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How Do We Prevent Decay?, continued
Silver nitrate was repopular-
ized in the U.S. for the treatment
of decay in the past decade by
Steven Duffin. In 1906, in Opera-
tive Dentistry Volume #1, The
Pathologies of the Hard Tissue
of the Mouth, G.V. Black advo-
cated the pharmacologic manage-
ment of caries in children using
silver nitrate. In 1924, Dr. Black
writes, “The idea that dental prac-
tice is purely mechanical and not
dependent upon knowledge of the
pathology of dental caries, should
be abandoned forever. It is an
anomaly of science that should not
continue.”
He recommended AgNO3 use in
cavity preparations to sterilize them,
similar to the Gluma (glutaralde-
hyde desensitizer) protocol, which
Gordon & Rella Christiansen
currently suggests.
Even though streptococcus mutans
was identified by J.K. Clark as a
high acid producing oral bacte-
rium in the lab in 1924, to this
day we continue to search for the
caries pathogen. Dr. Duffin muses
that it does not exist. He notes,
“So we see an infected tooth and
we go straight for the drill. Does
that not seem a little odd to you?
The highly infected mist trans-
ports bacteria to new sites in the
mouth. Drives microbes deep into
the dentinal tubules and closer
to the pulp and into the air we
breathe. Then settles into our hair.
It contaminates our entire working
environment. So why in the past
170 years have we not found a cure
for caries? We have misunderstood
the nature of the disease, blinded
by Koch’s postulates and artificial
data from in-vitro studies. We do
know that caries is the result of a
complex multi species biofilm shift
in ecology with hundreds of species
involved and the old rules just do
not apply.”
Dr. Duffin, a pedodontist, learned
that f lowing several applications
of silver nitrate over the infected
surface and covering it with fluoride
varnish ceased all caries activity.
Biofilm formation was inhibited
and children did not get new cavi-
ties and he could restore after the
caries arrest with no anesthesia.
Duffin Protocol: Isolate and dry
teeth and swab silver nitrate solu-
tion from a disposable dappen dish
with an applicator on decay, root
surfaces and open pits and fissures.
Cover with fluoride varnish. Repeat
procedure every two weeks four
times over a period of two months
if you are not going to restore the
decay. Use once if you will later
restore infected tooth structure.
Where can we use
si lver compounds?
Wherever we see decay. We all
have those patients who are
noncompliant: someone with
dementia, mental disabilities,
ignorance, lack of motivation,
brain damage, a wild tongue, an
uncontrollable gag ref lex, or a
systemic disease like Sjorgren’s
disease or diseases that affect
motor skills like arthritis or
multiple sclerosis. People who are
on drugs that cause xerostomia
or just have dry mouths are great
candidates.
Children especially can benefit,
and most of the research was
targeted to help them. Think of
anyone who is difficult to treat
and maintain. If nothing works,
and you are tired of filling teeth
you just filled in the last few years.
These silver compounds not only
arrest the decay, they—by virtue
of neutralizing the biofilm—allow
the gingiva to be healthy. It is a
pleasure to do a Class V resto-
ration without bleeding. What
is really great is that these salts
have been used around the world
on millions of people (mainly
children) for decades with great
research to support their efficacy.
Silver nitrate changes the bacteria
theol amino acid and nucleic acid
to silver amino acid and nucleic
acid which leave the cell with
no bioavailable amino or nucleic
acids so it dies. Nitrate is the
bi-product. Its various forms in
particular nitric oxide is a cell
signaling molecule that regulates
cellular function. Increasing the
amount of nitrates also poisons
the cell.
Silver Diamine Fluoride is noted in the literature to arrest
decay since the 1970s in Japan. It has been documented to treat and
prevent decay and relieve dental hypersensitivity in China, New Zealand,
Australia, India, Europe, Central and South America and the U.S. It
like silver nitrate stains cavities black which is a strong indicator that the
decay is arrested. It turns everything else black also. Pellicle stains can
be removed with pumice. The application procedure is the same as for
silver nitrate without the fluoride varnish. This past summer the FDA
approved Advantage Arrest Silver Diamine Fluoride 38% for the treat-
ment of dentinal hypersensitivity.
12 New Mexico Dental Journal, Winter 2016