Science & Tech

Radiographic verification of silver diammine fluoride action on proximal dental carious lesions in a teenager

May 6, 2021

This article documents the method of periodic interproximal saturation with silver diammine fluoride of contacting proximal tooth surfaces for caries attenuation and remineralization.

Theodore P. Croll, DDS

Joel H. Berg, DDS, MS

Applying silver diammine fluoride (SDF) with a dental soft pick to contacting proximal tooth surfaces attenuates the progress of caries lesions. (Note: The accurate spelling of diammine contains two m’s. The word is commonly misspelled with only one m.) This brief report describes that method and documents it with bitewing radiographs, 19 months’ results in a teenager—13 months after one application, followed by a second application six months later.

Figure 1: Soft dental pick dipped into SDF solution in inverted disposable dappen dish

Soaking the proximal tooth surface caries lesions with 38% SDF solution delivered with soft dental picks has been described in the literature.^1-3 Efficacy of uptake of the solution by such lesions was shown in a simple model using extracted teeth embedded in dental stone with a leather shoelace placed interproximally in the model to simulate soft tissue.² The clinical method for dental soft pick soaking of contacting proximal surface caries lesions can be summarized and shown as follows (figures 1–5):Identify beginning caries lesions radiographically.

Figure 2: SDF solution is shown clinging to a dental pick.

Floss proximal sites to rid regions of food debris and dental plaque.

Isolate with cotton rolls.

Air-dry sites.

Dip dental pick(s) into 38% SDF solution and assure that liquid is clinging to the tip (figures 1 and 2).

Insert tip(s) into place and leave in place for 60 seconds (figure 3).

Paint more SDF solution all along the sluiceway and move tip(s) in and out slightly several times to spread the fluid by capillary action along the tooth surfaces (figure 4).

Figure 3: Dental picks inserted. Sometimes two thinner picks can be used to maximize the amount of fluid.

Flood the region with 5% (or 2.5%) fluoride varnish with a small brush to insulate the SDF within the remineralizing fluoride “shield” (figure 5).

Have the patient occlude on a 2” x 2” gauze for a couple of minutes.

Figure 6 shows three dated bitewing radiographs, chronologically over 19 months. We acknowledge the few overlaps in the three bitewing radiographs; however,

Figure 4: Applicator paints SDF solution along sluiceways for increased soaking

one can reasonably argue that there has been no detectable advancement of the caries lesions, and some are perhaps actually smaller. We leave it to the reader to make judgments on the sizes of the lesions. It is particularly noteworthy that this teenage patient admitted that he flosses, but not daily. We consistently encourage compliance with flossing in our patients and share large demonstrative photographs of the results of not doing so. Periodic interproximal saturation with silver diammine fluoride to soak contacting proximal tooth surfaces for caries attenuation and remineralization has a much better chance of

Figure 5: Fluoride varnish covers and protects from salivary dilution and augments the remineralization potential of the procedure.

success when those sites are routinely cleared of food debris and oral bacteria.

References

Croll TP, Berg JH. Delivery of fluoride solutions to proximal tooth surfaces. Part II: Caries interception with silver diamine fluoride. Inside Dentistry. 2017;13(9):56-58. https://www.aegisdentalnetwork.com/id/2017/09/delivery-of-fluoride-solutions-to-proximal-tooth-surfaces

Croll TP, Berg JH. Delivery methods of silver diammine fluoride to contacting proximal tooth surfaces and history of silver in dentistry. Compend Contin Educ Dent. 2020;41(2):84-89.

Figure 6: Three dated bitewing radiographs, chronologically over 19 months

Croll TP, Berg JH, Donly KJ. Silver in medicine and dentistry: Exploring its history and rationale and understanding the benefits of SDF. Inside Dentistry. 2020;16(10):35-40.

THEODORE P. CROLL, DDS, a diplomate of the American Board of Pediatric Dentistry, is clinic director of Cavity Busters in Doylestown, Pennsylvania. He currently serves as adjunctive clinical professor of pediatric dentistry at the University of Texas Health Science Center in San Antonio as well as clinical professor of pediatric dentistry at Case Western Reserve School of Dental Medicine in Cleveland, Ohio.

JOEL H. BERG, DDS, MS, is a consultant in the dental industry and practices pediatric dentistry part-time. He is former dean at the University of Washington School of Dentistry and a past-president of both the American Academy of Pediatric Dentistry and the American Academy of Esthetic Dentistry. His career has placed him in leadership roles across the profession in the dental industry, academics, organized dentistry, and in private practice.