A silver bullet for cavities
It is deeply frustrating that some very young children get cavities, despite their parents’ best intentions. When we dentists see cavities starting, all we can really do, besides fillings, is to help families change their diet and hygiene, in hope to slow down the cavities and try to prevent new ones… until now. Finally, a non-invasive inexpensive solution has come that stops cavities.
Silver fluoride, a harmless clear liquid applied by the dentist, has been used to treat cavities in baby teeth in Japan for over 80 years, and for decades in other countries in Asia, South America, and Australia. Multiple clinical studies published by the American Association of Dental Research show that silver fluoride stops 90% of cavities on the outer surfaces of baby teeth. Application to cavities in baby teeth somehow prevents 60% of cavities in permanent teeth - truly revolutionary. The FDA cleared silver fluoride in August 2014, and after decades of waiting, it became available in the United States in April.
The procedure involves putting some cotton in the mouth (for isolation), drying the tooth, and brushing microliters of silver fluoride onto the cavities. Keeping their mouths open for a minute is tough for some kids, and this stuff doesn’t taste good, but that’s it.
Ironically, while healthy enamel stays pearly white, silver fluoride turns cavities black, like tarnished silver. Those of us who have seen cavities stop on their own know that they turn brown. This is mildly different, and similar to a silver filling. The discolored cavity can be removed and replaced by esthetic materials when the child develops the coping skills to get through treatment.
The purpose of silver fluoride in my practice is to avoid the intense interventions often used to get very young children and those with special needs to receive care – such as general anesthesia, oral sedation, and protective restraint. In my experience, parents would rather have me dab on silver fluoride every 3 to 6 months, than go through these interventions. I experience great joy when I see a child who started the silver fluoride treatment when they were 1-3 year old become old enough to sit for a filling. Initially, I bring kids back in 1-3 months to check the response. Then we decrease the frequency of visits to 3-6 months. When kids are old enough to tolerate our antics, we often replace the silver-stained cavities with normal fillings, particularly in their permanent teeth.
Another purpose of silver fluoride is access to care, for children – or anyone, with cavities but not the means for comprehensive dental treatment. The materials required for this intervention cost less than a dollar, and the dentist’s time required to place silver fluoride is less than for any other intervention (e.g. a filling). Another purpose is prevention. Putting silver fluoride on cavities when noticed at the check-up visit reduces the incidence of future cavities much more than just putting in fillings at the following visit.
Unfortunately, silver fluoride stops 90%, not 100% of cavities. There are efforts to figure out why 10% remain active. In children with many cavities I often see 1 or 2 that remain active – for example 1 of 17 in a patient with severe physiologic anomalies and cognitive disability, for whom general anesthesia is not safe. It may be the size of cavity, combined with the exhaustion of the dental pulp to fight off the bacteria. It may be a particular combination of bacteria remaining in the cavity. In either case it is easy to see: if the entire cavity remains black, it is stopped; if there are yellow or white patches, it is active and the child should return to the dentist.
This is a revolution in the fight against the world’s most prevalent disease, and we are ecstatic at the prospect of silver fluoride making dentistry easier for children.