Message in a Bottle Mailbag: Silver diamine fluoride during restorative procedures, Apple Watches for the whole team

The Message in a Bottle Mailbag is a monthly feature of the e-newsletter, Pearls for Your Practice: The Product Navigator. Each month, Editorial Director Joshua Austin, DDS, FAGD, answers reader-submitted questions to help you navigate your dental product decisions (and more!). This month, he answers a question about using silver diamine fluoride during restorative procedures and discusses buying the staff Apple Watches to use with OperaDDS.

Question

Stefanie from Florida asked: Does silver diamine fluoride affect bonding? Can it be used during restorative procedures?

Answer

Great questions, Stefanie. Silver diamine fluoride has the potential to be a mighty tool in the proverbial toolbox of all dentists. I attended the American Academy of Restorative Dentistry (AARD) meeting in February. Every year there is a large literature review by Terry Donovan, DDS, that gets published in the Journal of Prosthetic Dentistry. I have always found Dr. Donovan to be hilarious and simultaneously skeptical. He is not prone to hyperbole or overselling developments in dentistry. He has seen it all, so little excites him, other than an ice-cold beer. Dr. Donovan’s review this year started with silver diamine fluoride. Never in the five times I have been to AARD meeting have I heard him say that a particular material could “change dentistry,” but he said that about silver diamine fluoride. I think we all need to familiarize ourselves with this product and start using it in our practices for the good of our patients. (i)

The question about its effect on bonding is a great one. For direct restorations using glass ionomer cement, rinsing the prepared tooth with water after applying silver diamine fluoride can eliminate its effect on bonding. (1) If you do not rinse prior to starting the direct composite bonding procedure, bond strength could be reduced by 50%. (1)

For indirect restorations, silver diamine fluoride can decrease dentin bond strength by one-third, even after rinsing. (2) For indirect restorations, the treated superficial dentin should be excavated. (3)

To me, that is sort of scary. I don’t want to risk contaminating direct restorations or have the trouble of excavating healthy tooth structure on indirect restorations, so I prefer not to do any restorative procedures on the same day as silver diamine fluoride application—the fewer potential complications, the better. I am guessing we will see more research on this in the future. We can adjust our process as new literature is published, but for right now, I avoid bonding anything on the day we apply silver diamine fluoride. Thanks, Stefanie!

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Question

Jim from Nevada wrote: I like the idea of OperaDDS. Did you buy Apple Watches for your whole team to make it work?

Answer

Not all of them—just the clinical staff. The front desk folks are at a computer all day, so they use OperaDDS through the web portal, and the audio alerts let them know when they are being paged or have a new message. The dental hygienists and assistants aren’t always on computers, so the Apple Watches let them see alerts right away, no matter where they are. Also, I didn’t get them all Apple Watches at once. I started with my two assistants, then moved on to hygienists after that. I can see your concern though. If you have a large staff, that could get pricy. Great question!

Note

i. For more reading about using silver diamine fluoride in your practice, check out this article: Horst JA, Ellenikiotis H, Milgrom PL. UCSF protocol for caries arrest using silver diamine fluoride: rationale, indications, and consent. J Calif Dent Assoc. 2016;44(1):16-28.

References

1. Knight GM, McIntyre JM, Mulyani. The effect of silver fluoride and potassium iodide on the bond strength of auto cure glass ionomer cement to dentine. Aust Dent J. 2006;51(1):42-45.

2. Soeno K, Taira Y, Matsumura H, Atsuta M. Effect of desensitizers on bond strength of adhesive luting agents to dentin. J Oral Rehabil. 2001;28(12):1122-1128.

3. Horst JA, Ellenikiotis H, Milgrom PL. UCSF protocol for caries arrest using silver diamine fluoride: rationale, indications, and consent. J Calif Dent Assoc. 2016;44(1):16-28.

Editor's note: Do you have a question for Dr. Austin? Is there a product you'd like to see him review? Or would you like to submit your own Pearl? Send an e-mail to [email protected]. You might just see it in the e-newsletter, Pearls for Your Practice: The Product Navigator! If you're not a Product Navigator subscriber, click here to sign up.