Thursday, October 19, 2017

American Academy of Pediatric Dentistry Issues SDF Guidelines

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For the last couple of years, dental professionals have been hearing more and more about SDF (38% Silver Diamine Fluoride) to help treat caries in susceptible patients.  Applying SDF  can arrest carious lesions.  However, the drawback is that the areas treated are rapidly stained dark brown or black.  While not a miracle cure for dental disease, SDF shows great promise to help many people, especially children in impoverished areas or those with special needs.  
 
Recently, the American Academy of Pediatric Dentistry released a paper containing guidelines for SDF use in clinical practice.  The full paper can be accessed here in pdf format.  The abstract appears below:
 
Abstract

Background:  This manuscript presents evidence-based guidance on the use of 38 percent silver diamine fluoride (SDF) for dental caries management in children and adolescents, including those with special health care needs. A guideline workgroup formed by the American Academy of Pediatric Dentistry developed guidance and an evidence-based recommendation regarding the application of 38 percent SDF to arrest cavitated caries lesions in primary teeth.
 
Types of studies reviewed: The basis of the guideline’s recommendation is evidence from an existing systematic review "Clinical trials of silver diamine fluoride in arresting caries among children: A systematic review." (JDR Clin Transl Res 2016;1[3]:201-10). A systematic search was conducted in PubMed®/MEDLINE, Embase®, Cochrane Central Register of Controlled Trials, and gray literature databases to identify randomized controlled trials and systematic reviews reporting on the effect of silver diamine fluoride and address peripheral issues such as adverse effects and cost. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess the quality of the evidence and the evidenceto-decision framework was employed to formulate a recommendation.
 
Results: The panel made a conditional recommendation regarding the use of 38 percent SDF for the arrest of cavitated caries lesions in primary teeth as part of a comprehensive caries management program. After taking into consideration the low cost of the treatment and the disease burden of caries, panel members were confident that the benefits of SDF application in the target populations outweigh its possible undesirable effects. Per GRADE, this is a conditional recommendation based on low-quality evidence. Conclusions and practical implications: The guideline intends to inform the clinical practices involving the application of 38 percent SDF to enhance dental caries management outcomes in children and adolescents, including those with special health care needs. These recommended practices are based upon the best available evidence to-date. A 38 percent SDF protocol is included in Appendix II.
 

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