CDA Essentials 2017 • Volume 4 • Issue 6

21 Issue 8 | 2017 | N ews and E vents  What has it been like using SDF on your pediatric patients? We have had mostly positive results. My anecdotal experience is that it does seem to arrest carious lesions on anterior teeth better than on posterior teeth. Parents are receptive to using SDF if it will delay or prevent the need for using sedative agents. I’m currently using it on less than 10% of my patients because I have a population with high caries risk and I need to know that I will have compliance for follow-up. The reaction from caregivers has been mostly positive. My patients find the SDF application easy, but they say that SDF tastes bad!  Have the new AAPD guidelines on using SDF helped clarify best practices for you? I think the guidelines are a good start to consolidating best practices based on the best available evidence. I think some uncertainties remain in terms of the best time for application, the benefits of light curing SDF after application, and whether eating or drinking will affect outcomes. We don’t know the expected outcomes, in general, after application on certain carious lesions, and the efficacy of SDF when used on approximal lesions. We also don’t have definitive criteria on what determines caries arrest and how that assessment is made. The current guideline is for SDF use on primary teeth but I think as the guideline evolves we may see more information about permanent teeth. Chairside Perspective: USING SDF INAPEDIATRIC PRACTICE Soon after SDFwas approved for use in Canada, we spoke with Dr. Anjani Koneru about her plans to use SDF in her Saskatoon pediatric practice. Dr. Anjani Koneru Almost 6 months after she started using silver diamine fluoride (SDF), we caught up with Dr. Koneru again to find out more about her experience using SDF.  How do you decide to use SDF on a patient, rather than conventional treatment? One of my criteria is the type of carious lesion: the teeth must be asymptomatic with no prior history of dental pain. For teeth with larger lesions, I need to have a radiograph. I also consider the compliance of the caregiver, in terms of making changes to diet, improving oral hygiene, and whether they will bring the patient back for follow-up and SDF reapplication. Many of my patients seek care episodically and so SDF cannot be a definitive treatment for them. If I am worried about pulpal involvement or lack of compliance on the part of the caregiver, my preference is still to treat surgically.  What kind of impact do you think SDF will have on access to care for underserved patient groups? I think SDF could have great potential in offering an alternative treatment model for underserved populations groups. Access to care will be determined by which practitioners are able to diagnose caries, apply SDF and assess caries arrest. SDF will offer dental personnel another tool to treat more uncooperative patients who would normally require sedation; it is a more cost-friendly option for parents who do not have financial means and are delaying care because of costs. More work needs to be done, in terms of who can apply it and then what happens after in terms of assessment and care. a Theviewsexpressedarethoseoftheauthor anddonotnecessarilyreflecttheopinions orofficialpoliciesoftheCanadianDental Association.