Clinical Instructions for Using Silver Diamine Fluoride (SDF) in Dental Caries Management.

Manufacturer instructions for 38% silver diamine fluoride (SDF) are limited to current FDA clearance for tooth desensitization. There is a need for instructions to provide best-practice recommendations for off-label use of SDF for caries prevention and arrest. METHODS: The authors considered existing clinical approaches to the use of 38% SDF at pH 10 for the prevention and arrest of active dental caries, in light of the best current evidence. Application of SDF, with or without subsequent direct restoration, is included. The content was reviewed by stakeholders including but not limited to those listed on the consensus statement (Appendix A, below). RESULTS: 38% SDF for the prevention and arrest of active caries lesions, as well as compatibility with common direct restorative materials, such as glass-ionomer cement and resin composite, has a foundation in the scientific literature. A practical decision-flow diagram and accompanying best practices for treatment of caries lesions, based on clinical access and intention to restore, were developed based on available evidence and expert clinical observation when no evidence was available. CONCLUSIONS: Based on the best available evidence, a logical approach can be adopted regarding the practical use of 38% SDF for caries prevention and arrest. PRACTICAL IMPLICATIONS: SDF used as per these instructions for prevention on high-risk tooth surfaces and arrest of active caries lesions has a place in the practitioner's dental caries management armamentarium. When SDF is applied to active lesions, it can be used with or without subsequent restoration, depending on clinical context, expert judgment, and patient input.

Clinical outcomes for primary anterior teeth treated with preveneered stainless steel crowns.

PURPOSE: The purpose of this retrospective study was to explore clinical outcomes for NuSmile anterior preveneered stainless steel crowns. METHODS: A convenience sample of healthy children treated with anterior crowns was selected from a teaching clinic and private office. Crowns were placed by either a private practice dentist or pediatric dental resident. Clearly defined clinical outcomes were assessed by 3 calibrated examiners at recall, including: (1) presence; (2) chipping; (3) wear; (4) crazing; and (5) marginal location by clinical and radiographic examination. Factors affecting placement--such as operator experience and behavior--were also assessed. RESULTS: In 46 subjects (21 females, 25 males; mean age at placement=4 years, 2 months), 226 crowns with a mean post-placement time of 12.9 months were evaluated. Only 2 crowns matched natural teeth, with NuSmile crowns lighter in 83% of subjects. Most crowns (86%) were normal in size. Eighty-eight percent resisted fracture for 6 months. All but 3 crowns resisted color change for 6 months. Canine crowns were the least successful, but overall 91% of crowns retained good to excellent clinical appearance. CONCLUSIONS: NuSmile anterior preveneered crowns are a clinically successful restoration for primary incisors with early childhood caries.