Applicator Brushes for FluoriMax Varnish 100-Pack
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Mechanism of action
Upon application to the decayed surface, a layer of silver protein conjugate and silver minerals increases resistance to acid dissolution and enzymatic digestion. This treatment leads to an increase in mineral density and overall hardness of the decayed lesion. The silver acts as an antimicrobial agent, while the fluoride helps remineralize the affected area. Additionally, proteins that break down dentin are inhibited. Ammonia serves as a stabilizer, keeping silver and fluoride ionic in solution. It’s important to note that SDF may permanently discolour anything with exposed collagen, decayed or demineralized sites, and soft tissues. However, it does not affect healthy tooth structure.
38% Silver Diamine Fluoride
25% Silver, 5.5% Fluoride, 8% Ammonia
Indication
High-risk caries
Arrests the progress of an already formed cavity in permanent or primary teeth.
Benefits
Antimicrobial
Cost-efficient:
1 patient ≅ 2 drops ≅ $2.76 (based on a 5 mL bottle at $214.99);
5 mL bottle ≅ 155 drops
Dental hygienists and assistants can apply it
Increases mineral density and hardness
Increases resistance to acid dissolution
Increases same-day treatment options
No post-treatment limitation for the patient
Non-aerosol generating treatment
Outperforms other anti-caries treatments in killing cariogenic bacteria
Quick and easy application (less than 5 minutes)
Tinted blue for an easier application
User-friendly: no need for air, anesthesia, instruments or water
Other clinical uses
Behavioural or medical management patients
Carious lesions that cannot be treated in one visit
Lesions that are difficult to treat
Pediatrics
Root caries
Tooth sensitivity
Directions for use
SDF treatment without restoration placement
Review consent form and inform the patient of the staining.
- Provide protective eyewear. Apply vaseline to lips and surrounding tissues to avoid staining skin.
- Isolate the affected area with a cotton roll and/or dri-angle.
- Dry the lesion or surface.
- Dispense 1 drop into a disposable dish (1 drop treats up to 5 tooth surfaces).
- Apply Advantage Arrest® to the lesion.
- Allow it to soak in for 60 seconds and up to 3 minutes for cooperative patients.
- 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 rather than the metallic taste of SDF.
- Initial application arrests approximatively 74.1%; a second application within 1–2 weeks arrests ~91%.
- To optimize caries arrest, reapply at intervals of every 3–6 months OR apply a self curing Glass Ionomer restoration to help prevent bacterial reinfection.
- There are no SDF post op patient instructions.
SDF treatment with restoration placement
Review consent form and inform the patient of the staining.
- Provide protective eyewear. Apply vaseline to lips and surrounding tissues to avoid staining skin.
- Isolate the affected area with a cotton roll and/or dri-angle.
- Dry the lesion or surface.
- Dispense 1 drop into a disposable dish (1 drop treats up to 5 tooth surfaces).
- Apply Advantage Arrest® to the lesion.
- Rinse and dry the treated area.
- Proceed with your restorative steps for the material type you are using. To reduce staining of the filling, use a self cure GI, or “sandwich” technique of opaque GI at deeper levels and then composite. Please be aware, light curing will discolour more areas than just decay.
- There are no SDF post op patient instructions.
SDF treatment with restoration placement
Review consent form and inform the patient of the staining.
Interproximal decay can be treated using a Superfloss Technique.
How deep does it penetrate?
- ~ 25–30 microns into enamel
- ~ 200–300 microns into dentin
- ~ Up to 2 mm into a deep lesion
Silver Diamine Fluoride vs. SDF + Potassium Iodide
| Advantage Arrest™ — 38% Silver Diamine Fluoride (SDF) | 38% SDF + Potassium Iodide (KI) | |
|---|---|---|
| Efficacy on inhibition of development of caries | SDF + KI treatment inhibited the development of caries on GIC restorations, but was not as effective as SDF treatment alone. Moreover, a perceptible staining on the restoration margin was observed.1 | |
| Cost per patient (approx.) | Bottle: $2.76 (2 drops) based on a 5 mL bottle at $214.99 | Bottle: $2.92 (2 drops); Unit-dose: $11/patient |
| Storage & shelf life | 3 years at room temperature | 2 years refrigerated |
| Indications | Arrests the progress of an already formed cavity; Anti-caries | Anti-caries |
| Pediatric application | Yes | No — KI is not indicated for children |
| Tinted for placement visualization | Yes (blue) | No |
| Barrier | Cotton rolls | Rubber dam |
| Non-staining | No | No |
| Multiple application steps | No | Yes |
| pH | 10 | 13 |
New GEL Formula
“SDF precipitates on the dentin surface and within dentinal tubules were found for both liquid and GEL, with a slight tendency for the GEL to be more abundant. 2
Gel formula
Negative control
Liquid formula
Benefits
- Reduces accidental drops on cheeks, counters, floors, and other areas
- Excellent for root surface applications
- Improves handling
- Up to 125 applications per syringe
- 100 curved tips included per box
- Cost effective, multi-use
- 3-year shelf life
- Minimizes accidental staining of nearby surfaces
Clinical tips
- Tips should be disposed of between patients
- Can be sucked back into syringe to avoid waste
- Syringe should not be applied directly into the mouth without a barrier
References
- Zhao et al. Effects of Silver Diamine Fluoride and Potassium Iodide Treatment on Secondary Caries Prevention and Tooth Discolouration in Cervical Glass Ionomer Cement Restoration, 2017. ↩︎
- Kiesow, Andreas, et al. Dentin tubule occlusion by a 38% silver diamine fluoride gel: an in vitro investigation. BDJ Open, vol. 8, no. 1, 2022, p. 1. PubMed, doi:10.1038/s41405-022-00095-8. ↩︎
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