Jeremy Horst, a researcher and dentist practicing his trade at Alameda Pediatric Dentistry in California, had a patient whose mouth was full of cavities. But the little guy also had a number of other health problems, and he might not be able to tolerate the anesthesia required for a dentist’s standard approach to cavities -- drill and fill.
Instead, Horst proposed a treatment plan in common use for decades in Japan -- silver diamine fluoride, and it stopped the 8-year-old’s tooth decay in its tracks.
The compound combines the powers of two elements long central to dentistry -- silver -- often used in fillings for its antimicrobial properties, and fluoride, which hardens enamel. Together with ammonia, a stabilizing agent, silver diamine fluoride can be applied like ointment to the teeth, seal the cavity and prevent further tooth decay.
Horst said kids who get their cavities filled one year have a 70 percent chance of coming back the next year with more cavities. “Those fillings and those crowns aren’t doing anything to the disease.”
“Part of the reason we’ve been estranged from the medical community is that our methods don’t work,” Horst told a crowd of oral health professionals convened by CCO Oregon in Eugene on Tuesday, detailing his research at the University of California San Francisco, and his applied practices at the Alameda clinic.
Rather than treating the symptoms of tooth decay over and over throughout the life of their patients, he said silver diamine fluoride, now with the approval from the U.S. Food & Drug Administration, has the potential to cure the disease. Goodbye cavities, goodbye scary dentist visits and the whine of the drill.
Silver diamine fluoride and another cavity-fighting compound, silver nitrate, had been known to science in the late 19th century, but Horst said it fell out of favor with the advent of local anesthesia, which allowed dentists to drill away the cavity, even though the practice hasn’t worked as well as the less invasive application of the silver compounds. “Once you could numb teeth, you could drill on them, and we forgot about all of this,” he said.
Silver diamine fluoride is not manufactured in the United States -- it is generally imported from Japan -- because the FDA only this year approved the marketing of its use to fight cavities. It took 10 years of studies and a monumental public health campaign, which Horst credited in part to Mike Shirtcliff, the president and CEO of Oregon’s Advantage Dental, along with Peter Milgrom, a professor of dentistry at the University of Washington.
Shirtcliff told The Lund Report that he already uses silver diamine fluoride in his own practice, and promotes the use of silver nitrate as a temporary measure until the other compound can be more widely available. Now he’s looking for an American factory capable of producing silver diamine fluoride.
Normally, a heavily financed pharmaceutical company banking on a huge profit is needed to navigate the scientific rigors needed for FDA approval, financing the studies to prove a drug’s effectiveness. But there was no sugar daddy to bankroll approval of a low-cost product that can reverse what sugar does to teeth, which, if effective, could take work away from dentists, even as it saves teeth and the system billions of dollars. “There’s not a model for a public health organization to get [a treatment] approved,” he said.
The one drawback of silver diamine fluoride is that it stains the teeth black because of the way the silver oxidizes. Horst masks this unsightly effect on front teeth by applying potassium iodide, which keeps teeth white. He said research is limited on the effect that the potassium iodide has on teeth or the treatment, but he hopes to conduct his own study in the next three years.
Tooth decay is the result of bacteria feeding on sugar to dissolve tooth enamel, and reducing the intake of refined sugar as much as possible, Horst recommended several other products that will prevent tooth decay before it stops. Regular use of fluoride-based toothpaste remains one of the most effective ways a person can protect his or her teeth, but he also prescribes xylitol gum for young mothers, which can keep them from passing bad bacteria onto their children.
Chris can be reached at [email protected]
Editor's Note: The subheadline incorrectly attributed the campaign to get silver diamine fluoride approved by the FDA. As stated in the body of the article correctly, that push was led by Peter Milgrom at the University of Washington, with help from Mike Shirtcliff of Advantage Dental.
