SDF for dentine lesions

What it is and when to use it
SDF is a clear, colourless liquid that arrests active cavitated carious lesions and remineralises demineralised enamel and dentine.36 Some products have a blue tint, but these are not available in the UK. Although licensed to treat dentine sensitivity in the UK and some other countries, it is more usually used 'off-label' to arrest carious lesions. It turns active carious lesions black; therefore, consent to treatment must be obtained and it must be handled with care as it will temporarily stain skin, mucosa and most surfaces on contact.
SDF is an effective way of treating active lesions for primary and permanent teeth (coronal dentine and root).37,38 It can be used opportunistically while the patient is in the dental chair by applying to other high-risk surfaces. SDF is effective in arresting early childhood caries39 and exposed root surfaces.40 It is more successful when used in cleansable lesions and accessible areas of the mouth.41 When caries is more severe or affects multiple teeth, repeated applications of SDF controls the disease (for example, applied after two weeks and six weeks, then six months as required).42

How it works and clinical effectiveness
SDF penetrates infected dentine,43 making the lesion twice as hard as healthy dentine.44 It produces a dense superficial layer and fills in micro-cavities with solid metallic silver.45 It also acts directly on the plaque biofilm,46,47 inhibiting bacterial growth.48,49 Removing carious tissue before SDF application is not necessary as it does not improve caries arrest.50
SDF has been shown to have some effect in preventing carious lesions in primary teeth, with one review showing that, by applying it at least once per year, 61% of new caries lesions might be prevented.51 SDF is clinically effective as well as cost-effective, and has the advantage of combined use with all other caries management techniques.51,52

Non-AGP use
Carious tissue is not removed at all. To minimise droplet and aerosol production, the surface is dried with cotton instead of compressed air, then SDF is applied using a micro brush. Arresting lesions using SDF can provide a solid foundation for restorations53,54 and can be combined with ART in primary or permanent teeth or the HT. There are currently no clinical trials of efficacy, so combinations may be thought of as a 'belt and braces' approach to synergise the benefits of both treatments.