How To Get Silver Diamine Fluoride Off Skin

Silver diamine fluoride (SDF) has been widely recognized equally an effective noninvasive tool for the prevention and management of dental caries. And it has proven to exist an invaluable treatment during the COVID-xix pandemic.

Equally noninvasive dentistry continues to rising in popularity, CareQuest Plant of Oral Wellness dedicated its latest webinar to an exploration of SDF. Our adept panel explored the science backside SDF, best practices for use today and in the future, and the challenges of incorporating information technology into practise.

And nosotros received lots (and lots) of questions — both earlier and during the prove.

Because the bear witness was but sixty minutes, our clinical experts — Jeremy Horst Keeper, DDS, PhD, managing director of clinical innovation at CareQuest Innovation Partners and Sharity Ludwig, EPDH, MS, director of culling care models at Advantage Dental Oral Health Center and Affiliated Practices — didn't have time to answer all, or fifty-fifty most, of the questions.

As a bonus for webinar participants and a resource for anyone interested in SDF, hither, Jeremy and Sharity answer 17 questions on SDF:

1. What are the risks related to SDF?

The short-term sense of taste and odor can be off-putting. They become away with a little water on the tongue or, preemptively, y'all tin add a smear of toothpaste on the tongue or gauze that is used to keep the expanse dry. The primary side effect is that any porous molar structure (caries or hypomineralization), will stain black. If SDF comes into contact with pare, it will cause a small dark spot that volition go away on its ain in one-2 weeks. If it comes into contact with existing white fillings, it might stain the margins if they are open. And if a filling is placed the same day, information technology volition probably stain. Lastly, notation that the most severely sensitive patients might not want to be treated a second or 3rd time.

ii. Is SDF recommended once a year or twice a year? And how would one in private exercise code this?

Based on my practice, for frequency, I align this with caries. If moderate take chances, I'd suggest two times per year. If high risk, at least two times per twelvemonth, just I volition see them four times per year and utilize either SDF or alternating with PVP-Iodine in conjunction with fluoride varnish. For coding, it is dependent on the intended utilise of the SDF. If information technology's for prevention, D1355 or D1208, every bit the lesion isn't notwithstanding cavitated. If there is breakup in the tooth structure, and then I would employ D1354.

3. Are most insurances reimbursing for SDF now?

Most insurance plans reimburse dental teams for treatment using D1354. The CDT code for prevention in healthy surfaces by tooth, D1355, just launched in 2021. D1208, for total mouth prevention should exist, is almost always, reimbursed.

four. At my Indian Wellness clinic, SDF is not a covered procedure co-ordinate to MediCal. This makes it difficult to provide the service to our customs, as SDF is quite costly to buy. My clinic doesn't want to practice procedures that are not covered by insurance. Virtually of our patients cannot or volition not beget payment for SDF. Any thoughts?

Many tribes accept chosen to pay for SDF for many reasons. In IHS clinics dependent on Medicaid, the best step is to reach out to the Medicaid state dental director directly and permit them know the demand.

To address patients that cannot and will non pay for non-covered services: As a provider, it is our responsibility to inform the patient of their options, considering their wants, needs, and desires. Tin the organization come up with a toll-effective plan that may exist more accepted past patients? For instance, I have heard of offices charging a erstwhile set up fee for SDF treatments up to iv visits. Also, tin you accept your business office figure out what cost per visit is and have the fee be a break-even dollar amount to just comprehend costs? Not all patients will accept, but if at least one or a few do, you're helping them to make a departure in their oral health.

5. What is the evidence for the use of SDF equally a preventative for older adults? Would you recommend it every bit part of a prevention protocol for adults with dry out rima oris?

The evidence is strong, at 60%. (Come across more than in CareQuest Establish's newest infographic on SDF). I e'er notice it interesting when providers ask me almost use on adults. From my perspective, we know it is more than effective and then fluoride varnish, so why not use it? In my feel, information technology comes downwards to the esthetic aspect of SDF, so I approach it with patients regardless of age. I start by asking what is of import to the patient for their oral wellness and present options that align.

six. What are the supervision restrictions for placement of SDF in Florida (or whatsoever state)? Can a hygienist identify in a mobile dental setting without a dentist present?

You can find land-specific and supervision information in this helpful resource from the American Dental Hygienist Association. There'south also a very helpful infographic, "Awarding of Silver Diamine Fluoride (SDF) by Dental Hygienists," about scope of practice from the Oral Health Workforce Research Center.

7. Does application of SDF have any effect on bondability of the remineralized tooth structure to composite if a filling is placed later in the future?

No, not from my experience. If y'all rinse before bonding, you can do so to maximum strength immediately (but wait at to the lowest degree one minute to allow soaking in). A same-solar day composite will stain, though. Afterward a week, there won't be a problem.

viii. Can you consider the stain to exist a good thing for posteriors, for example, to show that the SDF is working?

Absolutely! That is what I share with my patients to put a positive spin on information technology.

9. When looking at bitewings, when would SDF be recommended for an interproximal lesion as compared to fluoride varnish? Should the lesion be into the dentin? Halfway through the enamel? Or another indicator?

SDF can be considered for the handling of a caries lesion at any phase before irreversible pulpitis. Although SDF clinical trials have focused on prevention of new lesions and handling of cavitated lesions, I think information technology is fair to assume that the greater efficiency and effectiveness of SDF over fluoride varnish for prevention could also interpret to treatment of non-cavitated lesions (for example, enamel lesions). Of class, the side effects are long-term stain, short-term taste, and smell. If in that location's no visible cavity, at that place won't be stain.

10. Should we use SDF instead of sealants for prevention?

You lot should make the conclusion with your patients, merely information technology is about xx times more than cost effective to utilize SDF than sealants. Per tooth, SDF is near 60% preventive fraction while sealants are about 70%. Because material and time, SDF is the more price-effective preventive handling.

11. How tin you tell if the caries run a risk has been lowered vs. the lesion being arrested?

Speaking to caries risk, I mentioned the risk assessment used for the clinical algorithms was focused on the clinical presentation of the teeth. As changes in the teeth occurred, you would see a change in gamble level. In my experience in working with dentists, arrest varies to some degree, but dark, difficult, glassy advent are common terms shared past dentists.

12. How do you use SDF preventively? Do you lot place information technology on all teeth?

Focus on high-take chances surfaces for patients — exposed roots, occlusal surfaces of newly erupted molars, proximals in teens, etc. You can learn more than on the topic — run into Prevention of Caries by Argent Diamine Fluoride 38% — at this link.

13. When SDF is practical for prophylaxis to surfaces with no caries — for example to an erupting molar — does the tooth plough black?

SDF will discolor teeth if there is a breakup in molar structure.

14. Why would y'all cover with fluoride if SDF, by definition, already has fluoride? Is it overkill?

To cover the flavor and protect the decay-SDF reaction from dilution past saliva. The fluoride from varnish is not necessary. Providers have too used Vaseline in place of varnish to prevent the saliva washout.

15. Is SDF recommended for extensive decay, such as lesions that are close to the pulp? Or are at that place negative effects if SDF is placed too closely to the pulp chamber?

SDF is somehow incredibly well-tolerated by the pulp. We do not put it directly on the lurid, e'er, merely with at least a band of dentin over the pulp, information technology seems to desensitize and preclude sensitivity.

16. Tin you say more than about interproximal caries/superfloss technique sensitive or as long every bit it gets "shut"?

It is water based, and so the drier yous become the tooth/disuse, the more it will wick in via capillary action. The superfloss is an option just there is no testify that it is helpful, and there have been a few semi-formal comparisons. The floss may soak the SDF or help information technology in. I merely dry and apply at the embrasures.

17. How is SDF detected radiographically?

Sometimes a radiolucent line appears in the outer layer of the cavity, only normally, there is no radiographically visible alter. The goal is to encounter no modify in the size of the lesion over time.

Editor's Note: To view the total recording of the webinar, Providing Minimally Invasive Intendance with Argent Diamine Fluoride (SDF), visit the CareQuest Institute webinar library.