A comprehensive set of resources to support the use of Silver Diamine Fluoride (SDF) as a treatment to arrest dental caries in the primary dentition is available on the BSPD website. The technique is expected to be more widely used in the coming months as dental teams find ways to minimise aerosol generating procedures. These resources can be found here: https://www.bspd.co.uk/Professionals/Resources.
Included among the resources is a Patient Information Leaflet (PIL) which has been made editable so hospitals and dental practices can add their own logo. A Standard Operating Procedure and a Consent Form have also been developed. A powerpoint explaining the background to the technique as well as a demonstration video to show how SDF is applied has been created and are on our YouTube channel.
The resources have been compiled by Laura Timms, an Academic Clinical Fellow at the University of Sheffield Dental School with an interest in SDF. She has just won a prestigious joint grant from RCS and BSPD to make a video to explain the SDF technique to children.
She was motivated to understand more about the technique having been troubled by the extent of decay in some of her young patients; she wanted to find a treatment that would help keep them out of discomfort.
SDF is licensed in the UK for the treatment of sensitivity but Laura was aware of research which shows it has good results when painted onto dental decay in the primary dentition. “Using SDF can buy time for children who cannot manage dental treatment by stopping the decay getting worse until they can have further dental treatment. It’s simple, quick and effective.”
Without treatment, the children would be at risk of requiring extractions under general anaesthetic and suffering from pain and abscesses while waiting for a hospital appointment. SDF contains both silver and fluoride in a solution of ammonia. It arrests caries until the child is older and more compliant with dental treatment.
The disadvantage of the technique is that it stains the dental decay black. Some parents find the staining reassuring, however, as it shows that the treatment is working on the decay. If the child is subsequently able to cope with more demanding treatment, fillings or preformed metal crowns may be placed over the SDF.
There is another option for the biological management of children with dental caries and that is the Hall technique. Preformed crowns are placed over decayed teeth and will also arrest the progress of caries. These are usually well tolerated but may be more challenging to place in very young children.
Laura added: “Ideally, I hope that the new SDF resources will help dental teams treat children in the family dental practice with which they are familiar and either delay or eliminate a referral into hospital.”
Claire Stevens, spokesperson for BSPD and a Consultant in Paediatric Dentistry, said: “All paediatric dental teams working in hospital departments want to keep procedures under general anaesthetic to a minimum currently which makes Laura’s work timely. Ideally, more children will be treated in their family dental practice instead of being referred into secondary care for a general anaesthetic. We are very grateful to Laura for her hard work.“
Laura says she distilled the new guidance from pre-existing resources from Sheffield University and Sheffield Teaching Hospitals, University College London Eastman Dental Hospital, Glasgow Dental Hospital and School and Dundee Dental Hospital teams. She is now working with children on a patient-centred video thanks to the grant awarded by BSPD and RCS.
Links to resources: