UCSF Protocol for Caries Arrest Using Silver Diamine Fluoride: Rationale, Indications and Consent

Abstract

The Food and Drug Administration recently cleared silver diamine fluoride for reducing tooth sensitivity. Clinical trials document arrest and prevention of dental caries by silver diamine fluoride. This off-label use is now permissible and appropriate under U.S. law. A CDT code was approved for caries arresting medicaments for 2016 to facilitate documentation and billing. We present a systematic review, clinical indications, clinical protocol and consent procedure to guide application for caries arrest treatment.

Figures

Figure 1

Graphic summary of randomized controlled trials demonstrating caries arrest after topical treatment with 38% silver diamine fluoride (SDF). Studies are arranged vertically by frequency of silver diamine fluoride application. Caries arrest is defined as the fraction of initially active carious lesions that became inactive and firm to a dental explorer. SDF (38% unless noted otherwise); q6mon, every six months; q1year, every year; q3mon, every three months; GIC, glass ionomer cement; NaF, 5% sodium fluoride varnish; + OHI q6mon, SDF every year and oral hygiene instructions every six months.

Figure 2

Graphic summary of randomized controlled trials demonstrating caries prevention after topical treatment of carious lesions with 38% silver diamine fluoride. Prevented caries is defined as the fraction of new carious lesions in treatment groups as compared to those in the placebo or no treatment control group. Chlorhex, 1% chlorhexidine varnish.

Figure 3

Clinical protocol for the UCSF dental clinics.

Figure 4

UCSF special consent form.