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Has anyone used silver diamine fluoride?

Has anyone used silver diamine fluoride yet? What are the pros, cons and patient reception? Coverage and Coding success?



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Silver diamine fluoride has higher efficacy in arresting dentinal caries compared to 5% sodium fluoride varnish. It also has a greater effect in relieving dentinal hypersensitivity. The silver ions in silver diamine fluoride contribute to its effectiveness as a desensitizer through the formation of silver phosphate, which can also occlude the dentinal tubules beyond the formation of fluorapatite alone to occlude tubules. The only con is that arrested caries lesions can stain; sound enamel and dentin won’t stain apparently. I’m not an insurance code expert, but I believe the Code on Dental Procedures and Nomenclature (CDT Code) in 2015 provides three codes that can potentially be used for silver diamine fluoride. These codes are: D1999 – Unspecified preventive procedure, D9910 – Application of a desensitizing medicament D1208 – Application of topical fluoride, excluding varnish. In 2016 the Code on Dental Procedures Nomenclature (CDT Code) will list an additional code for the arresting of carious lesions with silver diamine fluoride or silver nitrate. D1354 – Interim caries arresting medicament applicaton. I would verify with the different insurance providers regarding coverage.
Good article about silver diamine fluoride: http://www.dimensionsofdentalhygiene.com/2015/07_July/Features/New_Addition_to_the_Caries_Armamentarium.aspx
Study regarding caries prevention and arrest: http://www.ncbi.nlm.nih.gov/pubmed/19278981

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We use Silver Fluoride in my office and I think its a great option for arresting dental caries. Our doctors try to be less aggressive if they can and especially with very young children. If the doctors detect caries that can be treated with the silver fluoride rather than drill on the tooth they recommend the treatment. Children do very well with the treatment. We have them return to the office once a month for five total treatments or until the decay is arrested. In Oregon we as dental hygienist are allowed to apply it along with dental assistants. We code it out as Application of a desensitizing medicament and Application of topical fluoride.

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