Clinical Protocol of Silver Diamine Fluoride for Caries Management

Objectives: Background: Silver diamine fluoride (SDF) is cleared by the Food and Drug Administration of the United States as an anti-hypersensitivity agent. Its instructions of use by the manufacturer are primarily based on the treatment of dentine hypersensitivity. However, dentists based on their clinical experience often use SDF as an off-labelled cariostatic agent for management of dental caries.

Objective: To review the literature on the clinical protocol of SDF for preventing or arresting dental caries.
Methods: Method: A search of English publications using five databases, namely Embase, Medline, PubMed, Scopus and Web of Science was performed with keywords (silver diamine fluoride OR silver diammine fluoride OR SDF) AND (protocol OR instructions OR guidelines) AND caries AND (arresting OR arrest OR preventing OR prevention). Publications offering guidelines on clinical protocol of SDF for caries management were included.
Results: The search identified 189 publications and 11 author teams were included. Nine author teams recommended isolating the tooth with cotton rolls and/or gauzes before SDF application. However, they had significant variations in recommending the exposure time, which ranged from 1 to 3 minutes. Seven author teams suggested removing excess SDF by blotting with cotton pellet, whereas two author teams recommended rinsing the SDF-treated tooth with water. Five author teams suggested applying fluoride varnish after SDF application to avoid dilution of SDF by saliva.
Conclusions: Clinicians generally isolate the caries tooth with cotton rolls and/or gauzes. The exposure time suggested for SDF application is 1 to 3 minutes. Some authors recommended applying fluoride varnish after SDF application.