Silver Diamine Fluoride, not a complete solution to caries risk

A recent article in the New York Times, “A Cavity-Fighting Liquid Lets Kids Avoid Dentists’ Drills,” highlighted use of silver diamine fluoride (SDF) as an alternative approach to treatment of cavities in children.

The article highlighted that SDF was faster and cheaper than drilling and filling, and it mentioned the downside that when applied, SDF blackens the tooth.
US Food and Drug Administration (FDA) clearance as a medical device for the treatment of tooth hypersensitivity, FDA classified SDF as a fluoride Hola! 523 DENTAL 1and cleared its use as a medical device for the same indication. A number of products are currently available in other countries, but at this time, Advantage Arrest is the only commercially available SDF product for dental treatment in the U.S.
SDF received coverage in the newspaper media for its use in treating cavities in children, although this might be more accurately described as caries control and management.  Likely a result of its fluoride content, when applied to a carious lesion, SDF has also been shown to lower caries risk of the adjacent tooth surface. While the article focused on the use of SDF in young children, it has also been shown to be effective in management of root caries in the elderly. It likely has additional applicability as an interim approach for managing problematic caries in individuals currently unable to tolerate more involved dental treatment.
SDF is not a complete solution to caries risk.  Single application has been reported to be insufficient for sustained benefit. Its downsides include a reportedly unpleasant metallic taste, potential to irritate gingival and mucosal surfaces, and the characteristic black staining of the tooth surfaces to which it is applied.
A search of ClinicalTrials.gov for silver diamine fluoride returned 14 studies, 7 of which have been completed, 5 that are recruiting, and 2 that have not yet begun recruiting. This suggests that more scientific insight and news will likely be Hola! 523 DENTAL 6forthcoming about this product.

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