Rechavia Dental Center

You Know the Drill…


By: Dr. Daniel Kaszovitz, DDS, FAGD

Now meet the drop. The drop contains silver diamine fluoride, and that’s important because it’s the first thing ever that can kill tooth decay.

For as long as dentistry has been around, the only way to treat decay has been to cut it out and fill the tooth. In the 1800s, compressed cobwebs, quartz, tin and molten metal (ouch) were tried to fill the cavity. Then for about 150 years, amalgam was the filling material of choice. Recently, white-bonded composite restoration has taken over.

Now the FDA has approved silver diamine fluoride (SDF). This is a game changer. I say this because now the question of what to fill the tooth with is no longer a question. In the right circumstances, you might be able to avoid the drill entirely.

Silver, in different forms, has been known for many years to be a very potent antibiotic. Many people are familiar with the burn cream Silverol, or similar preparations. This is a white cream which is rubbed on a burn to prevent infection. The cream, when exposed to air, turns dark as the silver is oxidized. So while the silver kills decay and stops cavities from growing, it’s not a panacea. You would not want this on your front teeth!

Some great applications for it: A child with cavities in the back baby teeth. We can’t leave them because the decay will continue to the nerve and he will be in pain, or the tooth will get infected. Filling the teeth could get quite costly and, depending on the child, would leave him with bad memories of the dentist, paving the way to becoming a poor patient in adulthood. Enter SDF: paint it on, wait one minute, and rinse. No drilling, no pain, no fuss. The cavity is now dead.

Another great application: I saw a patient last week who had a deep cavity, needing a crown. I removed most of the decay and realized how close we were to the nerve. Normally this would be an indication for a root canal and post under the crown. I stopped, applied the SDF, waited one minute, and filled a now clean tooth. No root canal necessary. When I called the patient later that night to see how she was feeling, I was very pleased to hear that although the decay was dangerously close to the nerve, she felt no discomfort. We had saved her a root canal! Finally, for the elderly, who have decay under crowns or are having a hard time managing their oral hygiene, this could be very helpful adjunct to their care. Of course, there is no magic bullet for every situation, but this is a great new tool in our tool box.

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