Silver Diamine Fluoride (SDF)

What is Sodium Diamine Fluoride and what are its advantages and disadvantages?
Sodium diamine fluoride (NaF(NH2)2) is a white crystalline compound that is commonly used in dental products, including toothpaste, mouthwash, and fluoride gels. It is a fluoride ion donor that can help prevent tooth decay by strengthening tooth enamel and reducing the formation of plaque. One commonly used brand is Advantage Arrest from Elevate Oral Care. 
Advantages of Sodium Diamine Fluoride:

• It can help prevent tooth decay and cavities by strengthening tooth enamel.
• It is relatively safe and effective when used in small amounts as directed by dental professionals.
• It is widely available and can be found in many dental products.
• It can help reduce tooth sensitivity by strengthening the dentin layer of the tooth.

Disadvantages of Sodium Diamine Fluoride:

• SDF will discolor teeth, usually gray, dark gray or black. This is the most common drawback. It's the main reason we don’t use it more. It didn’t take Dr Estafan long to realize that making teeth gray is not good for business. Fine if it’s under a crown or in a tooth that is not visible, but most teeth are visible. And once the tooth is discolored, its requires more invasive procedures to correct it. Use of SDF requires discussion of the risks & benefits prior to application.
• Ingesting large amounts of fluoride can be toxic and cause fluorosis, a condition that can discolor and weaken teeth. If you find yourself ingesting this - it’s time you found a new dentist. 
• Sodium diamine fluoride can irritate the stomach and cause nausea, vomiting, and diarrhea if ingested in large quantities.
• Some people may be allergic to fluoride and experience skin irritation or rash.
• Overuse of fluoride products can lead to dental fluorosis, which can cause white or brown spots on teeth and weaken tooth enamel.
• It is important to use fluoride products as directed by dental professionals and to follow proper oral hygiene practices, including brushing twice a day, flossing daily, and visiting the dentist regularly for check-ups and cleanings.

Will teeth stain or discolor with SDF?
Sodium diamine fluoride (SDF) has been known to cause discoloration on teeth, particularly when used in high concentrations and applied to areas of decay. The discoloration can appear as gray, black or brown spots on the affected teeth. However, when used in lower concentrations and applied properly, the risk of discoloration is significantly reduced.
It is important to note that SDF is often used as a treatment for dental caries (cavities) in children and adults who may not have access to more advanced dental care. In these cases, the benefits of using SDF to prevent further decay and protect the tooth outweigh the risk of discoloration. Simply put, gray teeth are better than rotting teeth. Additionally, the discoloration caused by SDF is often limited to the area where it is applied and may be less noticeable on baby teeth. Discoloration is a known side-effect of SDF and a discussion between dentist and patient needs to take place prior to its application.

How dark do teeth get with SDF?
The discoloration caused by sodium diamine fluoride (SDF) can vary depending on several factors, including the concentration of SDF used, the extent of decay, and the location of the decay on the tooth. The discoloration may make the tooth gray, dark brown or black. However, it's important to note that the discoloration caused by SDF is generally limited to the area where it is applied and may be less noticeable on baby teeth. Additionally, the discoloration caused by SDF is often less severe than the discoloration caused by traditional silver amalgam fillings. If discoloration does occur, it may be possible to remove or minimize it through professional dental cleaning or other treatments. In some cases, the discoloration may fade over time on its own. It's important to remember that the benefits of using SDF to prevent further decay and protect the tooth outweigh the risk of discoloration, particularly in patients who may not have access to more advanced dental care. Dr Estafan can discuss the potential risks and benefits of SDF treatment with you and recommend the most appropriate treatment plan for your individual needs.

Which is better, dental sealants or SDF?
Both dental sealants and sodium diamine fluoride (SDF) are effective in preventing tooth decay and are used in different situations, so it's not a matter of which is better, but rather which is more appropriate for each individual patient. Dental sealants are thin plastic coatings that are applied to the chewing surfaces of the back teeth (molars and premolars) to protect them from decay. They work by filling in the deep grooves and pits on these teeth, which can be difficult to clean with a toothbrush. Sealants are generally recommended for children and teenagers who are at high risk for developing cavities, but they can also be used for adults. Sodium diamine fluoride, on the other hand, is a topical fluoride treatment that is applied to the teeth to help prevent cavities and stop the progression of early cavities. It works by strengthening the tooth enamel and reducing the acid produced by bacteria that can cause decay. SDF is particularly useful for patients with early stages of decay or those who are at high risk for developing cavities. In general, dental sealants are recommended as a preventative measure for patients who have deep grooves or pits in their back teeth, while SDF is more appropriate for patients who have early-stage cavities or are at high risk for developing cavities. Ultimately, the decision of whether to use dental sealants or SDF should be made by a dental professional after evaluating the patient's individual needs and circumstances. Dental sealants do not cause discoloration of tooth structure like SDF does. 

The best way to know what's right for you is to get a checkup regularly with periodic x-rays. Dr Estafan can assess caries risk (likelyhood of getting cavities) and recommend both treatments like SDF, sealants, or fillings as well as behavioral changes (type and frequency of foods you eat plus when and how to compensate for the acidity). The behavioral changes will go much further to cavity prevention than any dental procedure will. Check out this video on decay prevention by Dr Estafan.

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