Revolutionary, painless method of treating children’s cavities used at UConn

Girl patient sitting in the dentist's office (Getty Images)

It’s no fun when a child has a cavity. The sheer sound of a drill can make a child not want to step foot into the dentist’s office.

Instead of a daunting drill, imagine a liquid treatment for the decaying tooth. No drill, no anesthesia needed.

That’s exactly the type of treatment children with dental cavities are receiving at the UConn School of Dental Medicine pediatric dental clinic.

Thanks to this revolutionary treatment—silver diamine fluoride (SDF)— UConn has changed the way it approaches the treatment of certain cavities.

SDF—with its creation being named one of the best pieces of health news in the past decade—is a liquid medication that is applied directly to children’s cavities. SDF does not replace the lost tooth structure, rather, it stops the progression of the cavity and any associated pain.

UConn has used this method to avoid or delay the necessity of more invasive treatment or treatment under general anesthesia.

“UConn’s pediatric dental clinic has successfully used this method since 2016,” said Drs. Bina Katechia and Gary Schulman, faculty at the UConn School of Dental Medicine. “We have been treating some cavities with SDF rather than filling affected teeth. SDF is a ‘tool in our toolbox’ for managing decay when conventional treatment cannot be tolerated by young children or those with special health care needs.”

Cavities, also known as dental caries or dental decay, are common and potentially severe.  In 2017, a Connecticut Department of Public Health Survey of kindergarten and third grade children found that 16% of those surveyed had untreated decay, with dental decay continuing to be a public health problem for Connecticut elementary school children.

Dental cavities can lead to problems with eating, sleeping, daily activities and self-esteem.  Traditional treatment of cavities ranges from fillings to extractions, with some fillings able to be performed with minimal intervention, requiring no anesthesia and limited drilling.  Cavities also can be severe and many young, anxious or medically compromised patients may have a harder time cooperating for dental procedures.

Silver compounds were previously used to fight infections before antibiotics.  In 1969, a Japanese study introduced SDF as an antimicrobial technique to fight dental cavities. Since that first study, many studies have followed to document the benefits of SDF. In 2016, the FDA approved the use of SDF.

SDF, in particular, has shown to stop the cavity from progressing and causing sensitivity in addition to killing certain bacteria in the cavity and inhibiting bacteria that may attack other teeth in the mouth.

At UConn, providers follow a specific and careful protocol to apply SDF.  Patients are screened as candidates for the treatment based on their medical history, risk of cavities, ability to cooperate for dental treatment and parental consent.

When SDF is recommended for treatment at UConn, its advantages and disadvantages are reviewed with patients and their parents.

“The advantages include easy and quick application. Pediatric dental providers typically apply the SDF liquid on decayed teeth and neither local anesthesia nor drilling is necessary because affected tooth structure does not need to be removed.  This is especially helpful for anxious patients who may become uncooperative with standard treatment that involves local anesthesia and drilling,” said Katechia and Schulman.

The downsides of this treatment are minimal. While the treatment is completely safe for use, there is a slight chance that the treatment can stain the teeth and tissue as SDF blackens the cavities and other decayed parts of the teeth. Healthy teeth, however, should not get stained.

SDF can also inadvertently stain the soft tissue in the mouth, lips, or cheeks which last for a few days. Providers are cautious about covering the patient’s clothing and applying petroleum jelly to the surrounding tissues.

Lastly, this treatment does not change the structure, so further restorations may be required to finish healing the tooth structure.

The pediatric dental clinic at UConn will continue to use and study SDF. Today, additional applications are being considered.

“As evidenced by the use of SDF, UConn is dedicated to the development and refinement of the most current techniques,” said Katechia and Schulman.

 

 

Reference List

Peters S. The Best Health News Over the Last Decade. https://www.usatoday.com/story/money/2019/12/18/the-best-health-news-over-the-last-decade/40796061/.

Health CD of. Every Smile Counts. Hartford; 2017.

Frencken JE, Holmgren C, van Palestein Helderman W. Basic Package of Oral Care.; 2002.

Liu A, Donly K. The use of silver diamine fluoride for caries arrest in children. Dental Economics. https://www.dentaleconomics.com/science-tech/pediatric-dentistry/article/14037011/the-use-of-silver-diamine-fluoride-for-caries-arrest-in-children. Published 2019.

Politano AD, Campbell KT, Rosenberger LH, Sawyer RG. Use of silver in the prevention and treatment of infections: Silver review. Surg Infect (Larchmt). 2013. doi:10.1089/sur.2011.097

Nishino M, Yoshida S, Sobue S, Kato J, Nishida M. Effect of topically applied ammoniacal silver fluoride on dental caries in children. J Osaka Univ Dent Sch. 1969.

Dos Santos VE, De Vasconcelos FMN, Ribeiro AG, Rosenblatt A. Paradigm shift in the effective treatment of caries in schoolchildren at risk. Int Dent J. 2012. doi:10.1111/j.1875-595X.2011.00088.x

Gao SS, Zhang S, Mei ML, Lo ECM, Chu CH. Caries remineralisation and arresting effect in children by professionally applied fluoride treatment – a systematic review. BMC Oral Health. 2016. doi:10.1186/s12903-016-0171-6

Rosenblatt A, Stamford TCM, Niederman R. Silver diamine fluoride: A caries “silver-fluoride bullet.” J Dent Res. 2009. doi:10.1177/0022034508329406