NEW Proximal SDF Application Without Floss

[@Witt3n]

Super educational videos as always 😄 I've seen you use soakes superfloss for this before. How do you know if the SDF reaches the contact area and the caries lesion, you by applying it with microbrush?

[@affiliatedchildrensdental]

@@Witt3n the study that shows microbrush alone was more effective is linked in the video description. Dr. Steve Duffin says it best, “Think like an atom.”

[@ljj926]

So no rinsing after application of SDF or varnish? Thank you for making this video!!

[@affiliatedchildrensdental]

right, don't rinse it off. It's ok if they drink after applying FluoriMax varnish - or follow the postop instructions of whatever brand you use.

SDFlosser in my practice. Tried and true, and it's no surprise that floss AND microbrush with SDF work best. Especially TIGHT contacts where we usually see our interproximal lesions. If you want the best % chance of arrest , don't rush or take shortcuts

[@affiliatedchildrensdental]

Untrue. There is no published clinical study using the SDFlosser device. There is, however, a published clinical study comparing floss to microbrush alone, as cited in this video's description, which demonstrates that the lesions treated with the microbrush alone were most successful. "There was a statistically significant difference in lesion progression based on application method; lesions where SDF was applied with Superfloss progressed more per month, on average, versus microbrush." Polacek J, Malhi N, Yang YJ, Scully AC, Soki FN, Boynton JR. Silver Diamine Fluoride and Progression of Incipient Approximal Caries in Permanent Teeth: A Retrospective Study. Pediatr Dent. 2021 Nov 15;43(6):475-480. PMID: 34937619.application.pubmed.ncbi.nlm.nih.gov/34937619/ And, no, do not attempt to cite my study with OSU, since we did not use the SDFlosser device and did not compare to placebo or microbrush alone. If you wish to still use floss or a SDFlosser, you're are most welcome to. It can still arrest about 84% of lesions. I prefer not to add unnecessary steps or cost, especially when it can also mean a longer and more uncomfortable appointment for the patient. I also prefer to "Think like an atom" (~ Dr. Steve Duffin).

@@affiliatedchildrensdental It is absolutely true. It’s obvious that it’s most effective to use absorbable/wicking/expanding floss AND microbrush with SDF for caries arrest. In fact, the article you cited had the best results using both floss and microbrush..and you said so yourself actually! Here’s what you said previously specifically about this topic and study: “SDF proximal application with or without floss?? Questions remain… but one thing is clear, SDF may be offered as a non-invasive treatment option for non-cavitated proximal caries lesions (other options include improved diet and oral hygiene, fluoride varnish, 5000ppm fluoride toothpaste, resin infiltration, and no treatment). The most recent AAPD journal includes a retrospective analysis of SDF applied to incipient approximal caries in permanent teeth, which is a welcome addition to the growing body of evidence for the use of SDF on non-cavitated surfaces. (Polacek J, Malhi N, Yang YJ, Scully AC, Soki FN, Boynton JR. Silver Diamine Fluoride and Progression of Incipient Approximal Caries in Permanent Teeth: A Retrospective Study. Pediatr Dent. 2021 Nov 15;43(6):475-480. PMID: 34937619) “The present study found that microbrush application of SDF was significantly more effective at slowing the progression of caries compared to application with Superfloss (P=0.005), even with relatively small sample sizes.” BUT WAIT! What exactly does that mean? It might not be what you initially think (at least it wasn’t for me). There is no description of the exact application protocols utilized, so I’m trying to peel back the layers of the onion and dig deeper into their outcomes. I’m left to question - how were the lesions isolated and dried? Exactly how was the SDF applied? How long was the SDF allowed to absorb? Was fluoride varnish applied afterward or not? Turns out there are 3 categories in their SDF application group; microbrush alone, Superfloss alone (which I can only assume, since there’s no description, that this means pre-dipping the floss into SDF and then flossing it into the contact, which I do not recommend because it tends to get on your fingers and sometimes also the patient’s lips), and both (which is how we did it for the Hammersmith paper mentioned below). Their findings are as follows; “Superfloss alone was used in 18 applications (eight progressed [44.4 percent]); microbrush alone was used in 33 applications (five progressed [15.2 percent]), and both were used in four applications (zero progressed [zero percent]). Lesion progression when SDF was applied with both microbrush and Superfloss was significantly lower compared to when SDF was applied with a microbrush (P=0.029) or Superfloss alone (P

[@affiliatedchildrensdental]

You’re quoting my post from February 10, 2022 and conveniently left out these statements from the same post, “…but there were only 4 teeth examined with that application method... I think we can all agree with their statement that “prospective studies with larger sample sizes are needed to support the findings of the current study.” And “So what’s the best proximal SDF application method? I don’t know.” It get it. It is difficult to accept and admit that you don’t need to do something you used to recommend. I struggled with this for years since I had taught people to use floss. But it is okay to evolve and move on. Sometimes you have to take Elsa’s advice and, “Let it go.” Yes, even the toothdoc1 from San Diego with a vested interested in the SDFlosser ;-)

[@cwtag]

I find it very difficult to keep the taste off the tongue. Either through saliva pooling, or a curious tongue, or even just having excess sdf that wasnt covered by the varnish. Do you have the same experience?

[@affiliatedchildrensdental]

Yes, that can definitely be a challenge. Try to dry the teeth thoroughly. Use a saliva ejector if saliva starts to pool. After a minute you can blot the excess SDF with the cotton roll before you cover the area with varnish. I also like to have them them bite down on the cotton roll and it also helps mask the taste and distract them. We will son have the ammonia free version, CSDS "Black Diamonds," in the US (Australian brand) and this will help.

[@cwtag]

@@affiliatedchildrensdental thanks! I'm sitting on pins and needles waiting for the ammonia free stuff! Well, pins but no more needles...

[@affiliatedchildrensdental]

@@cwtag HA!

[@sanaomar9953]

Thanks dr for the video .but can I covered at same day with RMGI because esthetic and diccoloration ?

[@affiliatedchildrensdental]

@@sanaomar9953 same day RMGI will stain the material. Between the teeth for incipient lesions you can barely see it. There’s photos on my website

[@sanaomar9953]

@@affiliatedchildrensdental thanks dr

[@steveduffin2142]

Beautiful ❤

[@affiliatedchildrensdental]

Thank, great SDF Master!