SDF Application

SDF application

Silver Diamine Fluoride (SDF) is a minimally invasive treatment that is used to arrest active dental caries especially in special healthcare needs, older adults and children. Easy, painless and usually requires no drilling.

Step-by-Step SDF Application:

Assessing a patient and securing consent

• Confirm that the lesion is a good candidate for SDF treatment.
• Describe that treated carious areas will become black forever.
• Ensure informed consent prior to treatment.

Prepare the Tooth

• Use cotton or toothbrush to remove food debris and plaque from the caries lesion.
• Typically no drilling is needed.

Protect Soft Tissues

• Put petroleum jelly on lips and around the gums to minimize staining.
• Also wear gloves and protective eyewear for clinician and patient.

Isolate the Tooth

• Isolate the tooth with cotton rolls, gauze or a dental dam.
• Make sure to keep the lesion dry for maximum effectiveness.

Dry the Lesion

• Gently dry the cavity using cotton or compressed air.

Apply SDF

• Place one drop of 38% SDF in a dappen dish.
• Use disposable microbrush to dip into solution.
• Directly apply SDF onto carious lesion until saturated.

Allow Absorption

• Do not remove the SDF from the lesion unless this is not possible, in this case it should be left for a minimum of 60 seconds.
• Keep isolated for this period.

Remove Excess Solution

• Use gauze or cotton pellets to remove excess SDF.
• Often (Optional but Used) Fluoride Varnish.
• A fluoride varnish can be applied to help decrease the metallic taste and to help remineralize adjacent teeth.

Post-Treatment Instructions

• Explain to the patient that the treated decay will turn black to show that the decay has been arrested.
• After 2-4 weeks, have the lesion reviewed to see if it has become hard and inactive.
• Reapplication can be suggested every 6-12 months depending on caries risk.

SDF application instructions

The following instructions are provided to help ensure the safe and effective use of 38% Silver Diamine Fluoride (SDF) to arrest dental caries.

Before Application

• Verify the lesion's suitability for SDF treatment.
• Inform the patient/caregiver that the treated decay will always look black.
• Get permission before going ahead.
• Ensure that proper personal protective equipment is worn (gloves, mask and eye protection).

Tooth Preparation

• Scrape the tooth surface to remove debris from food, loose carious material and plaque.
• Use cotton rolls, gauze or a rubber dam to isolate the tooth.
• Use petroleum jelly or cocoa butter to prevent staining of surrounding soft tissues.
• Pat or air dry the lesion.

SDF Application

• Place one drop of 38% SDF in a disposable dappen dish.
• Put a disposable microbrush into the solution.
• Apply a small amount of SDF directly to carious lesion.
• If possible, apply SDF to the lesion for at least 60 seconds.
• Do not touch or stain healthy gingiva, oral mucosa or clothing because SDF can stain these soft tissues temporarily and fabrics permanently.

After Application

• Use gauze or a cotton pellet to remove excess SDF.
• Remember to dispose of all contaminated materials in accordance with infection control procedures.
• Encourage the patient to not eat or drink for 30-60 minutes, if possible.
• Explain to the patient that the treated area will become dark for the next several days as a sign of a successful caries arrest.

Follow-Up Care

• Retest the lesion at 2-4 week intervals to ensure that the caries has been arrested.
• If a lesion is successfully arrested, it should be hard, dry and black.
• Repeat SDF application every 6–12 months or when clinically indicated for high-risk patient or when the lesion is still active.

Precautions

• Avoid using SDF for patients with a history of an allergy to silver.
• Do not apply on teeth with irreversible pulpitis, pulp exposure, or dental abscess.
• Do not get into eyes or on skin, rinse off by water if contact occurs.
• Keep away from light and store SDF, following manufacturer's directions.

SDF application steps

38% Silver Diamine Fluoride (SDF) is a simple, non-invasive method that can help to arrest active dental caries. The procedure generally takes just a couple of minutes and does not involve drilling or local anaesthetic.

Step 1: Assess the Patient

• Inspect the tooth to ensure a suitable lesion for SDF treatment.
• Make sure that there is no irreversible pulpitis, pulp exposure or dental abscess.
• Give a procedure explanation and explain that the decayed area will always be black.
• Obtain informed consent.

Step 2: Prepare the Tooth

• Scrape off the plaque, debris and loose particles from the surface of the tooth.
• Excavation of caries is not usually necessary.

Step 3: Isolate the Tooth

• Place cotton rolls, gauze or rubber dam to isolate the tooth.
• Use petroleum jelly around soft tissues to reduce staining.

Step 4: Drying the Lesion

• Air dry the area gently which has cavity with compressed air or cotton pellet.
• A dry surface will facilitate the penetration of SDF into the lesion.

Step 5: Dispense the SDF

• Add 1 drop of 38% Silver Diamine Fluoride to a disposable dappen dish.
• Typically, one drop will suffice for several small lesions.

Step 6: Apply the SDF

• Dip a disposable microbrush in the SDF solution.
• Apply a thin layer on the carious lesion making sure the entire lesion is covered.
• Do not contact with healthy tooth structure and soft tissues.

Step 7: Allow the Solution to penetrate

• When possible leave SDF on the lesion for 60 seconds or more.
• Isolate and leave the area dry during this time.

Step 8: Supervising the cutting and removal of excess material

• Use a cotton pellet or gauze to remove excess SDF.
• Use standard infection control practices for disposal of used materials.

Step 9: Fill in the Procedure

• Treatment can be repeated with fluoride varnish, if desired over the treated area.
• If possible, recommend that the patient abstain from all food and liquids for about 30-60 minutes.

Step 10: Schedule Follow-Up

• Check tooth after 2-4 weeks.
• A lesion that has been successfully arrested should feel firm, dry and black.
• Apply SDF every 6-12 months or as indicated by patient's caries risk assessment and clinical assessment.

Conclusion

The application of SDF is a safe, effective and minimally invasive method to manage dental caries, especially in children, the elderly and patients with special healthcare needs. Unlike traditional restorative treatment, SDF slows the progression of tooth decay in most instances without the need for anaesthetic and drilling. The treated decay permanently discolored but that is an indication that the carious lesion has been effectively arrested. With proper oral hygiene, regular dental visits and proper follow-up applications, SDF is a crucial part of maintaining the integrity of the tooth and long-term oral health.

SDF application in India GetWellGo

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FAQ

Does it hurt to apply SDF?

• No. SDF application is fast, non-invasive and is relatively painless. In most cases, it does not need to be drilled or local anaesthetized.

What causes the treated tooth to blacken?

• This area of a tooth that has decayed will darken in color post SDF application due to a chemical reaction between the silver and the decayed tooth tissue. This dark color is a normal staining which indicates that the cavity has been arrested.

What is the duration of SDF?

• The effect of SDF can persist for months, although reapplication can be recommended every 6–12 months based on the caries risk of the patient and the dentist's clinical judgement.

Is SDF as effective as a filling?

• Not always. SDF can prevent decay from getting worse but cannot repair the tooth's shape or function. Even if the cavity is arrested, large teeth cavities might need a filling or crown.

Is SDF safe for kids?

• Yes. SDF has been proven to be an effective and safe treatment for avoiding tooth decay under the guidance of a dental professional and is widely adopted in children's dentistry.

What I should not do following SDF application?

• Your dentist will probably ask you to not eat or drink for about 30–60 minutes following the procedure so that the material can set.