Wednesday, October 31, 2018

SearchResearch Challenge (10/31/18): Is this a safe treatment for caries?

Let's consider a real question... 

As you know, new therapies come onto the market every so often. Those therapies have risks and benefits.  How do you evaluate these things?  What do you do to actually do the research you need to evaluate these things? 

Consider this one:  SDF (Silver Diamine Fluoride) treatment is a way to treat teeth with a simple coating that not only prevents future cavities (caries), but also seems able to reverse the damage in some existing cavities.  

Suppose that you're considering getting this treatment for someone in your family.  How would you go about doing some checking to see if it's effective, and if it's safe.  (As you know, not all medical treatments turn out to be safe in the end; think radioactive water as a spa treatment... a really bad idea.)  

Ideally, we--the SearchResearchers of the world--would be able to do some kind of sanity check before taking on a new treatment regime.  

This leads to today's Challenge:  

1.  How would you go about determining if SDF is right for you, your family, or your child?  What would you do to research this?  Would you get SDF? 

Of course I'm interested in what YOU think about SDF, but just as importantly, HOW did you come to this determination?  What steps did you take?  What sources you think are credible, and why?  

Please leave notes about your process in the comments below. I'm looking for some great thoughts here.  Let us all learn how you would do this! 

Search on! 

(And of course, since it's Halloween today, be sure to consider the effects of SDF on vampire teeth!) 


  1. Interesting question as I'd never heard of SDF. I started searching using Silver Diamine Fluoride rather than SDF, looking for reputable scientific sources with regular Google & Google Scholar.

    First: the Halloween question. It should be good for vampires! It turns black on exposure to light but by the time it did this, the Vampire would probably be dead. A careful vampire attacking victims at night in poor light would be OK. Lots of sources mention the light issue eg. the SDF wikipedia link you gave.

    Without journal subscriptions, I depended on abstracts which aren't always that informative. In this case many were sufficiently informative to make me feel this is more a last-resort type treatment.

    As an example, a 2009 paper (J of Dental Research) states "SDF is more effective than fluoride varnish, and may be a valuable caries-preventive intervention" without significant adverse effects. This paper was a "five-database search reference review” which seems OK as SAGE is known as a top-tier science journal publisher. (I did not check tier ratings of any of the papers, so I don’t know how good this journal is. To make any firm decisions I'd want to know this).

    I was concerned at conclusions such as one from - a reputable US Government / NIH review. "To establish guidelines, more studies are needed to fully assess the effectiveness of SDF and to determine the appropriate application frequency." This study looked at previous work on PubMed, Scopus & ScienceDirect so looks OK. The actual conclusion in the paper was more nuanced saying that SDF is potentially a good treatment and more effective than other preventive management strategies for arresting dentinal caries at the right quantities BUT that although it shows potential, protocols need to be developed along with treatment guidelines. So too soon for me to be a guinea pig?

    Another positive review was in the premier science journal Nature "Systematic review finds that silver diamine fluoride is effective for both root caries prevention and arrest in older adults" This was the most definitive result. If this was the only paper I'd read, I'd be asking my dentist for this treatment. It's also current (mid-2018). Other recent papers backed this up but implied that it tended to be for special cases e.g. on Google Scholar: "Silver diamine fluoride can arrest dental caries and prevents its progression. By doing so, it provides an alternative care path for those patients in whom traditional restorative treatment cannot be done…." It appears not to be viewed as a standard treatment for all.;year=2018;volume=3;issue=1;spage=1;epage=4;aulast=Galui

    Most sources say that SDF can lead to staining, turning teeth black. This can be ameliorated with a Potassium Iodide application. Eg

    A Singapore based source has pictures of issues and also gives some warning, regarding reaction with gums, etc. Dentistry - Information on Silver Diamine Fluoride (SDF).aspx

    I was reassured by the conclusion at Horst.pdf which gave the good, bad & ugly, saying that SDF is the right product for a lot of caries cases. Before accepting this presentation as bona fide I checked the conference it was presented at in case it was a predatory conference. One of the Gold Sponsors was the American Dental Association and that was enough for me to feel this is a genuine conference.

    As research on SDF is on-going, I’m not convinced that all agree on it. I don’t want to be a guinea pig so I’d not volunteer for it for me or my family. If my dentist recommended it, then I’d probably say yes.

    1. This is an excellent answer. Thanks for all the details! I'm more optimistic than you are, mostly because it's been used for a LONG time in Europe and Asia with very few side-effects seen. (Silver allergies are the most common side-effect.)

      Well done!

    2. Interesting you mention it being present in Europe. I saw that for Asia and a bit for Europe but was suspicious of the Europe references because I'm based in Europe and I've never been offered it on the UK NHS. Maybe it's a private treatment not available to NHS patients OR maybe it's just not in the UK (yet). Will have to remember to ask my dentist on next visit. :)

  2. 1. How would you go about determining if SDF (Silver Diamine Fluoride) is right for you, your family, or your child? What would you do to research this? Would you get SDF?

    Happy Halloween, Dr. Russell and everyone.

    I started with a simple [SDF (Silver Diamine Fluoride)] and thinking after reading results add or limit my search to sites like FDA

    Silver Diamine Fluoride

    SDF was first approved for use in Japan more than 80 years ago. SDF was approved by the U.S. Food and Drug Administration (FDA) in 2014 for use in the United States. Site mentions is safe and not so expensive.

    Applying silver diamine fluoride to exposed root surfaces of older adults can be an effective way to prevent caries, according to the August issue of The Journal of the American Dental Association.July 27th, 2018

    [list of advantages Silver Diamine Fluoride] tried with [list of advantages for SFD] but didn’t have many good results

    SFD data It can be used in people 3 years or older. Affected area if not healthy will be stained.

    New Guideline Addresses the Use of Silver Diamine Fluoride in Pediatric and Special-Needs Patients From ADA ( American Dental Association)

    With [fluoruro diamino de plata dientes] found:

    Fluoruro diamino de plata. In Spanish. Made by California Dental Association

    Looks the SFD works and it is safe so, it is available in toothpastes? [Silver diamine fluoride toothpaste]

    Silver Diamine Fluoride and Fluoride Varnish: The Benefits of Fluoride Therapy

    Silver Fluoride: What Is It?


    In this first look, I think SFD works great and is very helpful. I am not sure if it is available everywhere and works when teeth problems are not bigger. I prefer to have small stain than the drill and pain other treatments have.

  3. think I entered something about vampires, dental hygiene, transylvania, SDF, Radithor and sRs images and this came up…
    the standard before/after… it must be true, it's on the interwob/google provided…
    results: your call…

  4. This is an evidence based recommediation for this treatment, by a credible source - the american pediatric association. So it seems good. the caveat - the evidence level is considered weak - but it's really difficult/rare to get strong evidence in evidence based medicine AFAIk.

  5. ba bing ——— Dan speaks truth, or some form thereof… as the morph continues.
    distance traveled, not depth… but point taken -
    20,000 leagues - not to be confused with 20,000 little leagues under the siege
    not to be confused with 20,000 little leagues under the siege - which is about commercialism in Taiwanese Little League…
    the SERP, "People also ask"
    around 13 minutes in - excellent presentation Dan!!… need more views
    "If you want to avoid confusion, perhaps it's best to look at the original French title, 20,000 Lieues Sous les Mers—20,000 Leagues Under the Seas. That plural, "seas," makes it clear that Verne's writing about a trip through the world's seas, not into their darkest depths."

    wiki EN
    wiki FR - Vingt mille lieues sous les mers

  6. I thought of 2 credible sources:

    1. is Canadian Dental Association (CDA) which recommends it for certain situations.

    2. I asked my dentist, who replied "Silver Diamine Fluoride is a great product that I’ve been using for over a year now. It is used in pediatric cases and geriatric cases where traditional drill and fill techniques are not applicable. I have the product Advantage Arrest in house and use it as required per the recommendations by the CDA. The next time you’re in ask me about it and I can give you some literature to read."

    Jon tU