advantage arrest bottle

Silver Diamine Fluoride

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Arrests the progess of an already formed cavity in permanent and primary teeth

Mechanism of action

With silver diamine fluoride (SDF), it is now possible to reverse and arrest the cariogenic process, even if cavitations are present. It results from a combination of ingredients that form silver-protein conjugates in decayed surfaces. The silver ions act directly against bacteria in lesions by breaking membranes and re-acidification13, 14, while the fluoride ion acts to prevent further demineralization. Hydroxyapatite and fluoroapatite then form on the exposed organic matrix, along with the presence of silver chloride and metallic silver.5

Video credit: Oasis Discussions

Video credit: New York Times

Benefits

Now blue for easier application!
• Antimicrobial
• Cost-efficient :
± $0.88 (1 drop) to ± $1.76 (2 drops) for 5 surfaces*
  • 8ml bottle = 250 drops
  • Each drop = Up to 5 surfaces
• Odourless
• Dental hygienists can apply it
• Increases resistance to acid dissolution and enzymatic digestion11
*Based on an 8ml bottle at 220$

• Increases in mineral density and hardness while the lesion depth decreases5
• No post-treatment limitations
• Outperforms other anti-caries treatments in killing cariogenic bacteria15
• Quick application in less than 5 minutes
• User-friendly, no need for:
  • Air or water
  • Instruments
  • Anesthesia

Clinical situations

• Alternative to restorative treatment
• Around margins of lesions to prevent secondary decay
• Avoid general anesthesia or oral sedation
• Behavioral or medical management
• Carious lesions that cannot be treated in 1 visit
• Difficult access to dental care
• Difficult to treat dental carious lesions
• High risk caries
• Liner

Other clinical use

Tooth sensitivity

Indications

Anti-caries

Ingredients

Medicinal Ingredient
38% Silver Diamine Fluoride
(25% Silver, 5.5% Fluoride, 8% Ammonia)

Non-Medicinal Ingredient
Water, FD&C Blue No 1

NPN

80075746

Protocol for Adults & Children 3 Years & Older

Precautions before use
1. Isolate the affected area of the tooth. Protect patient’s eyes. Minimize contact with gingival tissues.
2. If accidental contact occurs, thoroughly wash the area with water, saline solution or hydrogen peroxide.
3. To avoid any metallic taste, use a swipe of tooth paste in mouth or apply flavored chap-stick prior to treatment.

Application
1. Clean and dry the affected tooth surface.
2. For up to 5 surfaces, dispense 1-2 drop(s) of solution into a plastic and disposable dappen dish.
3. Transfer material directly to the tooth surface with an applicator and allow to seal for a few seconds.
4. Allow to air-dry for 60 seconds.
5. Excess can be wiped or rinsed away after application using a 2x2 or cotton roll.

Notes
• Does not need light cured, air dries, excess can be rinsed away after application.
• Can be reapplied at intervals of > one week; one application is normally sufficient.
• When using the silicone applicators, press straight down on the drop, or the SDF will move away from the applicator . Another test is to drop a drop on a piece of cardboard.  The drop should go flat, turn black in about 1 min, and then soak in completely.  If you find the drop sits high on the cardboard or doesn’t turn black, then there may be something else going on.

Protocol for Children 3 Years & Under

Same than for children 3 years and older, except for: 1-2 drops per 10 kg body weight

Educate your patients on staining!

Staining is an indicator of antimicrobial effectiveness.
The functional indicator of effectiveness is when the silver oxide is bound to the diseased collagen and intrinsic pigmentation of a carious lesion occurs. These oxides don’t polish away because the blackened lesion retains its dark color for a long period, which is why the antimicrobial effect is long lasting.

SDF stains demineralized areas and soft-tissues. Stains can be reduced by gentle polishing with tincture of weak iodine solution or by being covered with Glass Ionomer.
The staining is not immediate but will be noticed within hours. It will be limited to direct areas of contact. For soft-tissue, it will fade over a period of 24 to 72 hours.

SDF does not stain sound or healthy enamel or dentin.
SDF stains clothing, counters, floors and instruments.

Example of application

Black mat is an indicator that the lesion is static.

photos of advantage arrest in action illustration showing application of the product

History of silver diamine fluoride

1870-1912: SDF IS USED FOR 80 YEARS AS A CARIES-ARRESTING AGENT IN ASIA
Ohaguro, a custom of dyeing one's teeth black, was practiced in Japan and other countries. It was also beneficial, as it prevented tooth decay.

2014: ADVANTAGE ARRESTTM IS CLEARED BY THE U.S. FDA
Advantage Arrest is cleared by the U.S. Food & Drug Administration (FDA) for dentinal hypersensitivity.

2015: ADVANTAGE ARRESTTM IS AVAILABLE IN THE U.S.
Advantage Arrest is commercially available in the United States through Elevate Oral Care, LLC. Since then, it has been used extensively by oral health professionals in the U.S., off-label for the arrest of tooth decay.

fda logo

2016: GRANTED THE FDA BREAKTHROUGH THERAPY DESIGNATION FOR THE ARREST OF TOOTH DECAY
Advantage Arrest is granted the 1st Breakthrough Therapy Designation by the FDA for an oral care product. This designation represents the FDA’S effort to address an unmet, serious, life-threatening medical need where there is no available therapy and to expedite the review of such products. The designation was granted based on the FDA review of 10 worldwide randomized clinical trials evaluating silver diamine fluoride for caries arrest in children aged 3-9 or adults aged 60-89. Collectively these trials involved 1,500 subjects who were monitored for 1-3 years.

new york times logo

2016: THE NEW YORK TIMES PUBLISHES AN ARTICLE ON SDF
Advantage Arrest is the subject of hundreds of lectures, online posts and articles. It is featured on major consumer media outlets including the New York Times, which published a whole story entitled “A Cavity-Fighting Liquid Lets Kids Avoid Dentists’ Drills”.

2017: ADVANTAGE ARRESTTM IS APPROVED BY HEALTH CANADA
Advantage Arrest is granted the Health Canada indication of an anti-caries agent.

Meta analysis of sdf on arresting caries in children

Reference: International & American Associations for Dental Research 2016

advantage arrest meta analysis table for arresting in children

Testimonials

Just got back from the ASM (2017) last week where I ordered my first bottle of Advantage Arrest from Oral Science. By far my favourite company for quality products. This product enables you to arrest those "suspicious lesions". I can't see how this wouldn't be beneficial for every IRDH!

- Heather Wolframe, owner of Go Smile practice

My daughter, age 4, had a successful application of silver diamine fluoride (SDF) in Calgary to arrest decay in her primary molars. Even though I ensured limiting sugar intake, eating healthy homemade meals and following a strict dental hygiene, I was shocked when decay was diagnosed in her one tooth, and six months after that three other teeth were affected too. I was thrilled when I found out that Health Canada approved SDF for caries treatment under the product name Advantage Arrest, which is distributed by Oral Science. Our pediatric dentist has just ordered SDF product and I was happy we were able to try it with amazing early results. The decay was treated and arrested in all four teeth. The SDF application was easy; all four teeth were treated in 5-7 minutes. No tears, no fear, only smiles and a gift to take - the part my daughter enjoys the most. I believe it can truly revolutionize the dental care in young patients.

- Inna from Calgary, AB

Featured Publications

References

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