PAGD Keystone Explorer Summer 2020

14 www.pagd.org Q dentistry issues In April of 2018, my PEAK presentation focused on minimally invasive treatment with silver diamine fluoride (SDF). During the COVID-19 pandemic where minimizing aerosols has been recommended, it seems to be a fitting time to revisit the presentation. Silver diamine fluoride (SDF) has long been a staple in my health center, even in a world where we performed aerosol-generating treatment without question. In my presentation, I shared the case of a 9-year-old boy who started to develop interproximal incipient carious lesions. As interproximal lesions develop, we are faced with a decision. Do We Monitor the Lesions? Do We Utilize a Non- Operative Intervention? Do We Take Out the Drill and Perform Operative Treatment? As professionals, we can use our clinical judgment to determine when a handpiece is needed, but watching alone should never be an option. We know that by watching, we are just waiting for the lesion to grow. While taking out a handpiece and placing a restoration may certainly be acceptable to restore the tooth for someone with high caries risk, there will be little long term success without a change in hygiene and dietary habits. Over the span of this 9-year-old’s lifetime, the restoration will inevitably need to be replaced, and likely with a larger restoration each time. This “molar life cycle” image comes to mind. Whenever a tooth is prepared for a restorative treatment, the structural integrity of the remaining tooth is weakened. My PEAK Presentation Minimally Invasive Treatment Janine Burkhardt, DMD, MPH, FAGD