Caries: Treatment

Treatment

  • Removal of decayed tooth structure and replacement with dental restorative material, usually composite (white) or amalgam (silver)
  • Root canal therapy or extraction of the tooth if decay has progressed into the pulp of the tooth
  • Extraction is not without consequences. It may result in spacing issues, drifting of the retained teeth, and malocclusion of the neighboring tooth

Silver Diamine Fluoride

Silver Diamine Fluoride (SDF) is FDA approved as a desensitizing agent, but has "breakthrough therapy status" which facilitates its use in clinical trials. SDF may be indicated in older adults for caries management who have physical or cognitive limitations that prevent conventional restorative or invasive dental treatment (endodontics or extractions).  SDF is a topical application which when applied every six months, arrests 91% of carious lesions within two years. The University of California San Francisco School of Dentistry has published a protocol for the use of SDF for caries management.

Primary Indications for SDF Use:

  • Disease control for lesions in high-caries-risk patients at the diagnostic visit, regardless of the restorative plan
  • Difficult to treat carious lesions, such as furcations (areas where 2 or more roots meet, usually below the gum line but sometimes exposed due to periodontal disease and attrition) and crown margins
  • Patients with extreme caries risk (eg experiencing xerostomia from cancer treatments)
  • Individuals who cannot cooperate due to Alzheimer's disease or other forms of dementia, Parkinson's disease and other neuropsychiatric challenges
  • Patients living in nursing homes and other residential facilities with limited mobility and/or ability to seek care
  • Individuals without insurance benefits and/or living on fixed incomes

Malocclusion of Drifting Teeth after Extraction

UKDC
UKDC

Patient with Dementia

Robert Henry, DMD, MPH
Robert Henry, DMD, MPH

References

Tan HP, et al. A Randomized Trial on Root Caries Prevention in Elders. JDR 2010; 89(10);1086-1090.

Horst J. Silver Diamine Fluoride Use in older adults.  Decisions in Dentistry. 2016; 2(08): 30-33.

Silver Diamine Fluoride Fact Sheet, Association of State and Territorial Dental Directors, March 2017. Accessed on 1/24/2018

Horst JA, Ellenikiotis H, Milgrom PM, et al. UCSF protocol for caries arrest using silver diamine fluoride: Rationale, indications, and consent. Journal of the California Dental Association. 2016; 44(1): 16-28.