Dental Conditions Not Treatable by SDF
Assess for conditions not treatable by SDF
Silver diamine fluoride will not adequately treat the following conditions:
- Dental abscesses (with or without fistula)
- Abscesses with associated cellulitis
- Irreversible pulpitis
Dental abscess
- Dental abscesses, with or without fistula, require operative dental management with extraction or root canal therapy
- Pain elicited by pushing down firmly on a tooth helps to identify non-draining abscess
- Abscesses with associated cellulitis usually require antibiotics
Examples of Dental Abscesses
Photo with permission, S. Stille DMD,
Dental abscess with draining fistula
Photo with permission, S. Stille DMD,
Dental abscess
Photo with permission, S. Stille DMD,
Dental abscess with associated cellulitis
Irreversible pulpitis
- Irreversible pulpitis requires operative dental management with extraction or root canal therapy
- Irreversible pulpitis is defined by pain to cold lingering more than 60 seconds, spontaneous pain (without touching or eating), or pain interrupting sleep
- Silver diamine fluoride can cause irritation of directly exposed live pulp and teeth with irreversible pulpitis
- If patient has clinical findings of irreversible pulpitis, avoid SDF application on that tooth, and attempt to facilitate timely dental referral
- SDF will improve pain and sensitivity if there is no direct pulp exposure or irreversible pulpitis, and is cleared by the FDA for this indication
- Application to necrotic teeth (with no live pulp) should cause no pain and may help improve surrounding gum health and prevent cavities on other teeth
Examples of irreversible pulpitis
Photo with permission, M Kher, MDS
Photo with permission, M Kher, MDS
Photo with permission, M Kher, MDS
References:
Zaeneldin, A., Yu, O., & Chu, C. (2022). Effect of silver diamine fluoride on vital dental pulp: A systematic review. Journal of Dentistry. 2022 Apr:119:104066. doi:10.1016/j.jdent.2022.104066. Epub 2022 Feb 6.
Slayton, R. L., et al. (2018). Evidence-based clinical practice guideline on nonrestorative treatments for carious lesions: A report from the American Dental Association. J Am Dent Assoc.149(10):837-849.e19. doi:10.1016/j.adaj.2018.07.002.