Consent for Silver Diamine Fluoride Therapy to Control Tooth Decay

Silver Diamine Fluoride (SDF) is an antibiotic liquid that has been well-documented in the dental field for its successful ability to slow the progression and help arrest tooth decay. 38% SDF is an FDA approved liquid product which is typically applied two times a year to the affected teeth, or as needed. It is a conservative approach for interim treatment of active decay and also helps decrease sensitivity caused by the decay.

Compared to a traditional filling, the use of Silver Diamine Fluoride is non-invasive (i.e. no local anesthetic or numbing medicine is needed) and does not produce aerosols (i.e. no drilling required). It does not restore the form and function of a decayed tooth, but depending on the location and size of the cavity on the tooth, it may be used as a liner for a future filling material or crown to be placed. Utilizing SDF does not necessarily eliminate the need for future fillings, crowns, or extractions. Additional procedures will incur a separate fee.

After the SDF application, proper diet and good oral hygiene are critical for the long term success in slowing the decay progression. In an effort to protect our patients and reduce their exposure to COVID-19, the use of Silver Diamine Fluoride is recommended over traditional restorative measures at this time.

The Procedure: 

• Patient should brush and floss thoroughly the night prior and before coming to the office to clean residual food off the teeth and reduce aerosols at the office.
• Once in the dental chair, extra-oral soft tissue are protected by applying petroleum jelly.
• Teeth are dried and isolated.
• Silver Diamine Fluoride liquid is applied with a microbrush to affected areas in very small amounts. Depending on the location of the decay, SDF may be placed on floss then applied to the decayed areas by flossing between the teeth. Excess is removed with gauze.
• No local anesthetic/numbing medicine or drilling is needed since it is non-invasive!
• Once SDF is applied, the affected areas of the teeth will stain black permanently.
• Return for additional applications of SDF (as directed) and to monitor lesions with radiographs as indicated.

Contraindications (SDF will not be used if the patient has):

• An allergy to silver.
• Aphthous ulcers or painful sores on oral tissue.
• Decay extending close to the nerve of the tooth.
• Tooth with clinical radiographic abscess/infection.

Possible Side Effects:       

• Silver Diamine Fluoride (SDF) will turn the decayed part of the tooth dark black. This is a good indication that the decay process is stopping and not growing. Generally cavities are a yellow, brown, or a black color prior to SDF treatment.
• If SDF comes in contact with skin and/or gums, temporary discoloration will occur. It cannot be washed off but this will disappear on its own in 1-3 weeks as the skin sheds and regenerates new cells.
• SDF can also stain any clothes or other surfaces permanently if it comes in contact with it.
• If SDF is placed on a tooth that has a tooth-colored restoration on it, discoloration may occur.
• SDF placed on demineralized enamel (white lesions) may cause discoloration.
• SDF has a metallic taste that will go away rapidly on its own.
• Every reasonable effort will be made to ensure the success of the SDF treatment. There is a risk that the procedure will not stop the decay and no guarantee of success is granted or implied. The decay may still increase in size and further treatment may be needed.

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:

No warranty or guarantee has been made as the result or cure. It has been explained to me and I understand the consequences which may affect my child’s health if dental treatment is not performed.

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