Two Tools, One Smarter Approach to Early Decay

Tim Bizga, DDS, FAGD, remembers the days when he would note the earliest signs of decay in a patient’s otherwise healthy tooth yet would hesitate to pick up the handpiece, knowing that drilling might mean sacrificing more healthy structure than the small lesion itself.

“That’s what we had to do before,” recalled Dr. Bizga, who practices in Parma, OH. “Unfortunately, it meant carefully watching the decay until it progressed enough that I felt comfortable moving forward with drilling and restorative treatment.”

But since incorporating SilverSense SDF and FluoroDose into his workflow, there's been a better solution. Calling the duo a “one-two punch, if you’re a boxing fan” for treating early decay, Dr. Bizga has found SilverSense SDF and FluoroDose to be a dream team for caries care.

Strengthen with SilverSense SDF

“I was intrigued when I saw SilverSense SDF, and I said, ‘Wow, a liquid I can paint on carious infected teeth that can arrest decay and even harden and condition softened dentin,’” he shared. “I tell my patients that we’re going to 'paint medicine on their teeth.'"

In addition to being FDA-cleared to treat dentinal hypersensitivity, SilverSense SDF offers a pain-free way to treat infected lesions without staining healthy enamel or dentin. The 38% silver diamine fluoride formula fosters remineralization, inhibits calcium dissolution from hydroxyapatite, and prevents demineralization of enamel and dentin.¹

“This is an exceptional tool,” Dr. Bizga shared. “Besides young adults and children, I see elderly patients who develop root caries, and these lesions are often small and hard to access. Now, I have a liquid tool that will arrest the lesion.”

Lock in Benefits with FluoroDose

To help with a metallic taste that some patients report as a result of saliva mixing with silver diamine fluoride, Dr. Bizga reaches for FluoroDose, a dye-free, 5% sodium fluoride varnish that’s available in 6 patient-pleasing flavors: Caramel, Bubble Gum, Mint, Cherry, Melon, and the recently released DraganBerry, named in honor of Centrix’s founder, the late Dr. William B. Dragan.

FluoroDose offers a smooth, nonclumpy texture; dries clear in seconds upon contact with saliva; and adheres to the teeth for 4 to 6 hours, which is important to allow optimal fluoride uptake. This extended contact time enables long-term protection through the formation of fl uorapatite.

“Taste is always the initial thing patients notice," Dr. Bizga shared, “so these wonderful flavors of FluoroDose minimize the unwanted taste patients can sometimes experience. A layer of FluoroDose drives the treatment application of silver diamine fluoride deeper, sealing it in. Plus, FluoroDose adds a high dose of fluoride to the affected area.”

Case No. 1—A Young Adult Patient Skips the Drill

To illustrate the value of using both SilverSense SDF and FluoroDose, Dr. Bizga recalls 2 patient cases, beginning with one of his young adult patients.

“My college-aged patients leave home caries-free, but after being away from the watchful eyes of their parents, they tend to disregard oral hygiene and return with signs of decay,” he shared. “For these cases, I use Oral-B’s Super Floss and apply SilverSense SDF to the spongy, foamy portion of the floss. I floss underneath the contact and scrub it up and down against the lesion. Then I dry it off and apply FluoroDose over the top for the taste and to seal it in. Based on what I’ve seen with my patients, I then consider those lesions arrested, treated, and less likely to advance. When the patient returns, I take new bitewings. My treatment seems to hold ground, which means I don’t have to drill.”

Case No. 2—Making an Older Patient More Comfortable

“Another case concerns an older patient who had an open contact and a partially broken-out amalgam on the second molar," Dr. Bizga said. "We were nearing the holiday season, so he told me he didn’t want extensive work done on the tooth.

“After cleaning, I applied SilverSense SDF, which metabolically shuts down all the bacterial activity. I then filled with a glass ionomer restorative. It’s a sophisticated interim palliative-type treatment for the tooth that allowed the decay to be halted and the patient to be on his way. We’ll monitor the tooth and possibly address it at a later date.

“These 2 materials offer a treatment option for early incipient lesions that can be tough to access with conventional methods,” Dr. Bizga continued.

“We have the ability to put out the fire and at least hold ground because now the decay isn’t going to advance.”

_{1. Zheng FM, Yan IG, Duangthip D, Gao SS, Lo ECM, Chu CH. Silver diamine fluoride therapy for dental care. Jpn Dent Sci Rev.2022;58:249–257.}