening effect a hard pill to swallow, apparently much harder than for millions of people all over the world including Japan. So we simply gave up on this miracle solution…because of cultural pressures. And this lack of enthusiasm from the professional and our patients lead to many dental schools neglecting to educate our future dental professionals on this therapy.

 

Can the SDF Stain be Removed?

The SDF stain can not and should not be removed because that dark hard area is what protects the tooth from future decay and strengthens the tooth structure.  However, we can absolutely cover the black anti-microbial rock-like structure of the tooth that has been treated with SDF with tooth-colored restorations like fillings, crowns, and veneers. The good news is that teeth that have been treated with SDF are stronger and require less “drilling” and natural tooth removal than teeth without SDF treatment. 

 

What is an important takeaway here is that while SDF kills bacteria while keeping and strengthening our natural tooth structure on a molecular level, the traditional “drill and fill” dental care drills out the decay. As you know, bacteria are not visible to the human eye…even our superhuman dental eye…so what we tend to do is to remove some healthy tooth structure as well just to be certain that all the bacteria is gone.  And frankly, that stinks for our patients. With SDF-treated teeth, this over-prepping of teeth is NOT necessary! We only need to remove enough tooth structure to do the restoration.

 

Anything Else I Should Know About SDF?

Oh yes, we left the best part for last! SDF has a bacteria zombie effect.  Do you know how zombies (dead) kill the living?  Well.. SDF effectively turns dead bacteria into bacteria zombies that kill living bacteria, this means that the area that has been treated is unlikely to get future cavities. And other teeth are also less likely to get cavities as well. Is that super cool or what?!

 

SDF & No Drill, No Injection Dentistry

Now that you know no drill, no injection dentistry is possible with tools such as SDF, it’s time to learn more about how no drill, no injection dentistry works! Stay tuned for our blogs on Glass Ionomer and the SMART Technique, two other topics closely tied to SDF and your dental treatment.

 

Now What?

Well, now it’s time to find a dental team that values SDF as much as you do now!  If you live in Southern California, feel free to schedule a New Patient Visit with us. Otherwise please follow our blog posts or email us with any additional questions you would like us to answer in future posts.