T/F: dental caries is a transmissible bacterial disease
true
what components are needed for dental caries to occur?
-microogranisms
-host
-time
-substrate
what is SDF?
-a colorless, ammonia solution containing silver and fluoride ions
-25% Ag, 5% F, and 8% NH3
SDF has ________ properties
antibacterial
SDF reacts with what compound? What products are formed?
-reacts with hydroxyapatite
-forms Calcium Fluoride and silver phosphate
what is the purpose of CaF2?
-reservoir of F
-neutralizes imbalance in demineralization/mineralization
what is the purpose of Ag3PO4?
-crystal of low solubility in the oral environment, antibacterial
what does SDF do?
-inhibit dentin demineralization
-preserves collagen
-inhibits collagen breakdown
-increase dentin hardness
silver ions bind to _______ in bacteria cell cell causing it to rupture
surface proteins
T/F: silver ions prevent cell replication by binding to DNA and RNA
true
what are the functions of fluoride?
-inhibits demineralization
-promotes remineralization
-inhibits bacteria in plaque
Clinical trials demonstrated caries arrest after SDF. The results were even better when what was done?
SDF applied twice yearly over a period of two years
T/F: direct application of SDF to health surfaces in children also helps prevent caries
true
what is the general rule for arresting caries with SDF?
- 47-90% of caries arrest after 1 application at 6 month recall
- 90% arrest with semi-annual applications
does SDF affect the bonding of glass ionomer or composite resins?
no
what is SMART?
silver-modified atraumatic restorative technique
for any patient with active caries, we might consider replacement of _________ as the primary means to prevent new lesions
fluoride varnish
what is the agent of choice for caries prevention for patients without access to both sealants and monitoring
SDF
what are the indications for SDF?
- high caries risk
- non-invasive treatment for deciduous teeth about to exfoliate
- challenging treatment due to behavioral or medical management
- patients with carious lesions that may not all be treated in one visit
- poor access to dental care
can you use SDF on primary and permanent teeth?
yes
T/F: application of SDF on teeth with irreversible pulpitis is clinically acceptable
false- teeth should not have clinical signs of pulpal inflammation or reports of spontaneous pain
can you use SDF interproximally?
yes- as long as the surface is accessible with a microbrush or superfloss
what are the contraindications of SDF?
-silver allergy
-ulcerative gingivitis or stomatitis
decayed dentin will turn _________ as the caries lesion arrests after SDF application
black
what is the maximum dose for SDF?
25 ul (1 drop/ 10 kg) per treatment visit
1 drop of SDF can be used to treat approximately ______ teeth
5
what is the proposed treatment protocol for SDF assuming that consent was obtained and proper barriers/PPE are used?
1. place protective coating of petroleum jelly should be applied to lips and skin to minimize ST staining
2. remove gross debris from cavitation
3. place 1 drop of SDF in dish
4. remove saliva from area
5. isolate tongue and cheeks
6. dry lesion
7. apply
what is the proposed treatment protocol for interproximal SDF?
1. insert superfloss
2. apply SDF using microbrush to superfloss near carious lesion
3. slide into the interproximal area adjacent to the carious lesion
4. allow SDF to absorb for up to 3 minutes if reasonable
5. apply 5% F varnish over lesion
when should you have a follow up appointment following SDF treatment?
2-4 weeks after initial treatment
what material can serve as a definitive, long-term treatment (restoration) following the use of SDF?
glass ionomer
what is the hall technique?
cementation of stainless steal crown over teeth with proximal caries lesion or extensive tooth structure loss without using anesthesia
describe the protocol for SDF treatment with hall SSC technique
-place orthodontic separators interproximally
-place SDF on affected areas
-patient returns within 2 weeks for SSC via hall technique
-remove gross debris from cavitation
-remove orthodontic separators
-protect airway
-fit tooth with SSC
-occlusion should
what is the LD50 for SDF in mice?
oral: 520 mg/kg
subcutaneous: 380 mg/kg
what is the recommended limit for SDF in humans?
1 drop per 10 kg per visit