The Silver Bulletin

Phase 3 Clinical Trial – Complete and Published

After years of planning and work, the phase 3 clinical trial developed to support the Advantage Arrest® Silver Diamine Fluoride 38% Breakthrough Therapy Designation from the FDA for the arrest of carious lesions has been published. Dr. Margherita Fontana et. al., completed the study spanning years including the covid shutdown, with enough patients and enough data that the NIH-appointed Data Safety and Monitoring Board study closed the study to new children early because adding more participants would not have changed the far-reaching positive outcomes. 

In their article published in the prestigious journal JAMA Pediatrics, the researchers concluded “In this randomized clinical trial, 38% SDF was significantly more effective than placebo for arresting dentin caries lesions in primary teeth in young children with S-ECC, providing a noninvasive treatment for young high-risk children and supporting its consideration for FDA drug approval.” You can read the full study here. 

SDF Stain removal from skin.

If you’re like most avid users of SDF, it’s only a matter of time until you get some on your skin. Removing the stain is possible, but once and while we discover an easier way to do things, and we wanted to share this one. Just be careful with povidone iodine, as it can stain clothing. Here's a video of it being used.

Pediatricians and the use of SDF in their offices

The American Academy of Pediatricians conducted a survey on the knowledge and use of Silver Diamine Fluordie in pediatricans' offices. The results show that there has been very little adoption among pediatricians, although the interest in using it is high. The main delays for gaining use in these practices is lack of adequate training and a defined reimbursement method. You can find the full survey result here.

The use of Potassium Iodide reduces effectiveness of SDF

A published study reviewed the use of SDF and potassium iodide both in the effects of reducing staining, and also the amount of silver and fluoride the treated sites release. It found that sites treated with both SDF and KI release less silver and fluoride, and the stain increases over time to near normal SDF staining levels. The abstract is available here.

SDF GEL retrospective study on prevention of caries

A previous study demonstrated the efficacy of SDF GEL followed by fluoride varnish in the arrest of carious lesions. Now, a retrospective study looking at the same children who received treatment vs children in their same class that did not get treated showed that SDF GEL and Varnish has a lasting effect on formation of new caries. The study showed kids treated at 3-4 yrs of age with SDF GEL and Varnish at age 6-7 yrs had a prevalence of new caries rate of 4.4% vs. untreated kids having a 66.6% prevalence of new caries. Read the full study here.

Invasive Documentary

If you’ve been looking for a way to communicate minimally invasive dentistry (MID) practice to your colleagues and patients, a documentary will soon be released that will cover this topic. The team at ChartHouse Films has spent the past year interviewing some of the leading minds in MID and preventive dentistry. They’ve compiled a documentary designed to educate the public that we can treat tooth decay with medicine, and not just a drill. For now, only the trailer is available but look for the full documentary to be released soon. You can see the trailer here.

ADA video on SDF

The American Dental Association has released a video summarizing their position, guidance and application instructions for SDF. You can view the video here. 

Prevention of Caries by SDF vs Fluoride Varnish

Recently published research looked at how well SDF prevents caries lesions from developing as compared to 5% sodium fluoride varnish. This is different than the well-known ability of SDF to arrest lesions. In this double-blind randomized superiority trial, researchers looked at 730 children with nearly 18,000 sound tooths surfaces. They found that the semiannual application of SDF is superior to fluoride varnish at preventing caries in primary upper anterior teeth for proximal and smooth tooth surfaces. You can view the article here. 

American Samoa SDF training.

Dr. Peter Milgrom and Dr. Ohnmar Tut traveled to American Samoa, a territory of the United States to provide SDF training to all the dental personnel on the Islands working in public health and community health centers. They also provided Grand Rounds on Oral Health and SDF for the medical staff of LBJ Hospital. The didactic course work, labs, and supervised clinic practice focused on well-baby care and maternal oral health. 

This is part of an overall effort to introduce SDF in American territories and American-affiliated Pacific Island States where untreated dental caries is a serious problem. The training was sponsored by HRSA, MCH,   Pacific Islands Primary Care Association, and the AASTDD. 

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