Dentaltown August 2017 - 92

continuing
education

4.

Patients will
not complete
treatment

I've heard many colleagues say they
fear their patients will never get SDF
treatment done.
First, SDF is a treatment: a noninvasive, medicinal approach to managing
the bacteria that's contributing to decay
in the fi rst place-something fi llings
and crowns don't do. SDF alone does
not restore form or function to cavitated
teeth, but combining it with a glass
ionomer cement such as SMART makes
an excellent restoration.
Another viable option is SDF as
an indirect pulp therapy, along with
a stainless steel or Hall crown. When
new patients come in wanting SDF and
have giant holes that will trap food, I
educate them that I could apply SDF,

5.

but ultimately the tooth may also need
a restoration to prevent food impaction
or space loss.
Also, not every tooth is a candidate
for SDF. Teeth with abscesses and lesions
involving the pulp aren't eligible for this
treatment.
Shortly after the Times article was
published, a mother brought her 2-yearold to me all the way from Oklahoma
in favor of quadrant dentistry versus
general anesthesia. In the end, it cost
her more money and time, but she didn't
care; for her, all at once was too much,
and she had major safety concerns after
two highly publicized deaths of children
who had received dental treatment under
anesthesia the previous year. Where is
the harm in listening to our patients
and their concern-or, within reason,
accommodating their needs?

You can't bond to it

I've received numerous emails, and viewed
concerned and confused posts on online forums,
where dentists wonder if they can cement crowns
or bond adhesive restorations to SDF-treated tooth
structure. The answer is yes.
Dr. Ryan Quock of the University of Texas School
of Dentistry at Houston conducted an in vitro study
to examine whether SDF applied to noncarious
permanent dentin would adversely affect bond
strength of resin composite. The study showed that
there were no significant differences in microtensile
bond strength of composite to control versus dentin
samples treated with 38% SDF. The same was true
whether etch-and-rinse or self-etch adhesive was
used.20 A study by Dr. Ivy Wu on primary teeth
yielded similar data.21
In light of these results, it seems that bonding is
compatible with dentin pretreated with SDF. Quock
does recommend the mechanical preparation of
enamel and the DEJ to remove demineralization.
This preparation maximizes the bond to sound tooth
structure and improves the marginal seal.
It's important to be aware that light-curing
any restorative material on the same day that you

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AUGUST 2017 // dentaltown.com

Second opinions for IV and general
anesthesia are now commonplace for me,
and it's not unusual to have a patient come
from across town, or even out of state, to
receive noninvasive care. As I mentioned
earlier, the main reason patients come
to me for a second opinion is that they
weren't given any other options elsewhere.
The notion that an aggressive surgical
approach is the superior and only choice
is sadly misguided. In fact, gold-standard
OR/GA pediatric dentistry has relapse
rates of between 20 and 80 percent.18,19
The treatment planning discussion
is an important opportunity to educate
patients that fillings and crowns are not
cures for caries-and neither is SDF. They
must understand that if the behaviors
such as poor diet and hygiene persist,
these treatments will ultimately fail, and
the caries can (and will) return.

apply SDF poses an aesthetic issue; the curing light
will precipitate the silver out of the solution and
turn the entire restoration gray. Even a self-curing,
high-viscosity glass ionomer cement (HV GIC)-the
preferred material for SMART-will eventually
turn gray if it's applied the same day that SDF is
applied. Such discoloration can be avoided by placing
restorative materials during a separate visit, after
the SDF application. (Some high-quality HV GICs
such as Fuji Equia Forte are often opaque enough
to mask SDF-arrested caries.)
If you need to place a resin composite or resin-modified glass ionomer (RMGI) on the same
day as your SDF application, simply cure the SDF
after it's applied and before the resin placement.
The excess stain can be polished off sound enamel
using a slow-speed tufted prophy brush and plain
pumice before etching and placing your light-cured
restorative material. Universal opaquers such as
Shofu Beautifil can also effectively mask the black
scar under resins or RMGIs such as Fuji II LC.
Trying these techniques on extracted teeth can
help you gain experience before using the product
on a patient for the first time. Of course, this is a
nonissue if aesthetics are not a concern.
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