A Cavity-Fighting Liquid Lets Kids Prevent Dentists’ Drills

Nobody looks forward to creating a cavity drilled and filled by way of a dentist. Now there’s an alternate: an antimicrobial liquid which can be brushed on cavities to stop tooth decay – painlessly.

The liquid is named silver diamine fluoride, or S.D.F. It’s been useful for decades in Japan, but it’s been accessible in the us, underneath the brand name Advantage Arrest, for almost a year.

The Food and Drug Administration cleared silver diamine fluoride to use as being a tooth desensitizer for adults 21 and older. But research has shown it may halt the progression of cavities preventing them, and dentists are increasingly using it off-label for those purposes.

“The upside, the truly great one, is that you simply don’t have to drill so you don’t require an injection,” said Dr. Margherita Fontana, a professor of cariology with the University of Michigan.

Silver diamine fluoride is already employed in numerous dental practices. Medicaid patients in Oregon are experiencing treatments, and at least 18 dental schools have begun teaching the next generation of pediatric dentists using it.

Dr. Richard Niederman, the chairman with the epidemiology and health promotion department with the Nyc University College of Dentistry, said, “Being capable of paint it on in Half a minute with no noise, no drilling, is much better, faster, cheaper.”

“I would encourage parents to ask for it,” he added. “It’s less trauma to the kid.”

The main bad thing is aesthetic: Silver diamine fluoride blackens the brownish decay with a tooth. That will not matter with a back molar or possibly a baby tooth that may drop totally out, but some people are apt to be deterred with the prospect of your dark i’m all over this an evident tooth.

Until more insurers cover it, patients should also cover the fee. Still, it’s pretty cheap. Dr. Michelle Urschel, an anesthesiologist, was very happy to pay $25 to possess Dr. Jeanette MacLean, a pediatric dentist in Glendale, Ariz., paint over the cavity that her son Knox, 4, had recently developed.

A cavity that had being drilled cost $151. The liquid “was very reasonable,” Dr. Urschel said.

The noninvasive treatment could be ideal for the indigent, an elderly care facility residents and others who may have trouble finding care. And several anxious dental patients need to dodge the drill.

Nevertheless the liquid could be especially helpful for children. Nearly 1 / 4 of 2- to 5-year-olds have cavities, in line with the Centers for Disease Control and Prevention.

Some preschoolers with severe cavities have to be treated inside a hospital under general anesthesia, eventhough it may pose risks to the developing brain.

“S.D.F. provides a chance to reduce the number of toddlers with cavities going to the O.R.,” said Dr. Arwa Owais, an affiliate professor of pediatric dentistry with the University of Iowa.

Dr. Laurence Hyacinthe, a pediatric dentist in Harlem, used silver diamine fluoride on eight uncooperative children whose parents wished to delay a trip to the operating room.

Dr. MacLean said, “People feel that parents will reject it as a result of poor aesthetics.” But “if it implies preventing a young child from being forced to be sedated or having their tooth drilled and filled, there are several parents who enjoy S.D.F.,” she added.

Alejandra Bujeiro, 32, was delighted that her 3-year-old daughter, Natalia, didn’t have to have two cavities completed the back of her mouth. Instead Dr. Eyal Simchi, a pediatric dentist in Elmwood Park, N.J., brushed silver diamine fluoride on the decay.

Two front teeth, however, were drilled. The very next time, Ms. Bujeiro said, she’d opt for silver diamine fluoride. “I would apply it in baby teeth even if it’s right in front,” she said. When it comes to discoloration? “You can’t see it an excessive amount of.”

Silver diamine fluoride has another advantage over traditional treatment: It kills the bacteria that can cause decay. An extra treatment applied six to 18 months following the first markedly arrests cavities, research has shown.

“S.D.F. cuts down on the incidence of latest caries and progression of current caries by about 80 %,” said Dr. Niederman, that’s updating an evidence overview of silver diamine fluoride published in ’09.

Fillings, by comparison, don’t cure a dental infection.

“There’s nothing that goes on in an operating room that treats the root problem,” said Dr. Peter Milgrom, a professor of pediatric dentistry with the University of Washington who had been instrumental in receiving F.D.A. clearance for silver diamine fluoride and has an economic stake in Advantage Arrest.

That’s why some children will need to have pediatric dentist under anesthesia twice.

Attacks also cause acne, but a “dermatologist doesn’t take a scalpel and cut off your pimples,” said Dr. Jason Hirsch, a pediatric dentist in Royal Palm Beach, Fla. Yet “that’s how dentistry has approached cavities.” Dr. Hirsch carries a Facebook page called SDF Action, where dentists can discuss individual cases.
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