BY CATHERINE HAYES, DMD, SM, DR.MED.SC., DENTAL DIRECTOR, MASSHEALTH, AND FLOR PIEDRASANTA, MPH, MS, RDH, ADVISORS TO THE MMS COMMITTEE ON ORAL HEALTH
Physicians who encounter a patient with black-stained teeth should be aware that this may be due to a well-received alternative method of treating cavities. Silver diamine fluoride (SDF) is a cavity-arresting medicament that can be applied without aerosol-generating dental procedures or the removal of tooth structure. For these reasons, SDF is especially welcome during the pandemic — and one reason the Massachusetts Medical Society Committee on Oral Health felt it important to inform physicians about the
treatment.
“We want to make physicians aware of this safe, pain-free treatment, which may cause black teeth staining but can prevent cavity progression and is another alternative to traditional drilling,” says Michelle Dalal, MD, a pediatrician and vice chair of
the MMS Committee on Oral Health.
SDF is safe, cost effective, and minimally invasive and is used to stop or slow down the cavitation process. It is applied by dentists and hygienists on teeth that are not painful. SDF has been used on decaying teeth in Japan, Australia, and Argentina and other countries for over 80 years — but it has only been used in the United States since 2014, when it was approved by the FDA for sensitivity. Since that time, it has been used for its caries-arresting effect and is currently covered
in Medicaid programs of 36 states. Three months after MassHealth began paying for SDF in late June 2020, approximately 148 unique providers in Massachusetts had submitted 976 claims.
Dentists regard SDF as an excellent option for individuals with impaired cognition or physical limitations, and for managing dental disease in immunocompromised populations, the elderly, and children.
The treatment process is simple: SDF is a liquid that is brushed onto the carious lesion via a one-minute application. There are no post-treatment restrictions; the patient can eat and drink immediately afterward. SDF has been shown to kill bacteria and
can arrest more than 90 percent of caries. In some cases, teeth treated with SDF may subsequently require a more “traditional” restorative
procedure (i.e., a filling), which makes follow-up care important.
The one downside of SDF is it may stain the carious lesion a black or dark brown color. Staining begins within two minutes of application on unhealthy (carious) tooth structure
and may increase for up to six hours post-treatment. It does not stain healthy tooth structure. If the liquid contacts soft tissue (e.g., gingiva), it may leave a temporary stain that usually fades within 24–72 hours.
MassHealth covers SDF for dental providers at a frequency of twice per tooth per lifetime. While SDF is a great option for arresting cavities, proper case selection, parent and patient education, and close follow-up are important to the success of this
alternative method of treating cavities.
