Upon application to the decayed surface, a layer of silver protein congugates and silver minerals
forms, increasing resistance to acid dissolution and enzymatic digestion. Hydroxyapatite and
fluorapatite form. The treated lesion increases in mineral density and hardness. The silver acts as
an antimicrobial, the fluoride acts to remineralize and the proteins that break down the dentin are
inhibited. The ammonia acts as a stabilizer, keeping silver and fluoride ionic in solution. SDF will
always discolor anything with exposed collagen, meaning it will stain decayed or demineralized
sites and soft tissues, but not healthy tooth structure.
• Now tinted (blue), for an easier application!
• Cost-efficient : ± $0.88 (1 drop) to ± $1.76 (2 drops) for 5 surfaces*
• 8ml bottle = 250 drops
• Each drop = Up to 5 surfaces
• Dental hygienists and dental assistants can apply it
• Increases resistance to acid dissolution11
• Increases mineral density and hardness while the lesion depth decreases5
• No post-treatment limitations
*Based on an 8ml bottle at 220$
• Outperforms other anti-caries treatments in killing cariogenic bacteria15
• Quick application (less than 5 minutes)
• User-friendly, no need for:
• Air or water
How deep does it penetrate?
~ 25-30 microns into enamel
~ 200-300 microns into dentin
~ up to 2mm into a deep lesion
• Alternative to restorative treatment
• Around margins of lesions to prevent secondary decay
• Avoid general anesthesia or oral sedation
• Behavioral or medical management
• Carious lesions that cannot be treated in 1 visit
• Difficult access to dental care
• Difficult to treat dental carious lesions
• High risk caries
• Behavioral or medical management patients
• Carious lesions that cannot be treated in one visit
• Difficult to treat lesions
• High risk caries
• Root caries
• Tooth sensitivity
Arrests the progress of an already formed cavity in permanent or primary teeth.
Before application: take care of your patient
Show them the consent form, inform them of the staining and protect their eyes.
For Silver Diamine Fluoride treatment without restoration placement:
1. Isolate the affected area with a cotton roll or dri-angle.
2. Dry the lesion or surface.
3. Dispense 1 drop into a disposable dish (1 drop treats up to 5 tooth surfaces).
4. Apply Advantage Arrest to the lesion of tooth surface.
5. Allow it to soak in for 60 seconds. This is the most critical step in the process.
6. Remove excess with a cotton pellet or roll and then cover the treated area with a thin layer of fluoride varnish (FluoriMax).
This will create a barrier and keep the silver in contact for as long as possible.
It will also give your patient a nice flavor in their mouth rather than the metallic taste of SDF.
7. If no varnish is applied, let it dry completely for 60 seconds.
8. Repeat again in 1-3 weeks for highest chance of arresting the lesion.
9. To optimize caries arrest, reapply once at intervals of every 6 months OR apply a Glass Ionomer over top to seal out the nutrient source for any bacteria to survive under the restoration.
10. There are no post op patient instructions.
For Silver Diamine Fluoride treament with restoration placement:
1. Isolate the affected area with a cotton roll or dri-angle.
2. Dry the lesion or surface.
3. Dispense 1 drop of Adavantage Arrest into a disposable dish
(1 drop treats up to 5 tooth surfaces).
4. Apply Advantage Arrest to the lesion of tooth surface.
5. Allow it to soak in for 60 seconds. This is the most critical step in the process.
6. Rinse and dry the treated area.
7. Proceed with your restorative steps for the material type you are using. To reduce blackening of the filling:
• Polish away discoloration along the margins.
• Do not use a light cure step, use a self cure Gl, or “sandwich” of opaque GI at deeper
levels and then composite
(If you light cure Advantage Arrest, all of the silver will oxidize even on non-decayed
surfaces and your filling can appear dark).
8. There are no post op patient instructions. Interproximal Decay
Interproximal decay can be treated using a Superfloss Technique (see video).
Staining is an indicator of antimicrobial effectiveness.
The functional indicator of effectiveness is when the silver oxide is
bound to the diseased collagen and intrinsic pigmentation of a carious
lesion occurs. These oxides don’t polish away because the blackened
lesion retains its dark color for a long period, which is why the antimicrobial
effect is long lasting.
SDF stains demineralized areas and soft-tissues. Stains can be
reduced by gentle polishing with tincture of weak iodine solution
or by being covered with Glass Ionomer.
The staining is not immediate but will be noticed within hours. It will be
limited to direct areas of contact. For soft-tissue, it will fade over a
period of 24 to 72 hours.
SDF does not stain sound or healthy enamel or dentin. SDF stains clothing, counters, floors and instruments.
Example of application
Black mat is an indicator that the lesion is static.
History of silver diamine fluoride
1870-1912: SDF IS USED FOR 80 YEARS AS A CARIES-ARRESTING AGENT IN ASIA
Ohaguro, a custom of dyeing one's teeth black, was practiced in Japan and other countries. It was also beneficial, as it prevented tooth decay.
2014: ADVANTAGE ARRESTTM IS CLEARED BY THE U.S. FDA
Advantage Arrest is cleared by the U.S. Food & Drug Administration (FDA) for dentinal hypersensitivity.
2015: ADVANTAGE ARRESTTM IS AVAILABLE IN THE U.S.
Advantage Arrest is commercially available in the United States through Elevate Oral Care, LLC.
Since then, it has been used extensively by oral health professionals in the U.S., off-label for the arrest of tooth decay.
2016: GRANTED THE FDA BREAKTHROUGH THERAPY DESIGNATION FOR THE ARREST OF TOOTH DECAY
Advantage Arrest is granted the 1st Breakthrough Therapy Designation by the FDA for an oral care product. This designation represents the
FDA’S effort to address an unmet, serious, life-threatening medical need where there is no available therapy and to expedite the review of such
products. The designation was granted based on the FDA review of 10 worldwide randomized clinical trials evaluating silver diamine fluoride for
caries arrest in children aged 3-9 or adults aged 60-89. Collectively these trials involved 1,500 subjects who were monitored for 1-3 years.
2016: THE NEW YORK TIMES PUBLISHES AN ARTICLE ON SDF
Advantage Arrest is the subject of hundreds of lectures, online posts and articles. It is featured on major consumer media outlets including the New York Times, which published a whole story entitled “A Cavity-Fighting Liquid Lets Kids Avoid Dentists’ Drills”.
2017: ADVANTAGE ARRESTTM IS APPROVED BY HEALTH CANADA
Advantage Arrest is granted the Health Canada indication of an anti-caries agent.
Just got back from the ASM (2017) last week where I ordered my first bottle of Advantage Arrest from Oral Science. By far my favourite company for quality products. This product enables you to arrest those "suspicious lesions". I can't see how this wouldn't be beneficial for every IRDH!
- Heather Wolframe, owner of Go Smile practice
My daughter, age 4, had a successful application of silver diamine fluoride (SDF) in Calgary to arrest decay in her primary molars.
Even though I ensured limiting sugar intake, eating healthy homemade meals and following a strict dental hygiene, I was shocked when decay was diagnosed in her one tooth, and six months after that three other teeth were affected too.
I was thrilled when I found out that Health Canada approved SDF for caries treatment under the product name Advantage Arrest, which is distributed by Oral Science.
Our pediatric dentist has just ordered SDF product and I was happy we were able to try it with amazing early results. The decay was treated and arrested in all four teeth. The SDF application was easy; all four teeth were treated in 5-7 minutes. No tears, no fear, only smiles and a gift to take - the part my daughter enjoys the most.
I believe it can truly revolutionize the dental care in young patients.
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