Upon application to the decayed surface, a layer of silver protein conjugate and silver minerals forms, increasing resistance to acid dissolution and enzymatic digestion. Hydroxyapatite and fluorapatite form. The treated lesion increases in mineral density and hardness. The silver acts as an antimicrobial, the fluoride acts to remineralize and the proteins that break down the dentin are inhibited. The ammonia acts as a stabilizer, keeping silver and fluoride ionic in solution. SDF will always discolor anything with exposed collagen, meaning it will stain decayed or demineralized sites and soft tissues, but not healthy tooth structure.
Before application: take care of your patient: Show them the consent form, inform them about the staining and protect their eyes.
For Silver Diamine Fluoride treatment without restoration placement:
Isolate the affected area with a cotton roll or dri-angle
Dry the lesion or surface
Dispense 1 drop into a disposable dish (1 drop treats up to five tooth surfaces)
Apply Advantage Arrest to the lesion of tooth surface
Allow it to soak in for 60 seconds. This is the most critical step in the process
Remove excess with a cotton pellet or roll, and then cover the treated area with a thin layer of fluoride varnish (FluoriMax). This will create a barrier and keep the silver in contact for as long as possible. It will also give your patient a nice flavour in their mouth rather than the metallic taste of SDF
If no varnish is applied, let it dry completely for 60 seconds
Reapply again in 1-3 week(s) for the highest chance of arresting the lesion hard
To optimize the caries arrest, reapply once every 6 months OR apply a glass ionomer over the top to seal out the nutrient source for any bacteria to survive under the restoration
There are no post-op patient instructions
For Silver Diamine Fluoride treatment with restoration placement:
Isolate the affected area with a cotton roll or dri-angle
Dry the lesion or surface
Dispense 1 drop of Advantage Arrest into a disposable dish (1 drop treats up to five tooth surfaces)
Apply Advantage Arrest to the lesion
Allow it to soak in for 60 seconds. This is the most critical step in the process
Rinse and dry the treated area
Proceed with your restorative steps for the material type you are using. To reduce staining of the filling: Polish away discoloration along the margins
Do not use a light cure; instead, use a self cure Gl, or “sandwich” of opaque GI at deeper levels and then composite (If you light cure Advantage Arrest, all of the silver will oxidize even on non-decayed surfaces and your filling may appear dark)
There are no post-op patient instructions
Interproximal decay can be treated using a Superfloss Technique (see video on OS website).
Direction for use for children 0-3 years ol
Maximum of 1 drop per 10 kg of bodyweight per treatment visit 3.
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.
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.
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.
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.
Reason to switch
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.
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