Page 26 - GP Spring 2025

Dental Management: The application of access to dental services due to economic, the rapid growth of the 65-and-older cohorts
SDF is used to arrest carious lesions. 3 social or functional challenges, may bene- will further tax the U.S. oral health care sys-
fit from this treatment as well. The interim tem. 6
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Application Technique for Silver Nitrate & benefit of application of SDF to our patient
Silver Diamine Fluoride: far outweighed no treatment due to his un- An effective strategy to relieve this potential
known medical status. In this case, we did burden of dental caries in older adults is to
1. Isolate areas to be treated with cotton notice the lesions had been arrested after change the principle of caries management
rolls. Air-drying prior to application is three months. from an intervention-oriented approach to
thought to improve effectiveness. a prevention-oriented approach. While aes-
SDF demonstrates significant promise as a thetics is an important part of dentistry, oral
2. Remove debris from cavitation. Carious treatment for arresting and preventing root health professionals must remember that the
dentin removal is not necessary. When re- caries in adults, but the notable disadvan- main goal is oral health. Despite the apparent
1,8
moval is done, it may reduce the proportion tage is staining of the carious lesion black. drawback is that as the caries lesions become
of arrested caries lesions that become black, Various methods for caries prevention and arrested, the precipitation of silver byprod-
so it may be considered for aesthetic pur- arrest in older adults involve fluoride prod- ucts in the dental tissues stain the lesions
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poses. ucts whether self or professionally admin- black, which can be a deterrent for its use.
istered.
3. Dry lesion with compressed air. SDF continues to demonstrate its value as a
The professional mechanisms and risk fac- minimally invasive and effective treatment

4. Dip a brush into the SDF solution and ap- tors for the use of SDF in adults provide for managing root caries in adults. As high-
ply directly only on the tooth surface. distinct evidence for public health impli- lighted in this case, SDF offers a promising
cations. Ageing, multimorbidity, and poly- solution for patients with complex medi-
5. Allow 1-3 minutes for the silver diamine pharmacy make older adults vulnerable to cal histories or those who may not toler-
fluoride to react with the caries lesion. oral diseases. 5 ate conventional restorative procedures.
Its unique composition of silver and fluo-
6. Remove any excess material with the SDF’s non-invasive nature, requiring nei- ride effectively arrests caries progression
same cotton used to isolate. ther drilling nor anesthesia, makes it par- while supporting remineralization. Despite
ticularly suitable for patients with dental its well-documented benefits, including
7. Place fluoride varnish over the treated anxiety or those who are medically com- cost-effectiveness[8] and suitability for re-
teeth. promised. Finally, its cost-effectiveness and source-limited settings, further research is
adaptability to a wide range of patients and essential to solidify its role in adult dental
8. Glass ionomer can be placed over the car- clinical settings, especially in resource-lim- care. SDF has the potential to revolutionize
ious lesion. ited environments, underscore its value as caries management and significantly im-
an accessible and practical treatment option. prove access to care, making it an invalu-
9 Reevaluate and reapply SDF in 3 months, able tool in modern dentistry. SDF contin-
6 months and 12 months. Silver Diamine Fluoride (SDF) is a topical ues to be an important part of public health
antimicrobial agent primarily used in the strategies aimed at addressing dental decay
Discussion: Silver diamine fluoride (SDF) management of dental caries, particularly in in underserved, underinsured and high risk
is a clear liquid that combines the antibacte- pediatric, geriatric, and special needs popu- populations.
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rial effects of silver and the remineralizing lations. SDF is a colorless liquid composed
effects of fluoride. The use of ammoniacal of silver, fluoride, and ammonia, with silver This suggests that topical treatment with
silver fluoride for the arrest of dental caries acting as an antimicrobial agent and fluoride SDF may be sufficient to maintain most in-
was pioneered by Drs. Nishino and Yamaga aiding in remineralization. Its application is dividuals in their later years even when the
in Japan. Each milliliter of product con- non-invasive, quick, and relatively pain- patients are taking substantial numbers of
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tains 380 mg (38 w/v%) of 255,000 ppm sil- less, making it an effective alternative for prescription drugs that have been associated
ver and 44,800 ppm fluoride ions. It works patients who may not tolerate convention- with decreased salivation and higher car-
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by penetrating the tooth enamel, arresting al restorative treatments. The compound’s ies risk. Increased research and advocacy
caries progression through its ability to in- ability to halt caries development has made for this treatment can ultimately result in
hibit bacterial growth, remineralize affected it an important tool in both preventive and changes to insurance policy which can re-
dentin, and prevent further demineraliza- therapeutic dentistry. sult in the expansion of these preventive ser-
tion. 5 vices becoming routine coverage for adult
Conclusion: Dental caries is a preventable patients.
The patterns of disease for older adults also disease. In the older adult population, oral
vary from those seen in younger individu- health is an important component of an ac- References:
als. A significant portion of tooth decay is tive aging policy, which promotes healthy 1. Chan, A. K. Y., Tamrakar, M., Jiang, C.
recurrent disease associated with failing living, disease prevention and focusing on M., Tsang, Y. C., Leung, K. C. M., & Chu,
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restorations. In fact, the majority of tooth improving the quality of life of older adults. C. H. (2022). Clinical evidence for profes-
decay in older adults is restoration failure at Medical complexity, physical frailty, psy- sionally applied fluoride therapy to prevent
the gingival margin. 6 chological barriers and financial limitations and arrest dental caries in older adults: A
commonly challenge caries management in systematic review. Journal of Dentistry,
However, older adults, especially those with this population. In combination with more 125, 104273. https://doi.org/10.1016/j.
high caries risk and/or with limited to no older adults retaining their natural dentition, jdent.2022.104273

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