The side effects listed may not include all of the side effects reported by the drug’s manufacturer. If you notice other effects not listed above, please contact us with questions or concerns.
Treatment of tooth decay with Silver Diamine Fluoride does not necessarily prevent the need to place a regular filling in the affected tooth in the future in order to restore function and esthetics. If the tooth decay is not arrested, the decay process will progress and in that case the tooth may require further treatment such as repeat SDF application, fluoride varnish placement, a filling, a crown, root canal treatment, extraction, or referral for advanced treatment modalities.
If no treatment is completed, it can lead to growth of decay and deterioration of tooth structure. The cavity can spread to adjacent teeth, symptoms may increase and lead to pain, infection, swelling, and eventual extraction.
The above treatment technique has been explained to me to my satisfaction and I understand it fully. I have read this form, understand the treatment, have had the risks, benefits, and alternative treatments explained, and have had the chance to ask questions. I understand that I may refuse treatment. I also understand that this treatment may not be covered by my insurance (if applicable) and any estimates of insurance coverage discussed by any staff member was provided to me as courtesy. It is my responsibility to contact my child’s dental insurance company to discuss and understand my child’s policy. I give my consent to have the dentists at Bala Kids Dentistry administer Silver Diamine Fluoride on: