An alternate technique of care using silver fluoride followed by stannous fluoride in the management of root caries in aged care

Abstract

An alternate technique of care to prevent, arrest and manage root caries using aqueous silver fluoride followed by stannous fluoride (AgF+SnF2) in aged care is demonstrated by three case studies. With increasing age, the inability to maintain ones own oral care from dementia, illness or frailty and polypharmacy induced salivary gland hypofunction will result in dental caries becoming a progessively greater burden for the elderly. Future generations of elders will live longer and need to maintain many more teeth longer than earlier generations. Both silver diamine fluoride (SDF)and AgF+SnF2 arrest and prevent caries and are easy to use in residential aged care facilities. Clinical differences between SDF and AgF+SnF2 are discussed. However, in aged care, AgF+SnF2 may offer advantages over SDF. AgF+SnF2 used to arrest and prevent caries in children can be modified to provide effective but minimally invasive care for an ageing and frail population. These techniques are rapid, inexpensive and nonthreatening suited to treat frail elders, dementia patients exhibiting challenging behaviours and patients with multiple rapidly progressing decay. Silver fluoride, applied before placing glass-ionomer cement (GIC) restorations is an important adjunct to the atraumatic restorative technique and may retard caries reactivation more than GIC used alone.

Unexpected sequel to silver fluoride followed by stannous fluoride treatment of root stumps supporting an overlay denture in an aged‐care patient

“…Figure shows his condition as reported previously in an earlier publication . The patient had a lower overlay denture covering five carious anterior root stumps (Figures a and b).…”

“…As reported previously, the principal author has found that the higher pH of SDF, presumably due to the presence of ammonia, can cause gingival irritation or a transient chemical burn which may result in resistance to repeated frequent applications of SDF in patients showing challenging behaviors or in the elderly with thin tissue biotype . In contrast, the use of AgF+SnF 2 appears not cause gingival irritation even when applied to all root surfaces over a wide area.…”

“…(c) Appearance of root stumps following first application of silver fluoride followed by stannous fluoride. These photographs and Figure (a) below were published in the principal author's earlier article . Reprinted with permission…”

“…However, a major difference between the two products is that AgF+SnF 2 can be applied 3‐6 monthly or between visits on a weekly basis if required without causing a transient gingival burn. The principal author has found that frequent AgF+SnF 2 applications to all root surfaces even when not carious can significantly alter the management, prevention and treatment of root caries …”

“…In a previous article published in this journal, several case reports were presented where a technique involving the use of silver fluoride followed by stannous fluoride (AgF+SnF 2 ) was used to treat root‐surface caries in aged‐care patients . The solutions were aqueous 40% silver fluoride and 10% stannous fluoride (Creighton Dental, NSW Australia).…”