WHO & New USA Study Add Support For Silver Diamine Fluoride
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- Published: Tuesday, 14 February 2023 07:44
- Written by Peter Ingle
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Despite being approved for use in Japan since 1970, Silver Diamine Fluoride (SDF) remains in a twilight zone in UK dentistry, particularly general practice. A new study from the USA and a recent World Health Organisation statement will add to the calls for more widespread use of SDF.
Available in a variety of strengths and from assorted manufacturers, SDF is applied topically and can be used treat both sensitivity and caries. Widely used in Australia and Brazil since the 1980s SDF was approved for use in treating caries in Canada in 2017. SDF is only licenced in the UK to treat sensitivity. Despite this it is used off label, particularly in secondary care and the CDS to treat caries.
Using a product off label is not without risk as prescribers must be confident that they can demonstrate that it is backed by a body of credible evidence to support its efficacy, and there is no alternative licenced product. To assist in the use of SDF, the British Society of Paediatric Dentistry has produced an information and consent form, as well as a child friendly video explaining its use and benefits.
The World Health Organisation has now added dental caries medications to its list of essential medicines. It includes Fluoride toothpaste, glass ionomer cement and SDF in this category. The WHO states that, “The Committee noted that these products offer relevant benefits and can be used in atraumatic restorative treatment techniques and in non-specialized settings in alignment with WHO guidance on oral health interventions.”
It is expected that this endorsement by the WHO will lead to policy changes in many countries, as well as more payment systems accepting the use of these medicines.
The Journal of the American Medical Association (JAMA open network) has published the results of a study involving nearly 3000 New York school children. It concluded that SDF as a single dose given in elementary schools prevented about 80% of cavities and kept 50% from progressing over a two year period. Treatment with SDF was as effective as the existing standard of care using sealants. The randomised trial compared effectiveness of SDF and fluoride varnish with the use of glass ionomer sealants and fluoride varnish. For the same time and cost, the simpler SDF approach allowed more children to be treated.
As a result of the pandemic, the study was interrupted for two years after the initial applications. The study’s senior author, Richard Niederman, DMD, professor in the Department of Epidemiology & Health Promotion at NYU College of Dentistry, said, "I know of no other dental preventive intervention that had this great a beneficial impact across the pandemic."
In a nation where tooth decay remains the most common reason for hospital admission of children aged 6 to 10, a means to reduce these numbers, that is economic, and lends itself to the skill mix model should be irresistible. Licencing SDF for the treatment of caries, and incentivising its use could be one of the fabled “easy wins,” that have so far proved remarkably elusive.
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