Preventing and Arresting the Progression of Tooth Decay in Children with Silver Diamine Fluoride (SDF) at Herident Dental Clinic

Preventing and Arresting the Progression of Tooth Decay in Children with Silver Diamine Fluoride (SDF) at Herident Dental Clinic

What is dental fear?

It is a feeling of anxiety, fear, or phobia that some people may experience when visiting the dentist for oral care. In children, dental fear often occurs due to factors such as noise, pain, insecurity about unfamiliar instruments, and the feeling of being controlled during treatment.

What are the reasons?

Dental fear can stem from various causes, depending on each specific case. However, some common reasons include:

• Negative past experiences: If a child has had negative experiences at the dentist, such as pain or discomfort, they may develop fear and anxiety toward dental visits.

• Parental stress and anxiety: If parents are also anxious and stressed about dental care, children can sense this and mirror it by developing their own fears and phobias.

• Child’s age: Young children often do not understand or cannot express uncomfortable or painful sensations during oral treatment, leading to fear and anxiety.

• Dental equipment and tools: Unfamiliar instruments, loud noises, and sensations of pain during treatment can make children feel insecure and frightened.

• Lack of psychological preparation: If children are not mentally prepared before visiting the dentist, they may not know what to expect and can develop fear and anxiety about dental care.

Consequences:

Dental fear in children can lead to serious health and psychological consequences, including:

• Missing dental appointments: Children may be too afraid or reluctant to visit the dentist, leading to skipped appointments. This prevents them from receiving proper dental care and treatment, which can cause oral health problems in the future.

• Poor oral health habits: Negative impressions may discourage children from taking care of their teeth, resulting in dental issues such as cavities, gum disease, and even tooth loss.

• Negative impact on mental health: Dental fear and phobia can lower a child’s self-confidence and self-esteem, causing anxiety, stress, and emotional pressure.

• Behavioral effects: It may make children irritable, uncooperative, and resistant to new situations, creating challenges in their social and emotional development.

At Herident, each child receives both psychological and dental care. The first dental visit is designed as a playful “dental tour” where children can get familiar with the clinic, observe other brave kids having their first gentle and pleasant dental experiences.

The pediatric dental room at Herident is designed to be friendly and adorable, with child-specific dental chairs. Instead of just sitting in a dental chair, children experience an adventure like “climbing on a dinosaur’s back” or “hugging a panda’s back.”

For young children with cavities who are not cooperative with dental drilling, Herident dentists use SDF (Silver Diamine Fluoride) as a minimally invasive treatment to ensure both oral and psychological comfort.

Information about Silver Diamine Fluoride (SDF)

Silver Diamine Fluoride (SDF) is a dental agent used to prevent and arrest the progression of tooth decay. It was first introduced in Japan in the 1960s, where it was implemented nationwide for cavity prevention in children. In 2014, the U.S. FDA approved SDF for use, and American dentists began applying it in 2015. Canada adopted SDF in dentistry starting February 2017. Many other countries, including Brazil, China, Mexico, Argentina, Australia, and the United States, have also incorporated SDF into dental care.

SDF (Ag(NH3)2F) is a colorless solution at 38% concentration (44,800 ppm fluoride). It contains 25% silver for antibacterial action, 8% diamine as a solvent, and 5% fluoride for remineralization.

SDF has 3 main fuctions:

• Arresting the progression of tooth decay.

• Preventing cavities.

• Reducing dentin hypersensitivity.

Role in stopping cavity of SDF:

SDF hardens decayed tooth surfaces (verified using an explorer or periodontal probe) by leveraging silver’s antibacterial properties and fluoride’s ability to promote remineralization of the decayed area.

After application, some cavities may darken (turn brown or black) within 2–3 days. If the base and walls of the cavity are firm upon examination, it indicates that the lesion has been arrested.

Typically, a single application of SDF is sufficient for cavities on smooth surfaces or small, shallow pits and fissures on chewing surfaces. For larger cavities on chewing or interproximal surfaces, fillings remain the preferred treatment. However, if a child is uncooperative for restorative procedures, SDF can be applied temporarily to halt decay progression until the child is older and more cooperative for definitive treatment. In such cases, reapplication of SDF may be considered every 3 or 6 months depending on the child’s caries risk.

However, we need to check if the decay has already reached the pulp, SDF is not a viable option. A key limitation of SDF is that it causes black staining on decayed tooth areas; however, healthy enamel and non-demineralized areas will not discolor. Before applying SDF, dentists at Herident show parents and children before-and-after photos to prepare them for the aesthetic changes.

Although SDF stains decayed primary teeth black, it does not affect the permanent teeth that will eventually replace them. Due to aesthetic concerns, SDF is not recommended for anterior permanent teeth.

For primary front teeth treated with SDF, once the decay has been arrested and enamel has hardened, Herident dentists will proceed with additional measures such as fillings or crowns to restore the child’s healthy, attractive smile.

The SDF Application Procedure:

• Step 1: Clean the tooth surface using a toothbrush.

• Step 2: Isolate the decayed tooth surface with cotton rolls and a saliva ejector (if available).

• Step 3: Dry the tooth surface with cotton rolls, possibly combined with the saliva ejector.

• Step 4: Dispense a small amount of SDF onto a plastic dish, dip a bonding brush into the SDF, and apply it directly to the decayed tooth surface. Remove any excess SDF with cotton.

• Step 5: Keep the child's mouth open for about 3 minutes while seated in the dental chair (especially when using the saliva ejector).

Is SDF Safe?

In Japan, all children as young as 18 months receive dental checkups, and SDF is applied starting at this age. According to Japanese sources, there have been no reported cases of SDF causing harm to children’s overall health.

Another point to note: due to its high silver concentration, if SDF comes into contact with the gums or oral mucosa, the affected areas may experience mild irritation or temporary whitening. These effects typically resolve on their own within 48 hours without treatment and do not cause pain. Care must also be taken to avoid contact with the tongue, as SDF has a slightly sour, bitter, and metallic taste that may cause discomfort and make some children uncooperative.

Note: In addition to black staining on decayed tooth surfaces, any skin or clothing that comes into contact with SDF may also develop dark stains. These marks often appear within a few hours (or in some cases immediately) and typically fade within a week. To speed up stain removal from the skin, povidone-iodine 10% can be used: apply with a cotton swab to the stained area, then wipe with 70% or 90% alcohol.

Important Reminder: This product is for use only in clinics or specialized hospitals under a dentist’s supervision. Parents should never attempt to purchase or apply it at home due to the technical requirements for proper use.