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I love SDF. I tell my colleagues "I drink the black Kool aid". This is my pitch to patients:
"Sdf has three components. Silver, Diamine, and Fluoride. Silver is used to kill off bacteria. Diamine is a fancy name for a nitrogen containing compound that keeps the liquid very basic, the opposite of acidic, which bacteria don't like. And fluoride strengthens the tooth to become harder than regular tooth and resist future cavities.
SDF has 2 side effects. It will stain your gums a brownish color for a few days and it will stain cavities black. The gum color will go away but the cavity will always be black until we put a filling in it."
I typically will use SDF at an initial new patient exam to arrest caries before scheduling fillings. Small noncavitated carious lesions don't need fillings after SDF but they should be monitored. I work in public health so I see a lot of patients with a lot of dental needs. SDF is great in these clinics.
If you have any questions, please feel free to ask.
Can I specifically request this from my provider? Any reason why any of them wouldn't want to do it that's a legit concern or is there no downside other than some temporary cosmetic effect? Is this only for children's deciduous teeth or adult teeth as well?
I don't see why not. The evidence for treating cavitated caries (like, literally a small hole in your tooth from cavities) indicates that a filling would be better than SDF. But for small non-cavitated lesions (no hole, but can see on the xray there is a loss of mineral structure) then I would recommend SDF and better hygiene/diet habits and reassess.
Hang in there! You could ask your dentist for a prescription toothpaste that is basically just extra good at fighting cavities. Insurance probably doesn't cover the fluoride treatments but you can maybe ask to pay out of pocket?
At your age, your life is changing drastically. Your physical and emotional health are probably getting more challenges at this point in your life. Teeth are a part of that!
My insurance would cover fluoride treatments if needed, plus they’re not that expensive OOP (relative to dental work). But my dentist still doesn’t do them past 18
Colgate Prevident 5000 is what my dentist gives me on request, about $16 and lasts me 6 months perfectly between appointments (use as directed - once a day, don’t need much toothpaste either, and I pair it with another sensitive toothpaste in the mornings). Highly recommended, it made a big difference for me and I wish I had found it sooner. Only reason I knew about it was because of a dental student exam years ago!
>When I turned 18 they stopped and I started getting cavities. I asked for the fluoride. They said no.
I'd hazard a guess that that is not normal. I'm 26 and still get the fluoride every time.
Try another dentist and I would call and ask before you go. Mine offers the regular fluoride to anyone and it was around $70 since it’s not covered in my insurance. I do this every visit. The other best thing is to floss every evening before you brush your teeth.
I know it’s super hard to add something new with ADHD, I have it myself, but if you stick with it and have a healthy fear of dental work and/or big hits to your wallet, I promise it’ll get to the point where your mouth just doesn’t feel right if you don’t. I look forward to it now. The “glide” types of floss are the least annoying and irritating to use for me. I also got a low tier Sonicare. I haven’t had a cavity in maybe 15 years, even with several stints of multiple years of not going for lack of insurance.
I worked at a company that prioritized preventative over restorative dentistry and I do believe it will be more adopted in the next couple of decades. But unfortunately, dentistry isn't profitable unless it is in a managed care setting.
I switched dentists a while ago because every time I went in they "found" something to charge me for. Never a cavity but always "close" that they gladly chatge me hundreds to put a filling in. Place was just a used car dealership selling treatments and surgeries.
My step daughters dentist office was the same
Every single kid that went there was loaded with fillings and caps and pulled teeth.
I hated the place and moved her. Hasnt had a cavity since then somehow. And weirdly, the kids are the new place all have very few of any cavities that need work at all. They even tell us not to worry about work on some baby teeth if they are close to the age of losing them and such.
My daughter chipped a tooth and they flat out told me it would be pointless to fix because she would probably break the veneer too. If she wants a veneer when she is older and more responsible they will gladly do it. Her previous dentist made it seem like her teeth would all rot out if we left the chipped tooth alone.
Some places absolutely only car about money.
Sadly it's the norm with any business where the customer typically doesn't know anything about the product or what's actually needed. Which is why car mechanics and dealers are often so predatory
>Place was just a used car dealership selling treatments and surgeries.
We are thankful for the good and ethical dentists but you are right some of them are just used cars salesmen and even worse,criminals.
[Doing unnecessary root canals on kids](https://ag.ny.gov/press-release/2022/attorney-general-james-secures-over-750000-pediatric-dentistry-group-performing).
[Intentionally damaging patients' teeth so they would charge them and the insurance for crowns](https://www.jsonline.com/story/news/crime/2022/03/11/wisconsin-dentist-guilty-damaging-teeth-insurance-fraud-scheme/7001739001/).
Hmm interesting thought. I would say no. Most cat/dog tooth issues are from periodontal disease, which is the other major disease of the oral cavity, but it works completely differently than cavities and thus SDF wouldn't work for that.
I'm a registered veterinary technician - there is a veterinary dental sealant available but it works differently. It is meant to stop the accumulation of plaque and tartar under the gumline as dogs/cats are typically dealing with periodontal disease. Cavities are not common, especially for cats due to a few factors including diet.
So much this. Ever tried brushing a cat's teeth? My cat loves me and I can damn near handle her however, but forget going anywhere near her mouth easily and often. If even just vets had access to this and could apply it every couple years, it would save so many animal's lives, not to mention our bank accounts
Animals can get cavities, but not necessarily at the same frequency as humans. I'm a registered veterinary technician, and with dogs and cats it's not a common occurrence due to factors including their diet (less sugars than humans) and their mouth microbiome. We see periodontal disease, which is inflammation arising from plaque and tartar buildup which can lead to things like bone loss and infections with time.
There is a veterinary dental sealant available, but it works to stop the accumulation of plaque and tartar under the gumline so it's a bit different.
Oops sorry didn't answer that. Works just the same for people regardless of age. There is limited long term research on it's effectiveness, so I usually reapply it on people in a "2 time initial application" where there is a week or two between applications, then when they come in for their 6 month/12 month checkup I reapply it.
I am pretty sure this is what my elderly father got as a treatment since he isn’t great about his teeth brushing these days and can’t get dentures! Not 100% though.
In the US you need to be a healthcare provider to order it. It's super expensive so it would honestly probably be cheaper to have a dentist apply it.
But if you got your hands on some and smothered it around your teeth... maybe. It will basically stain organic stuff. So if you have food in your teeth it will stain that. So you might get some false positives.
You are more likely to stain your entire mouth and look like you smoked a smurf than you are to use it correctly. This also wouldn't tell you if you have cavities in the contacts between your teeth which would not be visible to you. If you don't mind the staining and lack access to dental care it's a good way to slow the progression of decay until you have dental care. You do have to reapply it every few months. More important is brushing and flossing to avoid forming cavities to begin with.
Since it stains cavities black, can it be applied to the "non-people facing" surfaces (lingual and occlusal surfaces) of the crown in order to check for cavities that are just beginning? My old coffee habit has stained portions of some of my crowns and I'm just wondering if they're really stains or very early cavities.
Further context: I have an MD so I can sorta get a prescription from DMD friends. I have been using Novamin products for years now and floss regularly. I have no plans of using SDF but I'm curious, hence, my question.
It can be used in that way, but it is highly likely to give false positives. Stain from dietary sources can be blackened by SDF while not being caries.
A better detection method would be to take a fine instrument and scrape the grooves that are dark. If it feels hard and scratchy, then it's probably fine. If it feels sticky or leathery, that indicates enamel breakdown from bacteria.
NovaMin and other hydroxyapetite-building products are really good too. There's some early evidence that they're as effective as SDF in some cases. Typically they're even more expensive than SDF.
You can order Novamin toothpaste on Amazon for a reasonable price here in the states (Sensodyne with Novamin to be exact). I've also been using the Italian version of BioRepair toothpaste that I order on Amazon for a decent price as well. They've helped tremendously.
I'd have no problem applying SDF around crown margins that are questionable for leakage. I'd want a dentist or hygienist to apply it because it's a bit technique sensitive because you'll want to avoid getting it on soft tissue so that means retracting the cheek and tongue and staying above the gingiva as much as possible. I wouldn't apply it on my own teeth and I'm a dentist.
Are you paid a flat salary being in public health? Most of the private dentists seem to be reluctant to use it because if they really utilize SDF it would significantly reduce revenue.
Hah, you make a very good point. Most dentists are on a business model of costly procedures. Preventative medicine is not revenue generating model of care. Maybe in pediatric dentistry mindset and model of care is different.
>Preventative medicine is not revenue generating model of care.
This sentence is evil. It should be about the quality of life of your patients, not what makes the most money.
That's assuming a lot. Public health uses it a lot more because of the demographic. Lower income, lower dental IQ, more cavities. Alongside cultural differences on the importance of oral health, patients can come in for a new patient exam and then not return for a few years. Private practice, patients are well insured, are paying out of pocket and actively seeking care. More motivated.
SDF slows the progressions of cavities. Cavities that form very slowly over months and years. Private practice you will get them taken care of promptly from the practice scheduling and motivation of the patient. Public health may take more time as there are more people trying to access fewer resources.
There is no point in using SDF in private practice as patients that receive regular care will not have many cavities and any that form can be taken care of quickly or remineralized.
If Dentists were concerned about sdf reducing revenue, they wouldn't tell people to brush and floss. Proper oral hygeine would decimate the dental industry over night yet people continue to forget to brush and floss.
You're asking a very ignorant question for someone with so much knowledge over dental practices and protocols.
SDF was absolutely fantastic when my 2 year old had a cavity. I was so thankful that our pediatric dentist recommended it. It was much less traumatic than getting a filling. My kiddo is almost 8 now and they have "reactivated" it (reapplied) every 6 months since she had it done. That cavity spot was rock solid. About a month ago the dentist added filling material on top, but there were no shots or drilling bc the cavity had been arrested long ago.
Anytime I've asked about any 'alternative' ways with my dentists. I always get the 'everything you read about is just total fake and only the traditional stuff works' and they make me feel like I just 'believe anything I read on the internet'.
That attitude seems pretty common and has turned me off from any medical professional, dentist, or otherwise.
How do I find dentists or other medical professionals that are interested/curious about newer treatments or procedures? Even if experimental and unproven I might be interested in it if it's accessible, if the risk factors or other things are appropriate.
It's not like I'm approaching it like I'm approaching it naively "I read X can fix this, can you do X". I just often ask generally if they heard of it, or what are their thoughts on Y, even just asked open endedness things like, is there anything that looks promising that might be available in the future. They all seem bitter and close minded on anything that isn't something they are already doing, like all medical tech is just 100% locked in as-is and they don't even want to learn something new. Maybe they just don't want to talk to me about it, which is fine, but most just seem generally hostile and immediately look down upon me for even mentioning it.
I have severe enamel hypoplasia and have only six original teeth left (22 have crowns 18 had to have root canals. Yay genetics.)
Would this treatment be something good to inquire about for my last remaining whole teeth?
Yeah for people with hypoplasia any aggressive preventive treatment is worth considering. Depending on the type of hypoplasia (the qualitative properties of your enamel) it may stain your teeth more than regular enamel. I would hit the prevident5000 toothpaste hard and maybe do fluoride trays every so often (although I'm not aware of research on this last point, so the effectiveness may be lacking, but the science seems sound)
Any type of tooth! It can stop existing cavities by killing off those bacteria and making a shell of hardened tooth to prevent future cavities. It's not 100% effective in every situation though.
Findings in title quoted from the linked summary^1 and its hyperlinked journal paper.^2
Excerpt:
>In a study of nearly 3,000 schoolchildren, silver diamine fluoride—a liquid that is brushed onto the surface of teeth to prevent cavities or keep them from worsening—was as effective against cavities as dental sealants, the standard of care.
>The findings, published in *JAMA Network Open*, offer an efficient and cost-effective approach to improving children’s oral health through school-based care.
>In 2017, NYU College of Dentistry researchers received funding from the Patient-Centered Outcomes Research Institute (PCORI) to run the nation’s largest school-based cavity prevention study, which they named Caried*Away*.
>The study included 2,998 children in kindergarten through third grade at 47 New York City schools. The schools—which serve a racially diverse group of students, most of whom are from low-income families—were randomized to receive either the simple or complex treatment.
>Upon visiting each school, the clinical research team—which included a supervising dentist, dental hygienists, registered nurses, and assistants—did baseline exams to measure any tooth decay, and then applied fluoride varnish and either sealants or SDF, depending on whether the school was assigned to receive the complex or simple treatment.
>
>The initial visits took place in 2019 and early 2020, and were paused when the COVID-19 pandemic temporarily closed New York City schools and halted all school-based care.
>Two years later, schools allowed the clinical research team to resume, and they returned to each school for follow-up visits.
>The researchers found that both the simple and complex treatments were successful: just one cavity prevention treatment prevented more than 80% of cavities (81% for SDF and 82% for sealants) and stopped half of cavities from progressing (56% for SDF and 46% for sealants).
>“Without prevention, dental cavities grow continuously if not treated. One Caried*Away* cavity prevention treatment, provided just before schools closed during the pandemic, was remarkably effective over the following two-year period,” said Richard Niederman, DMD, professor in the Department of Epidemiology & Health Promotion at NYU College of Dentistry, co-principal investigator of CariedAway, and the study’s senior author.
>“I know of no other dental preventive intervention that had this great a beneficial impact across the pandemic.”
^1 *School dental program prevents 80 percent of cavities with one-time, non-invasive treatment*, New York University, 9 Feb. 2023, https://www.nyu.edu/about/news-publications/news/2023/february/school-dental-program-prevents-80-percent-of-cavities.html
^2 Ruff RR, Barry-Godín T, Niederman R. Effect of Silver Diamine Fluoride on Caries Arrest and Prevention: The CariedAway School-Based Randomized Clinical Trial. *JAMA Network Open*. 2023;6(2):e2255458. *https://doi.org/10.1001/jamanetworkopen.2022.55458
*Corrected a typo.
Permanent stains or removable? I've been using chlorhexidine rinse off and on that does mildly stain them with tiny brown lines, but it's easily removed at the dentist.
In Hawaii, certain anti-fluoridation groups gained power to prevent fluoridation of most of the water systems. The Honolulu city council banned any water additives in 2003, essentially making water fluoridation illegal on Oahu, the most populous island. Public health officials and dentists want to reverse the ban, but are blocked by long-serving HI State Senator Mike Gabbard (yes, that's Tulsi Gabbard's father).
Sen. Gabbard's justification for banning water fluoridation is that the water should be "pure" and he says it's unnecessary because of treatments like fluoride tablets and brushed-on fluoride treatments like those in this study. But this approach has made it more likely that children in poorer families get tooth decay because they have less access to dentists, and Hawaii overall has some of the worst dental health in the nation.
The only population on Oahu that gets fluoridation is military families living on base. Dentists here have noted a distinct difference between the teeth of children living on military bases and the general population, where military base children have far fewer cavities.
But with the recent Red Hill water supply scandal (where the US Navy leaked fuel into the larger Oahu water supply), it's hard to tell the local populace that the US military is giving their population healthier water. So I see the local politicians trying to push these topical fluoride treatments more.
So do they also ban water disinfectants too? I can't imagine a tropical area like Hawaii without chlorine or chloramines bodes well for reduction of pathogens.
My mom had awful cavities when she was a child and says the single biggest reason the later generations didn't have such issues is because of fluoridated water, not better brushing or dentists. If you notice, a majority of old timers have extremely poor teeth
I got veneers and was asked what colour I wanted them, so of course i got them natural off-white because bright white teeth are just too much and don’t even look good
>I’ve had dentists tell me not to use whitening strips because they damage your enamel
[Well, they're wrong.](https://pubmed.ncbi.nlm.nih.gov/15934684/)
There's a confusion here over different whitening products. Whitening *strips* generally whiten with hydrogen peroxide, which is fine. Whitening *toothpaste* usually whitens by abrasion, which is bad.
I like that study, and I just skimmed through it, but there is one very important thing about it that people should be aware of. It's listed right at the bottom...
> DISCLOSURE
> The authors work for Colgate
I'll take another look at it later when I have some time as it looks like a decent test, but people should be aware of a bias there.
EDIT: While there is a bias in this study, I also want to point out that this IS a peer-reviewed study from the Journal of Esthetic and Restorative Dentistry (VOLUME 17, NUMBER 1. 2005). This is why I'm very interested in the results, but I'll need more time to digest it, unlike the teeth in the study (pun intended).
Of course they're going to say that, they're very expensive whitening treatments that are completely uncessesary except for aesthetics. They are going to try their best to avoid saying anything that might put you off of purchasing
Interestingly tooth whitening is effective to treat gum disease, it was discovered as a side effect of a gum disease treatment by an orthodontist who put peroxide in a retainer, it’s not sensible if you have any cavities though.
Don’t get sucked in to do Zoom whitening. It looks great but holy f I felt like I’d be biting into ice cream with tooth sensitivity for 48 hours. It was so unpleasant I will never do it again although my teeth were blindingly white that 48 hours or tooth nerve pain was an agony I never want to feel again. And I’ve given birth. The zoom whitening is my pain threshold line.
Day to day life would destroy it. It's essentially a scam, to me personally. Like, skin gets darker in the sun. It just DOES, and you can barely do anything to prevent it. You have to be a hermit.
The tooth equivalent of that is not eating to maintain the white. Not doable. Unless you wax and ceramic coat the teeth or something magical. So people have to keep coming back to get another refresher treatment. So, scammy.
That's because in America, it's expensive to become a dentist, expensive to maintain a practice, dental insurance sucks even worse than Medical insurance, there are not public subsidies, so all dentists are required to run like small businesses with low margins
It’s really an apples to oranges comparison. Dental insurance is not true insurance. It’s more of a discount plan. The cap, usually $1500 a year, hasn’t gone up in decades. I hate having to figure out with the patient what can wait for the next year without hopefully getting worse. Dental insurance for the dentist is more like a really expensive marketing strategy since reimbursements to the dentist are usually about 60 percent of the full fee for a service. Those reimbursement rates are not keeping up with inflation and in some cases are lower than they were a decade ago. I also have to pay administrative staff to stay on top of ever more easily denied claims. It all around blows.
That being said, I never push whitening and let the patient bring it up themselves. Rude.
It's not just the dentists. In fact I'd say the dentists are just following the general culture, which is obsessed with having perfectly straight and white teeth.
Teeth whitening and other cosmetic procedures is major $$ for dentists, so some dental practices push it hard on their patients, and don't give a damn if they are being manipulative about it. If they continue pitching that to you then I would leave the practice. I just left a practice for using similar tactics, they pretty much were harassing me at every appointment to get my teeth whitened, even after I pretty directly told them to cut it out.
Read up on how the American Dental Association has, for more than half a century, been successfully lobbying to keep dental services from being covered by to Medicare (with the exception of very limited situations) if you want an interesting side read on how the dental community will literally downplay the health benefits of dental care when it suits them. Which makes it even more disgusting when they push cosmetic procedures on you to line their pockets, claiming that they have your best health interests in mind.
There are ethical dentists out there, but seemingly harder and harder to find these days.
For what you ask? Was it a private care facility? That's why.
One dentist on youtube said his colleague gives root canals for everyone, because that's the best business decision for them. He got some 200 k student loans to pay off.
She’s probably in a high pressure sales enviro. If your teeth and gums are sensitive after it’s not because of the polish. Those rubber cups are very soft. Chances are high the scaling process is what causes the sensitivity. Your teeth probably were whiter after the fact, especially if you had stains, but it’s hard to notice because it’s subtle. Take a before/after pic if you don’t believe me. Am hygienist and I deal with heavy handed hygienists all the time.
My dentist is rather against whitening treatments.
He and I were having a convo about my attempts to find an Enamel Protection toothpaste that didn't have Whitening as a feature, too, as every single damn toothpaste on the shelf seems to have whitening agents. He railed for a moment about how ridiculous it was to have a whitening agent in an enamel/sensitivity toothpaste because the actions are opposites!
I'd be concerned that your hygienist does not have the long term durability and health of your teeth in mind.
I’ve been meaning to take better care of my teeth, and you seem to be doing really well - can you tell me if the water pik is a good alternative for normal dental floss? I loathe flossing with a passion, I have a small mouth and trying to get half my hand in to floss between teeth is gruesome and hurts my jaw. I’ve considered one of those water ones many times - do you feel like it can replace traditional floss?
The thing about flossing is you need to get under the gums along each tooth. The same when brushing, you’re really trying to massage the bristles where the tooth and gum meet on both sides to remove food etc.
Waterpik is better than nothing but flossing is golden in maintaining healthy teeth and gums.
I can't speak to if it can totally replace the benefits of regular floss but it's certainly better than not flossing at all. My dentist (not this hygienist in this anecdote) told me to get it because I was doing chemo. It was less likely to give me an infection or bleeding like flossing could (most chemo causes a lot of dental/mouth issues). I like the water pik for things like popcorn since it doesn't push it into the gums if you get something stuck.
My hygienist told me you still need to floss. The waterpik is going to reach some areas floss will not, but the floss gets into areas (mostly tight areas between teeth) the waterpik will not. Also, the small mouth thing could be a problem; I find it more difficult to fit the waterpik than to floss. Do you use floss piks or traditional string floss? If you aren't already using disposable floss piks, total game changer for me versus the long strand of floss.
Teeth are generally going to be sensitive after a cleaning regardless. It's not like she damaged your teeth with the heavy grit polish. Sounds to me like she asked if you wanted to get your teeth whitened to remove the stains, listened when you said no, and then tried to help as best she could. All without damaging your teeth or health.
Bad news, pushing for whiter teeth not limited to American dentists. Had the exact same "problem", though for me the offered solution was "drink less tea". Yeah, and get into coffee?
Yeah, got the heavy grit polish every time, with the temporary sensitivity increase as well.
Also, whitening **will** affect your tooth health, and not in a good way.
As a hygienist, if we don't get the stain off the dentist comes in to do their exam and tells us we didn't do a good job. I can respect that you don't want to do whitening but removing surface stains is part of our job. Generally I use pumice powder if the stain is very difficult.
Hygienist here, light-moderate-heavy stain can lead to decay, especially on the chewing surfaces of molars with deep grooves and fissures, don’t think it’s necessarily dentists obsessed with perfect white teeth but rather being proactive about possible decay later on!
Stain on the teeth has a rougher surface texture compared to clean enamel, it attracts and holds plaque and bacteria more easily. So there are non cosmetic reasons to remove significant staining on teeth.
The majority of patients are aware of discoloration/staining. Mentioning tooth whitening procedures then dropping it when a patient isn't interested seems like a reasonable approach to me.
I think that's more drs and hygienists taking what they think matters to people and doing something about it. They are probably just responding to all the inquiries to get their patients teeth whiter
If there was some amalgamation of chemical to keep my teeth from rotting aside from regular dental hygiene, I really don't care if they turned it black or whatever. Living with just 10-20% salivary glands has humbled my appreciation of dental practice.
This is different than a sealant. A sealant protects a tooth and covers it. This desensitizes and treats decay.
It could be used as a topical preventative. Sealants using glass ionomer are also an option if your concern is GMA leak.
I use it as such. I have two specialties as it relates to children and dentistry and their health.
SDF is the best medicine. It keeps children out of operating rooms. It helps kick the can down then road until a child is more cooperative.
Next.
Check out THE HALL TECHNIQUE.
THIS IS THE FUTURE.
Why do we not use sealant or anything else like this for adults?
I use prevident at the moment, which is fine but I'd rather have some barrier that also protects?
We do place sealants on adult teeth. Younger kids tend to get them because they’re not good at taking care of their teeth. Insurances generally don’t pay for them after a certain age but they can be done for adults too.
I’m confused as to way you said to check out the Halls technique, we’ve been capping for so long and this seems the same, maybe I’m confused on how it’s applied and that’s the difference but it’s a cap like the others I’ve seen so I’d imagine it has the same benefits as caps we’ve already had. Could you explain better why this is the future?
Pediatric dentist here… as someone who uses SDF every single day, it is certainly a tremendously valuable resource particularly for children who cannot cooperate for traditional treatment. Having said that in front teeth a black stain in contrast with a white tooth is horrendously ugly to the point I very rarely recommend it (even after parents consent they often regret it). In back teeth the difficulty is isolation (SDF is supposed to be applied to a completely dry tooth). The issue is if the child cannot cooperate for traditional treatment, then usually they cannot hold open for an ideal, isolated application of the SDF. Finally, SDF is to be reapplied every so often and is largely dependent on patient compliance more so than traditional fillings. Terrific material for sure, but not without its limitations.
Also sealants are a preventative treatment for teeth without decay. If handled properly, current dental literature shows no complication with BPA. Moreover SDF is not an alternative to sealants because it is not a preventative treatment but rather one that works on a tooth that already presents with decay.
Do you have any adult dentist colleagues that use SDF regularly? I'm neither a kid or elderly but I'd still much rather have a black stain on my back teeth at least rather than the old drill/fill/cycle of tooth destruction.
90% of the time it slows the progression of the cavity instead of fully arresting it.
Short answer is no but worth noting state insurance only covers SDF on baby teeth of children 6 or under. Which is ridiculous but that's currently where we're at at least in NJ
Leave it to reddit that the top comment is blatant harmful disinformation. Sealants do not slowly release BPA "or other material" into the patient. There is some material in sealants that uncured can react with saliva to form BPA in **trace** amounts, but this is only present when the sealant is initially placed and has **zero** long term impact on health. It's not even present in blood or saliva samples taken 6 months after the sealants are placed.
Get sealants for your kids. First molars are the cornerstones of the adult dentition and they are the first permanent teeth to erupt. It could save their teeth as adults for years.
The problem is that a sealant can be used both preventatively and curatively. You can apply it and not “have” to monitor it.
SDF is curative in early carious lesions and is not preventative in the sense sealants are. The title is just misleading to a degree. If a hole has started to form and you apply SDF, it counts as “preventing” it.
Both techniques have a use case. For example, a rural community that has visiting dentists every 6 months. Or poorer countries that receive volunteer trips. Fissure seal all adult molars. Place SDF on carious lesions.
>**LePhatnom**
>The problem is that a sealant can be used both preventatively and curatively. You can apply it and not “have” to monitor it.
>SDF is curative in early carious lesions and is not preventative in the sense sealants are. The title is just misleading to a degree. If a hole has started to form and you apply SDF, it counts as “preventing” it.
>Both techniques have a use case. For example, a rural community that has visiting dentists every 6 months. Or poorer countries that receive volunteer trips. Fissure seal all adult molars. Place SDF on carious lesions.
From the linked content,^1 that I quote in my excerpt comment:^3
>The researchers found that both the simple and complex treatments were successful: just one cavity prevention treatment prevented more than 80% of cavities (81% for SDF and 82% for sealants) and stopped half of cavities from progressing (56% for SDF and 46% for sealants).
^1 *School dental program prevents 80 percent of cavities with one-time, non-invasive treatment*, New York University, 9 Feb. 2023, https://www.nyu.edu/about/news-publications/news/2023/february/school-dental-program-prevents-80-percent-of-cavities.html
^3 https://www.reddit.com/r/science/comments/1107x6h/a_single_dose_of_noninvasive_dental_treatment/j87icod/
Just finished reading the study and note one particular issue.
Both sealant and SDF treatment is combined with 5% fluoride varnish.
The problem here is that sealants have been proven to work in the absence of varnish. Varnish itself and nothing else also drastically decreases cavities by approximately 1-2 per year when applied at a certain interval (cannot recall how often it is. Either 6 or 12 monthly).
So can you really postulate that SDF works better than sealants alone in preventive care?
Further study is needed in SDF alone in prevention- i cannot for the life of me think of the mechanism of action though. I can however, tell you how it stops existing decay.
i dont see why you think that would be an issue. sealant + fluoride is the standard of care and recommended treatment by the CDC.
even if you think sealant works fine without the fluoride, how exactly does that negatively affect the interpretation of these results? The study is demonstrating that SDF+fluoride varnish is non-inferior to sealant+fluoride varnish. why would they not include fluoride varnish in the experiment. no one said sdf is better than sealants alone. the study demonstrates sdf+fluoride is not inferior to sealant+fluoride. these are the two relevant conditions.
there are also multiple publications over the past decade that have shown just what you are asking for, comparing sdf to sealant without addition of fluoride, and every single one ive seen shows sdf is effective at treatment and prevention (when prevention was assessed).
this also doesnt address what you said in your original comment in which you state SDF is not preventative, while sealant is. Which is just wrong.
SDF is great and has its uses however many parents are not thrilled by the staining. It turns carious lesions black.
[Google images SDF staining](https://www.google.com/search?q=sdf+staining&client=safari&hl=en-us&source=lnms&tbm=isch&sa=X&ved=2ahUKEwjNyNif14_9AhUsMjQIHZteBHYQ_AUoAXoECAEQAw&biw=1366&bih=917&dpr=2)
How in the world is this a top comment, including a dental sealant that "slowly releasing BPA"??? This is a false statement that likely came from a holistic dentist that practice non-evidence based dentistry or turn to evidence that aren't even supported. That being said, silver diamine flouride is an amazing treatment (some may even consider preventative) of caries, especially for pediatric patients without permanent dentition since it stains unconditionally.
> Do you have any good further reading sources concerning the use of BPA in sealants?
[Here's a link.](https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/resources/research/oral-health-topics/201608_ppr_bisphenol_a_released_from_resin_based_dental_sealants.pdf?rev=36b75ab425a148b9946336388c99e232&hash=2538570AE98EFA3710CA15F69F9D68C7#:~:text=By%20comparing%20the%20overall%20daily,when%20measured%20after%2024%20hours.) Looks like they've stopped using some of worse stuff and current versions leech a level of BPA that is negligible.
Such an embarrassment how slow dentists have been to accept SDF, negligence really.
It's good for all ages not just kids or elderly, most people would prefer a small black stain on a back tooth than an invasive filling that has to be redone and eventually ends in tooth loss. Problem is SDF is too effective, cheap, and easy=bad for business.
Hygienist here. Sealants are still the #1 most effective way at preventing dental caries in children. If you have a molar with a deep pit or fissure on it, you WILL get a cavity on it if the end of the fissure is thinner than the bristles of the tooth brush
Dentists who want to be unscrupulous wouldn’t do so by doing a ton of unnecessary small fillings. As far as dental procedures go, a filling is about the most work for least pay of almost anything you can do
My instant thought is, could this be applied on a dog's teeth? For anyone with small dogs, their teeth are generally awful and they need regular dentals done. By the time they're in their teens it's common for them to have very few teeth, even with regular tooth brushing at home.
Obviously the dog would need to be unconscious or immobile (one dog is given a 'relaxer' when getting scans that's safely used), but if it could have similar results to those in kids, it could be a game changer.
I'm guessing it's a diet issue. Cavities in humans is a diet issue, it wasn't as big of a thing in preindustrial societies.
Humans choose not to eat our traditional diet, and we do all these workarounds. Dogs should just have their appropriate diets, but it's generally super expensive, with many breeds having raw meat diets as their optimal diet.
Small dogs can't chew the harder kibble or raw bones that would normally clean their teeth. It's harder to give them a natural diet because their breed isn't natural.
My dog (Chihuahua mix) is turning 13 this year and his doctor was astonished at how healthy his teeth are, especially for his size/breed (never had a cleaning in his life).
He only eats wet food, but his favorite treats are carrots so now I'm wondering if crunching on carrots has helped keep his teeth clean in some way.
I think you’re onto something there! I’m convinced that my dogs’ teeth keep clean because they gnaw on rope toys (which I KNOW they shouldn’t have btw). They only get toys when they’re next to me and any fibres that come off, I steal. But because they’re softer than hard toys, they can sink their teeth into them. They do get stinky fast, so I buy them often. I can def see the crunchy carrots cleaning a small dog’s teeth.
I use it as part of a comprehensive caries management approach. Many cavities can be arrested or even reversed if caught early enough. The key here is early diagnosis.
Magnification, diagnostic lasers, IR imaging, electronic caries detectors are among the excellent tools in the modern dentist’s toolkit.
SDF is an excellent part of this approach.
Here is my website’s page on the subject if interested. https://www.laserdentistbaltimore.com/filling-free-decay-management
SDF is amazing. I’ve seen it arrest caries in small children who couldn’t tolerate treatment at such a young age.
It’s also great for desensitization if you have abfraction (which I do).
Didn't say that: but the two groups historically resistant to treatment are kids and seniors with cognitive decline.
My adult son has SDF as do many other adults.
My son had SDF treatment on a ton of teeth; I had to take antibiotics while pregnant and he was born without enamel in a lot of places. It’s not the most slightly solution, but extremely non-invasive and has been stable for 4 years now.
Both antibiotics and high fever are considered prenatal risks for enamel hypoplasia. I had both during my pregnancy, so cannot honestly attribute to either with specificity- just did so here for the sake of staying brief and on topic.
I was on amoxicillin- if I remember correctly, my child is near 5 now- preemptively (pericarditis) for dental surgery early in my 3rd trimester.
Prenatal exposure to antibiotics:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3909430/
Prenatal fever and association with enamel hypoplasia:
https://journals.sagepub.com/doi/abs/10.1177/00220345530320041801
This stuff is a godsend, I use it quite often on kids. I find it especially useful in younger (4-6 yo) kids who have never had dental treatment, and they have incipient to moderate levels of decay in between their primary and/or adult molars.
It's still useful in adults, and I use it in areas where access to fix decay would be difficult.
I mean, I'm not thrilled by these results. The absolute risk reduction was 0.11. They didn't state it in the paper, but this means the number needed to treat is ~9.1. That means, on average, you'd need to treat 9 kids just to prevent one extra cavity. In the case of an intervention where risk is zero, obviously any benefit is warranted (and this might be such a case though I'm not convinced there are extensive enough long-term follow-up studies to definitively say SDF is conclusively and totally without risk), but in any case this (while maybe helpful at population scale) definitely doesn't strike me as wonderful.
> I mean, I'm not thrilled by these results. The absolute risk reduction was 0.11. They didn't state it in the paper, but this means the number needed to treat is ~9.1. That means, on average, you'd need to treat 9 kids just to prevent one extra cavity.
Or 9 teeth on one kid - and then it doesn't sound too bad.
If you have kids with cavities in their baby teeth, this saves you the agony of a filling. I was annoyed that I had to push for it over an actual filling, as if they couldn't appreciate how traumatic it can be for a parent to watch their kids completely melt down in the dentist chair.
If I recall correctly, SDF has been used in other countries for a while, but only recently put to use in the US.
> as if they couldn't appreciate how traumatic it can be for a parent to watch their kids completely melt down in the dentist chair.
The parents? The kids aren't exactly having a good time either.
Our experience is that parents often project their own anxieties about treatment onto their kids.
Many times a supposedly "hard to treat" kid relaxes and is better behaved with no parent in the room.
I used to work as a nurse in a pediatric dental clinic as a sedation nurse. When this stuff came out, my boss would really try to present it as an option to parents with kids who had cavities on baby teeth, especially when families did not have dental coverage. The enamel on baby teeth is also much thinner than adult teeth, so even if parents used that as a way to delay full treatment until it could be paid for, it kept a small cavity from becoming a root canal.
I honestly don't remember many parents taking him up on the offer of the SDF, once they learned it permanently caused the places of a decay to turn black.
My partner is a dentist and she said this is also the case. She offers SDF as an option all the time but parents decline it when they discover it will make their kids teeth black.
I have a question. My sons get fluoride foam rubbed on their teeth at their dental appointments. Does it work as well as the silver diamine fluoride? I’m wondering if I should ask about this at their next appointment. It’s not for another 5 months though, so I was hoping a dental tech or dentist could weigh in. Thanks.
Dental tech here, father is a dentist and my daughter (5) has had this SDF treatment. It turns the weakened spot black.
[spot](https://i.imgur.com/tmrhfcV.jpg)
From what the pediatric dentist told me, the particles are "attracted" to the weak spots and fill it in with silver, that's why it's black. I watched her apply it all over that tooth and a few days or weeks later(can't remember) it turned black. She has had two applications of it and this remains the only spot. Fluoride on its own can't seal like SDF. Regular childhood sealants require the teeth to be dry for application so it's very hard to do on a child. This does not require that so it's literally just rubbed on and that's it.
Definitely ask about it, I think my Dr says it's $35 out of pocket "per tooth" but she put it on a couple teeth. My daughter's insurance covers it.
Brush and floss every day, but when I was a child, I was given many fluoride treatments and have never had a cavity in my life, and neither have my siblings, I turn 44 soon.
Umm silver fluoride treats existing cavities, it is different than the fluoride used to prevent cavities. It basically stops the decay from progressing to the nerve and causing infection. It is frequently used on children whose tooth will be lost shortly or elderly people who cannot withstand dental treatment or those who cannot fix their teeth because of money or health status. It will turn the tooth black too. Article is not very accurate
In the study, they used SDF application as a preventative solution. So they applied SDF and then varnish over that. It was as good at prevention/arrest of Carie’s as the sealant + varnish group.
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I love SDF. I tell my colleagues "I drink the black Kool aid". This is my pitch to patients: "Sdf has three components. Silver, Diamine, and Fluoride. Silver is used to kill off bacteria. Diamine is a fancy name for a nitrogen containing compound that keeps the liquid very basic, the opposite of acidic, which bacteria don't like. And fluoride strengthens the tooth to become harder than regular tooth and resist future cavities. SDF has 2 side effects. It will stain your gums a brownish color for a few days and it will stain cavities black. The gum color will go away but the cavity will always be black until we put a filling in it." I typically will use SDF at an initial new patient exam to arrest caries before scheduling fillings. Small noncavitated carious lesions don't need fillings after SDF but they should be monitored. I work in public health so I see a lot of patients with a lot of dental needs. SDF is great in these clinics. If you have any questions, please feel free to ask.
Can I specifically request this from my provider? Any reason why any of them wouldn't want to do it that's a legit concern or is there no downside other than some temporary cosmetic effect? Is this only for children's deciduous teeth or adult teeth as well?
I don't see why not. The evidence for treating cavitated caries (like, literally a small hole in your tooth from cavities) indicates that a filling would be better than SDF. But for small non-cavitated lesions (no hole, but can see on the xray there is a loss of mineral structure) then I would recommend SDF and better hygiene/diet habits and reassess.
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Hang in there! You could ask your dentist for a prescription toothpaste that is basically just extra good at fighting cavities. Insurance probably doesn't cover the fluoride treatments but you can maybe ask to pay out of pocket? At your age, your life is changing drastically. Your physical and emotional health are probably getting more challenges at this point in your life. Teeth are a part of that!
My insurance would cover fluoride treatments if needed, plus they’re not that expensive OOP (relative to dental work). But my dentist still doesn’t do them past 18
Find another dentist.
I would ask around for a new dentist who would be willing to do it. No reason you have to stick with the same guy.
Our dentist does them. I only get them every other visit because they make me nauseous. Maybe find another dentist?
hmm. dentists are weird
Colgate makes an excellent extra- fluoride toothpaste; without insurance it's $7
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Colgate Prevident 5000 is what my dentist gives me on request, about $16 and lasts me 6 months perfectly between appointments (use as directed - once a day, don’t need much toothpaste either, and I pair it with another sensitive toothpaste in the mornings). Highly recommended, it made a big difference for me and I wish I had found it sooner. Only reason I knew about it was because of a dental student exam years ago!
yeah just more fluoride. Prevident 5000 is the most common one I think
>When I turned 18 they stopped and I started getting cavities. I asked for the fluoride. They said no. I'd hazard a guess that that is not normal. I'm 26 and still get the fluoride every time.
I still get it every time too, but my insurance doesn't cover it. Fortunately my dentist only charges $30 for it, so it's not terrible.
3m makes high fluoride toothpaste fellow add friend. It's called clinipro. I use it now after a dentist recommendation
Try another dentist and I would call and ask before you go. Mine offers the regular fluoride to anyone and it was around $70 since it’s not covered in my insurance. I do this every visit. The other best thing is to floss every evening before you brush your teeth. I know it’s super hard to add something new with ADHD, I have it myself, but if you stick with it and have a healthy fear of dental work and/or big hits to your wallet, I promise it’ll get to the point where your mouth just doesn’t feel right if you don’t. I look forward to it now. The “glide” types of floss are the least annoying and irritating to use for me. I also got a low tier Sonicare. I haven’t had a cavity in maybe 15 years, even with several stints of multiple years of not going for lack of insurance.
I worked at a company that prioritized preventative over restorative dentistry and I do believe it will be more adopted in the next couple of decades. But unfortunately, dentistry isn't profitable unless it is in a managed care setting.
I switched dentists a while ago because every time I went in they "found" something to charge me for. Never a cavity but always "close" that they gladly chatge me hundreds to put a filling in. Place was just a used car dealership selling treatments and surgeries.
My step daughters dentist office was the same Every single kid that went there was loaded with fillings and caps and pulled teeth. I hated the place and moved her. Hasnt had a cavity since then somehow. And weirdly, the kids are the new place all have very few of any cavities that need work at all. They even tell us not to worry about work on some baby teeth if they are close to the age of losing them and such. My daughter chipped a tooth and they flat out told me it would be pointless to fix because she would probably break the veneer too. If she wants a veneer when she is older and more responsible they will gladly do it. Her previous dentist made it seem like her teeth would all rot out if we left the chipped tooth alone. Some places absolutely only car about money.
Sadly it's the norm with any business where the customer typically doesn't know anything about the product or what's actually needed. Which is why car mechanics and dealers are often so predatory
>Place was just a used car dealership selling treatments and surgeries. We are thankful for the good and ethical dentists but you are right some of them are just used cars salesmen and even worse,criminals. [Doing unnecessary root canals on kids](https://ag.ny.gov/press-release/2022/attorney-general-james-secures-over-750000-pediatric-dentistry-group-performing). [Intentionally damaging patients' teeth so they would charge them and the insurance for crowns](https://www.jsonline.com/story/news/crime/2022/03/11/wisconsin-dentist-guilty-damaging-teeth-insurance-fraud-scheme/7001739001/).
That oughta be malpractice.
I asked my dentist and he said no.
Can it be gotten without prescription anywhere outside US?
Could there be a benefit to incorporating this in pet food/pet care? I know dental health is a continuing concern for most cats and dogs.
Hmm interesting thought. I would say no. Most cat/dog tooth issues are from periodontal disease, which is the other major disease of the oral cavity, but it works completely differently than cavities and thus SDF wouldn't work for that.
I'm a registered veterinary technician - there is a veterinary dental sealant available but it works differently. It is meant to stop the accumulation of plaque and tartar under the gumline as dogs/cats are typically dealing with periodontal disease. Cavities are not common, especially for cats due to a few factors including diet.
So much this. Ever tried brushing a cat's teeth? My cat loves me and I can damn near handle her however, but forget going anywhere near her mouth easily and often. If even just vets had access to this and could apply it every couple years, it would save so many animal's lives, not to mention our bank accounts
Do animals get cavities? I've only seen periodontal disease in animals, not cavities, and I don't think this would help with that.
Animals can get cavities, but not necessarily at the same frequency as humans. I'm a registered veterinary technician, and with dogs and cats it's not a common occurrence due to factors including their diet (less sugars than humans) and their mouth microbiome. We see periodontal disease, which is inflammation arising from plaque and tartar buildup which can lead to things like bone loss and infections with time. There is a veterinary dental sealant available, but it works to stop the accumulation of plaque and tartar under the gumline so it's a bit different.
Does it only help for developing teeth like with children or can adults benefit from it too?
Oops sorry didn't answer that. Works just the same for people regardless of age. There is limited long term research on it's effectiveness, so I usually reapply it on people in a "2 time initial application" where there is a week or two between applications, then when they come in for their 6 month/12 month checkup I reapply it.
I am pretty sure this is what my elderly father got as a treatment since he isn’t great about his teeth brushing these days and can’t get dentures! Not 100% though.
practice icky grey murky subsequent deer serious price voracious slimy -- mass edited with https://redact.dev/
In the US you need to be a healthcare provider to order it. It's super expensive so it would honestly probably be cheaper to have a dentist apply it. But if you got your hands on some and smothered it around your teeth... maybe. It will basically stain organic stuff. So if you have food in your teeth it will stain that. So you might get some false positives.
Can it be gotten without prescription anywhere outside US?
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Report back?
You are more likely to stain your entire mouth and look like you smoked a smurf than you are to use it correctly. This also wouldn't tell you if you have cavities in the contacts between your teeth which would not be visible to you. If you don't mind the staining and lack access to dental care it's a good way to slow the progression of decay until you have dental care. You do have to reapply it every few months. More important is brushing and flossing to avoid forming cavities to begin with.
Since it stains cavities black, can it be applied to the "non-people facing" surfaces (lingual and occlusal surfaces) of the crown in order to check for cavities that are just beginning? My old coffee habit has stained portions of some of my crowns and I'm just wondering if they're really stains or very early cavities. Further context: I have an MD so I can sorta get a prescription from DMD friends. I have been using Novamin products for years now and floss regularly. I have no plans of using SDF but I'm curious, hence, my question.
It can be used in that way, but it is highly likely to give false positives. Stain from dietary sources can be blackened by SDF while not being caries. A better detection method would be to take a fine instrument and scrape the grooves that are dark. If it feels hard and scratchy, then it's probably fine. If it feels sticky or leathery, that indicates enamel breakdown from bacteria. NovaMin and other hydroxyapetite-building products are really good too. There's some early evidence that they're as effective as SDF in some cases. Typically they're even more expensive than SDF.
You can order Novamin toothpaste on Amazon for a reasonable price here in the states (Sensodyne with Novamin to be exact). I've also been using the Italian version of BioRepair toothpaste that I order on Amazon for a decent price as well. They've helped tremendously.
I'd have no problem applying SDF around crown margins that are questionable for leakage. I'd want a dentist or hygienist to apply it because it's a bit technique sensitive because you'll want to avoid getting it on soft tissue so that means retracting the cheek and tongue and staying above the gingiva as much as possible. I wouldn't apply it on my own teeth and I'm a dentist.
Are you paid a flat salary being in public health? Most of the private dentists seem to be reluctant to use it because if they really utilize SDF it would significantly reduce revenue.
Hah, you make a very good point. Most dentists are on a business model of costly procedures. Preventative medicine is not revenue generating model of care. Maybe in pediatric dentistry mindset and model of care is different.
>Preventative medicine is not revenue generating model of care. This sentence is evil. It should be about the quality of life of your patients, not what makes the most money.
Capitalism wins again
That's assuming a lot. Public health uses it a lot more because of the demographic. Lower income, lower dental IQ, more cavities. Alongside cultural differences on the importance of oral health, patients can come in for a new patient exam and then not return for a few years. Private practice, patients are well insured, are paying out of pocket and actively seeking care. More motivated. SDF slows the progressions of cavities. Cavities that form very slowly over months and years. Private practice you will get them taken care of promptly from the practice scheduling and motivation of the patient. Public health may take more time as there are more people trying to access fewer resources. There is no point in using SDF in private practice as patients that receive regular care will not have many cavities and any that form can be taken care of quickly or remineralized. If Dentists were concerned about sdf reducing revenue, they wouldn't tell people to brush and floss. Proper oral hygeine would decimate the dental industry over night yet people continue to forget to brush and floss. You're asking a very ignorant question for someone with so much knowledge over dental practices and protocols.
Yes, public health is usually salaried
SDF was absolutely fantastic when my 2 year old had a cavity. I was so thankful that our pediatric dentist recommended it. It was much less traumatic than getting a filling. My kiddo is almost 8 now and they have "reactivated" it (reapplied) every 6 months since she had it done. That cavity spot was rock solid. About a month ago the dentist added filling material on top, but there were no shots or drilling bc the cavity had been arrested long ago.
Anytime I've asked about any 'alternative' ways with my dentists. I always get the 'everything you read about is just total fake and only the traditional stuff works' and they make me feel like I just 'believe anything I read on the internet'. That attitude seems pretty common and has turned me off from any medical professional, dentist, or otherwise. How do I find dentists or other medical professionals that are interested/curious about newer treatments or procedures? Even if experimental and unproven I might be interested in it if it's accessible, if the risk factors or other things are appropriate. It's not like I'm approaching it like I'm approaching it naively "I read X can fix this, can you do X". I just often ask generally if they heard of it, or what are their thoughts on Y, even just asked open endedness things like, is there anything that looks promising that might be available in the future. They all seem bitter and close minded on anything that isn't something they are already doing, like all medical tech is just 100% locked in as-is and they don't even want to learn something new. Maybe they just don't want to talk to me about it, which is fine, but most just seem generally hostile and immediately look down upon me for even mentioning it.
I have severe enamel hypoplasia and have only six original teeth left (22 have crowns 18 had to have root canals. Yay genetics.) Would this treatment be something good to inquire about for my last remaining whole teeth?
Yeah for people with hypoplasia any aggressive preventive treatment is worth considering. Depending on the type of hypoplasia (the qualitative properties of your enamel) it may stain your teeth more than regular enamel. I would hit the prevident5000 toothpaste hard and maybe do fluoride trays every so often (although I'm not aware of research on this last point, so the effectiveness may be lacking, but the science seems sound)
Will SDF offer any protective benefits for adult teeth, and specifically will it provide protection for existing caries?
Any type of tooth! It can stop existing cavities by killing off those bacteria and making a shell of hardened tooth to prevent future cavities. It's not 100% effective in every situation though.
Findings in title quoted from the linked summary^1 and its hyperlinked journal paper.^2 Excerpt: >In a study of nearly 3,000 schoolchildren, silver diamine fluoride—a liquid that is brushed onto the surface of teeth to prevent cavities or keep them from worsening—was as effective against cavities as dental sealants, the standard of care. >The findings, published in *JAMA Network Open*, offer an efficient and cost-effective approach to improving children’s oral health through school-based care. >In 2017, NYU College of Dentistry researchers received funding from the Patient-Centered Outcomes Research Institute (PCORI) to run the nation’s largest school-based cavity prevention study, which they named Caried*Away*. >The study included 2,998 children in kindergarten through third grade at 47 New York City schools. The schools—which serve a racially diverse group of students, most of whom are from low-income families—were randomized to receive either the simple or complex treatment. >Upon visiting each school, the clinical research team—which included a supervising dentist, dental hygienists, registered nurses, and assistants—did baseline exams to measure any tooth decay, and then applied fluoride varnish and either sealants or SDF, depending on whether the school was assigned to receive the complex or simple treatment. > >The initial visits took place in 2019 and early 2020, and were paused when the COVID-19 pandemic temporarily closed New York City schools and halted all school-based care. >Two years later, schools allowed the clinical research team to resume, and they returned to each school for follow-up visits. >The researchers found that both the simple and complex treatments were successful: just one cavity prevention treatment prevented more than 80% of cavities (81% for SDF and 82% for sealants) and stopped half of cavities from progressing (56% for SDF and 46% for sealants). >“Without prevention, dental cavities grow continuously if not treated. One Caried*Away* cavity prevention treatment, provided just before schools closed during the pandemic, was remarkably effective over the following two-year period,” said Richard Niederman, DMD, professor in the Department of Epidemiology & Health Promotion at NYU College of Dentistry, co-principal investigator of CariedAway, and the study’s senior author. >“I know of no other dental preventive intervention that had this great a beneficial impact across the pandemic.” ^1 *School dental program prevents 80 percent of cavities with one-time, non-invasive treatment*, New York University, 9 Feb. 2023, https://www.nyu.edu/about/news-publications/news/2023/february/school-dental-program-prevents-80-percent-of-cavities.html ^2 Ruff RR, Barry-Godín T, Niederman R. Effect of Silver Diamine Fluoride on Caries Arrest and Prevention: The CariedAway School-Based Randomized Clinical Trial. *JAMA Network Open*. 2023;6(2):e2255458. *https://doi.org/10.1001/jamanetworkopen.2022.55458 *Corrected a typo.
We’ve known the benefits of SDF for a while but it’s mostly used on Peds. In the US, people are hesitant to use it because it stains
Geriatrics too
Permanent stains or removable? I've been using chlorhexidine rinse off and on that does mildly stain them with tiny brown lines, but it's easily removed at the dentist.
permanent stain, and its dark black
I want to add that it’s very difficult to cover up without blockout composite too. So permanent and difficult to fix once the stain is there.
What brand rinse has that stuff in it? Was looking for toothpaste with it a while back but had no luck
I believe it's prescription only, at least in the US. Mine was a prescription from my dentist.
In Hawaii, certain anti-fluoridation groups gained power to prevent fluoridation of most of the water systems. The Honolulu city council banned any water additives in 2003, essentially making water fluoridation illegal on Oahu, the most populous island. Public health officials and dentists want to reverse the ban, but are blocked by long-serving HI State Senator Mike Gabbard (yes, that's Tulsi Gabbard's father). Sen. Gabbard's justification for banning water fluoridation is that the water should be "pure" and he says it's unnecessary because of treatments like fluoride tablets and brushed-on fluoride treatments like those in this study. But this approach has made it more likely that children in poorer families get tooth decay because they have less access to dentists, and Hawaii overall has some of the worst dental health in the nation. The only population on Oahu that gets fluoridation is military families living on base. Dentists here have noted a distinct difference between the teeth of children living on military bases and the general population, where military base children have far fewer cavities. But with the recent Red Hill water supply scandal (where the US Navy leaked fuel into the larger Oahu water supply), it's hard to tell the local populace that the US military is giving their population healthier water. So I see the local politicians trying to push these topical fluoride treatments more.
So do they also ban water disinfectants too? I can't imagine a tropical area like Hawaii without chlorine or chloramines bodes well for reduction of pathogens.
Meanwhile, my city (Buffalo) quietly stopped putting fluoride in the water back in 2015.
My mom had awful cavities when she was a child and says the single biggest reason the later generations didn't have such issues is because of fluoridated water, not better brushing or dentists. If you notice, a majority of old timers have extremely poor teeth
I worked with it for years, it does work. As long as the decay is monitored. Also you can fill over it with glass ionomer.
Glass ionomer is the nectar of the gods
I can see why you’re the party guy, Dave.
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It's unnecessary and not a significant part of oral hygiene, it's not even a realistic appearance, nobody has neon white teeth like veneers naturally
I got veneers and was asked what colour I wanted them, so of course i got them natural off-white because bright white teeth are just too much and don’t even look good
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>I’ve had dentists tell me not to use whitening strips because they damage your enamel [Well, they're wrong.](https://pubmed.ncbi.nlm.nih.gov/15934684/)
There's a confusion here over different whitening products. Whitening *strips* generally whiten with hydrogen peroxide, which is fine. Whitening *toothpaste* usually whitens by abrasion, which is bad.
I like that study, and I just skimmed through it, but there is one very important thing about it that people should be aware of. It's listed right at the bottom... > DISCLOSURE > The authors work for Colgate I'll take another look at it later when I have some time as it looks like a decent test, but people should be aware of a bias there. EDIT: While there is a bias in this study, I also want to point out that this IS a peer-reviewed study from the Journal of Esthetic and Restorative Dentistry (VOLUME 17, NUMBER 1. 2005). This is why I'm very interested in the results, but I'll need more time to digest it, unlike the teeth in the study (pun intended).
When used correctly, the strips do not, in fact, damage teeth.
Of course they're going to say that, they're very expensive whitening treatments that are completely uncessesary except for aesthetics. They are going to try their best to avoid saying anything that might put you off of purchasing
Interestingly tooth whitening is effective to treat gum disease, it was discovered as a side effect of a gum disease treatment by an orthodontist who put peroxide in a retainer, it’s not sensible if you have any cavities though.
Tip for tea drinking, after you finish the cup, rise/gargle/swish with water for about a minute. Works for really anything with sugar too.
If I gargled water after every cup of tea I'd be a fish.
Don’t get sucked in to do Zoom whitening. It looks great but holy f I felt like I’d be biting into ice cream with tooth sensitivity for 48 hours. It was so unpleasant I will never do it again although my teeth were blindingly white that 48 hours or tooth nerve pain was an agony I never want to feel again. And I’ve given birth. The zoom whitening is my pain threshold line.
I'm going from the "were" that it didn't last.
It doesn’t last. All forms of whitening will eventually rebound and have to be touched up with time.
Day to day life would destroy it. It's essentially a scam, to me personally. Like, skin gets darker in the sun. It just DOES, and you can barely do anything to prevent it. You have to be a hermit. The tooth equivalent of that is not eating to maintain the white. Not doable. Unless you wax and ceramic coat the teeth or something magical. So people have to keep coming back to get another refresher treatment. So, scammy.
That's because in America, it's expensive to become a dentist, expensive to maintain a practice, dental insurance sucks even worse than Medical insurance, there are not public subsidies, so all dentists are required to run like small businesses with low margins
‘Dental insurance sucks even worse than medical insurance’ my medical insurance says ‘’challenge accepted’’
It’s really an apples to oranges comparison. Dental insurance is not true insurance. It’s more of a discount plan. The cap, usually $1500 a year, hasn’t gone up in decades. I hate having to figure out with the patient what can wait for the next year without hopefully getting worse. Dental insurance for the dentist is more like a really expensive marketing strategy since reimbursements to the dentist are usually about 60 percent of the full fee for a service. Those reimbursement rates are not keeping up with inflation and in some cases are lower than they were a decade ago. I also have to pay administrative staff to stay on top of ever more easily denied claims. It all around blows. That being said, I never push whitening and let the patient bring it up themselves. Rude.
It's not just the dentists. In fact I'd say the dentists are just following the general culture, which is obsessed with having perfectly straight and white teeth.
Teeth whitening and other cosmetic procedures is major $$ for dentists, so some dental practices push it hard on their patients, and don't give a damn if they are being manipulative about it. If they continue pitching that to you then I would leave the practice. I just left a practice for using similar tactics, they pretty much were harassing me at every appointment to get my teeth whitened, even after I pretty directly told them to cut it out. Read up on how the American Dental Association has, for more than half a century, been successfully lobbying to keep dental services from being covered by to Medicare (with the exception of very limited situations) if you want an interesting side read on how the dental community will literally downplay the health benefits of dental care when it suits them. Which makes it even more disgusting when they push cosmetic procedures on you to line their pockets, claiming that they have your best health interests in mind. There are ethical dentists out there, but seemingly harder and harder to find these days.
>I hate that American dentists seem to be so obsessed with white teeth Sounds like your hygienist was the problem, not the dentist?
For what you ask? Was it a private care facility? That's why. One dentist on youtube said his colleague gives root canals for everyone, because that's the best business decision for them. He got some 200 k student loans to pay off.
She’s probably in a high pressure sales enviro. If your teeth and gums are sensitive after it’s not because of the polish. Those rubber cups are very soft. Chances are high the scaling process is what causes the sensitivity. Your teeth probably were whiter after the fact, especially if you had stains, but it’s hard to notice because it’s subtle. Take a before/after pic if you don’t believe me. Am hygienist and I deal with heavy handed hygienists all the time.
My dentist is rather against whitening treatments. He and I were having a convo about my attempts to find an Enamel Protection toothpaste that didn't have Whitening as a feature, too, as every single damn toothpaste on the shelf seems to have whitening agents. He railed for a moment about how ridiculous it was to have a whitening agent in an enamel/sensitivity toothpaste because the actions are opposites! I'd be concerned that your hygienist does not have the long term durability and health of your teeth in mind.
I’ve been meaning to take better care of my teeth, and you seem to be doing really well - can you tell me if the water pik is a good alternative for normal dental floss? I loathe flossing with a passion, I have a small mouth and trying to get half my hand in to floss between teeth is gruesome and hurts my jaw. I’ve considered one of those water ones many times - do you feel like it can replace traditional floss?
The thing about flossing is you need to get under the gums along each tooth. The same when brushing, you’re really trying to massage the bristles where the tooth and gum meet on both sides to remove food etc. Waterpik is better than nothing but flossing is golden in maintaining healthy teeth and gums.
I can't speak to if it can totally replace the benefits of regular floss but it's certainly better than not flossing at all. My dentist (not this hygienist in this anecdote) told me to get it because I was doing chemo. It was less likely to give me an infection or bleeding like flossing could (most chemo causes a lot of dental/mouth issues). I like the water pik for things like popcorn since it doesn't push it into the gums if you get something stuck.
That’s very helpful, thank you so much! I also wish you healing and strength during your treatment/recovery <3
My hygienist told me you still need to floss. The waterpik is going to reach some areas floss will not, but the floss gets into areas (mostly tight areas between teeth) the waterpik will not. Also, the small mouth thing could be a problem; I find it more difficult to fit the waterpik than to floss. Do you use floss piks or traditional string floss? If you aren't already using disposable floss piks, total game changer for me versus the long strand of floss.
Teeth are generally going to be sensitive after a cleaning regardless. It's not like she damaged your teeth with the heavy grit polish. Sounds to me like she asked if you wanted to get your teeth whitened to remove the stains, listened when you said no, and then tried to help as best she could. All without damaging your teeth or health.
Bad news, pushing for whiter teeth not limited to American dentists. Had the exact same "problem", though for me the offered solution was "drink less tea". Yeah, and get into coffee? Yeah, got the heavy grit polish every time, with the temporary sensitivity increase as well. Also, whitening **will** affect your tooth health, and not in a good way.
I'm really sorry, that's terrible!
As a hygienist, if we don't get the stain off the dentist comes in to do their exam and tells us we didn't do a good job. I can respect that you don't want to do whitening but removing surface stains is part of our job. Generally I use pumice powder if the stain is very difficult.
Hygienist here, light-moderate-heavy stain can lead to decay, especially on the chewing surfaces of molars with deep grooves and fissures, don’t think it’s necessarily dentists obsessed with perfect white teeth but rather being proactive about possible decay later on!
Stain on the teeth has a rougher surface texture compared to clean enamel, it attracts and holds plaque and bacteria more easily. So there are non cosmetic reasons to remove significant staining on teeth. The majority of patients are aware of discoloration/staining. Mentioning tooth whitening procedures then dropping it when a patient isn't interested seems like a reasonable approach to me.
Yea you can tell people are american by their extremlly white teeth. It's not natural.
Well said. Smiles in coffee stained, healthy, teeth.
Hygienists clean your teeth, not dentists.
I think that's more drs and hygienists taking what they think matters to people and doing something about it. They are probably just responding to all the inquiries to get their patients teeth whiter
If there was some amalgamation of chemical to keep my teeth from rotting aside from regular dental hygiene, I really don't care if they turned it black or whatever. Living with just 10-20% salivary glands has humbled my appreciation of dental practice.
This is different than a sealant. A sealant protects a tooth and covers it. This desensitizes and treats decay. It could be used as a topical preventative. Sealants using glass ionomer are also an option if your concern is GMA leak. I use it as such. I have two specialties as it relates to children and dentistry and their health. SDF is the best medicine. It keeps children out of operating rooms. It helps kick the can down then road until a child is more cooperative. Next. Check out THE HALL TECHNIQUE. THIS IS THE FUTURE.
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Why do we not use sealant or anything else like this for adults? I use prevident at the moment, which is fine but I'd rather have some barrier that also protects?
We do place sealants on adult teeth. Younger kids tend to get them because they’re not good at taking care of their teeth. Insurances generally don’t pay for them after a certain age but they can be done for adults too.
I got sealant done my last visit. My teeth are very sensitive to cold and it mitigated the problem so much. I highly recommend. Edit: am adult
What do you think of nano hydroxyapatite?
I’m confused as to way you said to check out the Halls technique, we’ve been capping for so long and this seems the same, maybe I’m confused on how it’s applied and that’s the difference but it’s a cap like the others I’ve seen so I’d imagine it has the same benefits as caps we’ve already had. Could you explain better why this is the future?
No drilling, SDF+glass ionomer and push on the hall crown. Preserving as much tooth as possible.
Pediatric dentist here… as someone who uses SDF every single day, it is certainly a tremendously valuable resource particularly for children who cannot cooperate for traditional treatment. Having said that in front teeth a black stain in contrast with a white tooth is horrendously ugly to the point I very rarely recommend it (even after parents consent they often regret it). In back teeth the difficulty is isolation (SDF is supposed to be applied to a completely dry tooth). The issue is if the child cannot cooperate for traditional treatment, then usually they cannot hold open for an ideal, isolated application of the SDF. Finally, SDF is to be reapplied every so often and is largely dependent on patient compliance more so than traditional fillings. Terrific material for sure, but not without its limitations. Also sealants are a preventative treatment for teeth without decay. If handled properly, current dental literature shows no complication with BPA. Moreover SDF is not an alternative to sealants because it is not a preventative treatment but rather one that works on a tooth that already presents with decay.
Do you have any adult dentist colleagues that use SDF regularly? I'm neither a kid or elderly but I'd still much rather have a black stain on my back teeth at least rather than the old drill/fill/cycle of tooth destruction.
90% of the time it slows the progression of the cavity instead of fully arresting it. Short answer is no but worth noting state insurance only covers SDF on baby teeth of children 6 or under. Which is ridiculous but that's currently where we're at at least in NJ
Leave it to reddit that the top comment is blatant harmful disinformation. Sealants do not slowly release BPA "or other material" into the patient. There is some material in sealants that uncured can react with saliva to form BPA in **trace** amounts, but this is only present when the sealant is initially placed and has **zero** long term impact on health. It's not even present in blood or saliva samples taken 6 months after the sealants are placed. Get sealants for your kids. First molars are the cornerstones of the adult dentition and they are the first permanent teeth to erupt. It could save their teeth as adults for years.
The problem is that a sealant can be used both preventatively and curatively. You can apply it and not “have” to monitor it. SDF is curative in early carious lesions and is not preventative in the sense sealants are. The title is just misleading to a degree. If a hole has started to form and you apply SDF, it counts as “preventing” it. Both techniques have a use case. For example, a rural community that has visiting dentists every 6 months. Or poorer countries that receive volunteer trips. Fissure seal all adult molars. Place SDF on carious lesions.
>**LePhatnom** >The problem is that a sealant can be used both preventatively and curatively. You can apply it and not “have” to monitor it. >SDF is curative in early carious lesions and is not preventative in the sense sealants are. The title is just misleading to a degree. If a hole has started to form and you apply SDF, it counts as “preventing” it. >Both techniques have a use case. For example, a rural community that has visiting dentists every 6 months. Or poorer countries that receive volunteer trips. Fissure seal all adult molars. Place SDF on carious lesions. From the linked content,^1 that I quote in my excerpt comment:^3 >The researchers found that both the simple and complex treatments were successful: just one cavity prevention treatment prevented more than 80% of cavities (81% for SDF and 82% for sealants) and stopped half of cavities from progressing (56% for SDF and 46% for sealants). ^1 *School dental program prevents 80 percent of cavities with one-time, non-invasive treatment*, New York University, 9 Feb. 2023, https://www.nyu.edu/about/news-publications/news/2023/february/school-dental-program-prevents-80-percent-of-cavities.html ^3 https://www.reddit.com/r/science/comments/1107x6h/a_single_dose_of_noninvasive_dental_treatment/j87icod/
Just finished reading the study and note one particular issue. Both sealant and SDF treatment is combined with 5% fluoride varnish. The problem here is that sealants have been proven to work in the absence of varnish. Varnish itself and nothing else also drastically decreases cavities by approximately 1-2 per year when applied at a certain interval (cannot recall how often it is. Either 6 or 12 monthly). So can you really postulate that SDF works better than sealants alone in preventive care? Further study is needed in SDF alone in prevention- i cannot for the life of me think of the mechanism of action though. I can however, tell you how it stops existing decay.
i dont see why you think that would be an issue. sealant + fluoride is the standard of care and recommended treatment by the CDC. even if you think sealant works fine without the fluoride, how exactly does that negatively affect the interpretation of these results? The study is demonstrating that SDF+fluoride varnish is non-inferior to sealant+fluoride varnish. why would they not include fluoride varnish in the experiment. no one said sdf is better than sealants alone. the study demonstrates sdf+fluoride is not inferior to sealant+fluoride. these are the two relevant conditions. there are also multiple publications over the past decade that have shown just what you are asking for, comparing sdf to sealant without addition of fluoride, and every single one ive seen shows sdf is effective at treatment and prevention (when prevention was assessed). this also doesnt address what you said in your original comment in which you state SDF is not preventative, while sealant is. Which is just wrong.
SDF is great and has its uses however many parents are not thrilled by the staining. It turns carious lesions black. [Google images SDF staining](https://www.google.com/search?q=sdf+staining&client=safari&hl=en-us&source=lnms&tbm=isch&sa=X&ved=2ahUKEwjNyNif14_9AhUsMjQIHZteBHYQ_AUoAXoECAEQAw&biw=1366&bih=917&dpr=2)
How in the world is this a top comment, including a dental sealant that "slowly releasing BPA"??? This is a false statement that likely came from a holistic dentist that practice non-evidence based dentistry or turn to evidence that aren't even supported. That being said, silver diamine flouride is an amazing treatment (some may even consider preventative) of caries, especially for pediatric patients without permanent dentition since it stains unconditionally.
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> Do you have any good further reading sources concerning the use of BPA in sealants? [Here's a link.](https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/resources/research/oral-health-topics/201608_ppr_bisphenol_a_released_from_resin_based_dental_sealants.pdf?rev=36b75ab425a148b9946336388c99e232&hash=2538570AE98EFA3710CA15F69F9D68C7#:~:text=By%20comparing%20the%20overall%20daily,when%20measured%20after%2024%20hours.) Looks like they've stopped using some of worse stuff and current versions leech a level of BPA that is negligible.
Such an embarrassment how slow dentists have been to accept SDF, negligence really. It's good for all ages not just kids or elderly, most people would prefer a small black stain on a back tooth than an invasive filling that has to be redone and eventually ends in tooth loss. Problem is SDF is too effective, cheap, and easy=bad for business.
Hygienist here. Sealants are still the #1 most effective way at preventing dental caries in children. If you have a molar with a deep pit or fissure on it, you WILL get a cavity on it if the end of the fissure is thinner than the bristles of the tooth brush
Why dont i get this treatment offered to me as an adult?
Filling cavities big business?
Dentists who want to be unscrupulous wouldn’t do so by doing a ton of unnecessary small fillings. As far as dental procedures go, a filling is about the most work for least pay of almost anything you can do
My instant thought is, could this be applied on a dog's teeth? For anyone with small dogs, their teeth are generally awful and they need regular dentals done. By the time they're in their teens it's common for them to have very few teeth, even with regular tooth brushing at home. Obviously the dog would need to be unconscious or immobile (one dog is given a 'relaxer' when getting scans that's safely used), but if it could have similar results to those in kids, it could be a game changer.
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I'm guessing it's a diet issue. Cavities in humans is a diet issue, it wasn't as big of a thing in preindustrial societies. Humans choose not to eat our traditional diet, and we do all these workarounds. Dogs should just have their appropriate diets, but it's generally super expensive, with many breeds having raw meat diets as their optimal diet.
Small dogs can't chew the harder kibble or raw bones that would normally clean their teeth. It's harder to give them a natural diet because their breed isn't natural.
My vet said that dry food cleaning their teeth was a myth. She said "It's a bit like saying you can brush your teeth with a granola bar."
Yes… unless you’re buying dental food for your dog which is designed to clean their teeth. As far as I know, no wet food can make that claim.
My dog (Chihuahua mix) is turning 13 this year and his doctor was astonished at how healthy his teeth are, especially for his size/breed (never had a cleaning in his life). He only eats wet food, but his favorite treats are carrots so now I'm wondering if crunching on carrots has helped keep his teeth clean in some way.
Crunching carrots is the perfect thing, hard enough to exercise teeth/bones but soft enough it can't break or wear them down.
I think you’re onto something there! I’m convinced that my dogs’ teeth keep clean because they gnaw on rope toys (which I KNOW they shouldn’t have btw). They only get toys when they’re next to me and any fibres that come off, I steal. But because they’re softer than hard toys, they can sink their teeth into them. They do get stinky fast, so I buy them often. I can def see the crunchy carrots cleaning a small dog’s teeth.
What about that lion they taught to eat tofu
I use it as part of a comprehensive caries management approach. Many cavities can be arrested or even reversed if caught early enough. The key here is early diagnosis. Magnification, diagnostic lasers, IR imaging, electronic caries detectors are among the excellent tools in the modern dentist’s toolkit. SDF is an excellent part of this approach. Here is my website’s page on the subject if interested. https://www.laserdentistbaltimore.com/filling-free-decay-management
SDF is amazing. I’ve seen it arrest caries in small children who couldn’t tolerate treatment at such a young age. It’s also great for desensitization if you have abfraction (which I do).
It's also good for seniors living with dementia and related conditions who can't handle their oral hygiene anymore.
I'm in my prime and have had SDF, way better than the old drill and fill, mind-blowing people think it's only for kids and seniors.
Didn't say that: but the two groups historically resistant to treatment are kids and seniors with cognitive decline. My adult son has SDF as do many other adults.
Gosh i cant wait until we get rid of cavities.
My son had SDF treatment on a ton of teeth; I had to take antibiotics while pregnant and he was born without enamel in a lot of places. It’s not the most slightly solution, but extremely non-invasive and has been stable for 4 years now.
What antibiotic causes a malformation of enamel in developing teeth?
Both antibiotics and high fever are considered prenatal risks for enamel hypoplasia. I had both during my pregnancy, so cannot honestly attribute to either with specificity- just did so here for the sake of staying brief and on topic. I was on amoxicillin- if I remember correctly, my child is near 5 now- preemptively (pericarditis) for dental surgery early in my 3rd trimester. Prenatal exposure to antibiotics: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3909430/ Prenatal fever and association with enamel hypoplasia: https://journals.sagepub.com/doi/abs/10.1177/00220345530320041801
This stuff is a godsend, I use it quite often on kids. I find it especially useful in younger (4-6 yo) kids who have never had dental treatment, and they have incipient to moderate levels of decay in between their primary and/or adult molars. It's still useful in adults, and I use it in areas where access to fix decay would be difficult.
Can it be gotten without prescription anywhere outside US?
I mean, I'm not thrilled by these results. The absolute risk reduction was 0.11. They didn't state it in the paper, but this means the number needed to treat is ~9.1. That means, on average, you'd need to treat 9 kids just to prevent one extra cavity. In the case of an intervention where risk is zero, obviously any benefit is warranted (and this might be such a case though I'm not convinced there are extensive enough long-term follow-up studies to definitively say SDF is conclusively and totally without risk), but in any case this (while maybe helpful at population scale) definitely doesn't strike me as wonderful.
> I mean, I'm not thrilled by these results. The absolute risk reduction was 0.11. They didn't state it in the paper, but this means the number needed to treat is ~9.1. That means, on average, you'd need to treat 9 kids just to prevent one extra cavity. Or 9 teeth on one kid - and then it doesn't sound too bad.
If you have kids with cavities in their baby teeth, this saves you the agony of a filling. I was annoyed that I had to push for it over an actual filling, as if they couldn't appreciate how traumatic it can be for a parent to watch their kids completely melt down in the dentist chair. If I recall correctly, SDF has been used in other countries for a while, but only recently put to use in the US.
> as if they couldn't appreciate how traumatic it can be for a parent to watch their kids completely melt down in the dentist chair. The parents? The kids aren't exactly having a good time either.
Kids often behave better when the parents *aren't* around during procedures.
I was going to say, what?! Parents are in the room these days? Not even once when I was a kid.
Our experience is that parents often project their own anxieties about treatment onto their kids. Many times a supposedly "hard to treat" kid relaxes and is better behaved with no parent in the room.
Nor the dentists
I used to work as a nurse in a pediatric dental clinic as a sedation nurse. When this stuff came out, my boss would really try to present it as an option to parents with kids who had cavities on baby teeth, especially when families did not have dental coverage. The enamel on baby teeth is also much thinner than adult teeth, so even if parents used that as a way to delay full treatment until it could be paid for, it kept a small cavity from becoming a root canal. I honestly don't remember many parents taking him up on the offer of the SDF, once they learned it permanently caused the places of a decay to turn black.
My partner is a dentist and she said this is also the case. She offers SDF as an option all the time but parents decline it when they discover it will make their kids teeth black.
A new thing for the conspiracy nuts to bang on about.
How do I convince the people fluoride isn’t a government plot? Silver!
I have a question. My sons get fluoride foam rubbed on their teeth at their dental appointments. Does it work as well as the silver diamine fluoride? I’m wondering if I should ask about this at their next appointment. It’s not for another 5 months though, so I was hoping a dental tech or dentist could weigh in. Thanks.
Dental tech here, father is a dentist and my daughter (5) has had this SDF treatment. It turns the weakened spot black. [spot](https://i.imgur.com/tmrhfcV.jpg) From what the pediatric dentist told me, the particles are "attracted" to the weak spots and fill it in with silver, that's why it's black. I watched her apply it all over that tooth and a few days or weeks later(can't remember) it turned black. She has had two applications of it and this remains the only spot. Fluoride on its own can't seal like SDF. Regular childhood sealants require the teeth to be dry for application so it's very hard to do on a child. This does not require that so it's literally just rubbed on and that's it. Definitely ask about it, I think my Dr says it's $35 out of pocket "per tooth" but she put it on a couple teeth. My daughter's insurance covers it.
diamine not diamond
SDF stains pretty bad but it does kick ass
Brush and floss every day, but when I was a child, I was given many fluoride treatments and have never had a cavity in my life, and neither have my siblings, I turn 44 soon.
Umm silver fluoride treats existing cavities, it is different than the fluoride used to prevent cavities. It basically stops the decay from progressing to the nerve and causing infection. It is frequently used on children whose tooth will be lost shortly or elderly people who cannot withstand dental treatment or those who cannot fix their teeth because of money or health status. It will turn the tooth black too. Article is not very accurate
In the study, they used SDF application as a preventative solution. So they applied SDF and then varnish over that. It was as good at prevention/arrest of Carie’s as the sealant + varnish group.
It also says “prevent from worsening.” Which is prevention of caries