SDF, 38%; this is the only brand currently available in the U.S.
New in the U.S., a tooth treatment called SDF (silver diamine fluoride) repairs about 80% of cavities with no need for drilling, filling, or anesthetic. It also prevents new cavities from forming.
This topical drug (painted onto cavities) costs very little, and greatly reduces the cost, labor, and pain of dentistry. Dental assistants can easily learn to use SDF. In the U.S. it will be especially important for fixing the teeth of the estimated 49 million people who now have no access to dentistry because of the cost (see UCSF Protocol, in "For More Information," below).
SDF is very important for treating children too young to cooperate with the dentist, since they might otherwise need general anesthesia, a serious risk in dental treatment of young children. It is also important for older adults, who often develop "root caries," which are hard to treat conventionally because they often extend below the gum line.
SDF has been used for decades in Japan and other countries, but it only became available to U.S. dentists in 2014, when the FDA approved it as a dental fluoride varnish. For treating cavities, it is widely accepted by experts, but still technically off-label until various FDA paperwork is completed. This means that U.S. dentists can use SDF for treating cavities now - but most have not used it yet. They may be more willing to try SDF for treating cavities if you ask for it.
SDF is officially approved for treating cavities in Canada. In the U.S. has been awarded "breakthrough therapy status" by the FDA - not approval for treating cavities, but a sign of SDF's potential importance for this use [Silver Fluoride as a Treatment for Dental Caries, Advances in Dental Research, 2018, full text behind paywall].
The difficulty introducing SDF in the United States illustrates some of the problems with treating medicine and healthcare as market commodities. Usually the FDA processing for a new treatment or indication is done by a huge pharmaceutical company, which will repay itself many times over with exorbitant prices if it gets a government-enforced monopoly. But SDF is cheap and generic, so the companies aren't interested. Almost all U.S. market incentives are to make medicine as expensive as possible, leading to unmanageable costs that are then controlled by arbitrarily denying access.
"Not a single adverse event has been reported to the Japanese authorities since they approved silver diamine fluoride (Saforide™, Toyo Seiyaku Kasei Co. Ltd., Osaka, JP) over 80 years ago. The manufacturer estimates that more than 2 million multi-use containers have been sold, including >41,000 units in each of the last three reporting years" (UCSF Protocol, below - UCSF is the University of California, San Francisco).
The main drawback is cosmetic. The decayed area of a tooth is permanently stained black by SDF; however, healthy tooth is not stained. Patients may want to avoid SDF treatment of cavities in conspicuous locations.
At this time SDF is unlikely to be covered by dental insurance. But the cost of this treatment is so low that it will likely be less than the co-pay for conventional cavity treatment. And many people don't have dental insurance anyway.
This writer received SDF treatment three times, at a new nonprofit clinic in Philadelphia, FIGHT Family Dentistry; we asked for SDF in advance, and the clinic ordered it and has it in stock. It is a relief to be finished with the dentist so fast, to have to come back less often, and to have painless treatment that does not require holding uncomfortable positions.
But SDF treatment in the U.S. may be hard to find; as of August 2017, most U.S. dentists had never used it (American Dental Association report, scroll down). In the U.S. today it is most likely to be used by pediatric dentists. In other countries it is used for all ages.
In April 2018 we could not find any patient community that focused on dental care. (For a list of some existing patient communities for other medical conditions, see http://www.epatientdave.com/communities/.)
This country needs organized patient advocacy for dental care. One project of such an organization could be a listing of dentists who use SDF. Dentists are often looking for more patients; and with a little public advocacy, offering SDF could be a powerful way to find them.
If you might help start such a project, you could leave a comment (use our "Discuss" tab, above), and/or contact this writer privately (use our "About" tab). A little advocacy now could result in pain relief and improved health for millions of Americans currently unable to prevent or fix their cavities due to the cost of conventional dental treatment. Dentists will be as busy and as prosperous as they are now, but able to treat many more people.
A New York Times article introduced SDF to the U.S. public in July 2016: A Cavity-Fighting Liquid Lets Kids Avoid Dentists’ Drills.
For dentists: UCSF Protocol for Caries Arrest Using Silver Diamine Fluoride: Rationale, Indications, and Consent , Jeremy A Horst, Hellene Ellenikiotis, and Peter M Milgrom, Journal of the California Association. In 2018 this treatment protocol was updated by the lead author: Silver Fluoride as a Treatment for Dental Caries Advances in Dental Research. The abstract of the 2018 article summarizes the changes from the 2016 protocol, based on suggestions from 4 new clinical trials: "to skip the rinsing step due to demonstration of safety in young children, start patients with high disease severity on an intensive regimen of multiple applications over the first few weeks, and continue with semiannual maintenance doses as previously suggested."
Also see two-page Silver Diamine Fluoride (SDF) Fact Sheet, July 2017, published by the Association of State and Territorial Dental Directors (ASTDD).
For recent pediatric guidelines, see Use of Silver Diamine Fluoride for Dental Caries Management in Children and Adolescents, Including Those with Special Health Care Needs, from the American Academy of Pediatric Dentistry, October 2017.
A Google or Bing search for "silver diamine fluoride" (preferably with the quotation marks) reports over 25,000 items (April 2018). However, our search for "silver diamine fluoride" on news.google.com only found 10 recent stories - indicating that the U.S. public is largely unaware of this treatment.
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