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Silver Diamine Fluoride

What is Silver Diamine Fluoride or SDF?

Silver Diamine Fluoride (SDF) is a topical medication used to treat and prevent dental caries from forming, growing, or spreading to other teeth and relieve dentinal hypersensitivity. It is a colorless or blue-tinted, odorless liquid composed of silver, ammonium and fluoride ions. Silver and Fluoride ions possess antimicrobial properties and are used in the remineralization of enamel and dentin on teeth for preventing and arresting dental caries. 

Who can perform application of SDF in the dental office? 

All licensed dentists may perform the application of SDF.  

Properly trained licensed dental hygienists and registered expanded function dental auxiliaries (EFDAs) may also apply SDF under supervision of a licensed dentist or under authorization of a dentist holding a Teledentistry Permit if they have met the requirements to practice when the dentist is not physically present - ORC 4715.431 (E & F).

SB 259 of the 132nd General Assembly effective 3/20/2019 set forth the guidelines for the Teledentistry Permit and authorization of dental hygienists and EFDAs to perform the application of SDF.  While the application of SDF is not currently listed in the permissible duties of dental auxiliary, the Board is in the process of amending the rules to allow this function under the supervision of the licensed dentist, as well as under authorization of a dentist holding a Teledentistry Permit. 

What are the education and training requirements for application of SDF?

Dental hygienists and EFDAs must complete a 2-hour course in the application of SDF from a Board-approved sponsor - OAC 4715-8-02.  The course must one (1) hour of didactic instruction and one (1) hour of clinical hands-on instruction. Course curriculum must meet the requirements set forth in - OAC 4715-23-02 in order to be acceptable by the Board. 

How do I complete the clinical hands-on requirement for the SDF course in light of COVID-19?

The Board recognizes that any clinical instruction will be difficult during this time in light of the COVID-19 pandemic.  Therefore, in an effort to move forward in allowing dental auxiliary to perform the application of SDF, the Board has set forth “soft launch” requirements to allow dental auxiliary to begin providing the application of SDF through December 31, 2021.  This “soft launch” requires the dental auxiliary to complete the didactic instruction from a Board-approved sponsor and then “shadow” a licensed dentist in the application of SDF.  The licensed dentist must then observe the dental auxiliary in the application of SDF to ensure competency prior to any authorization or supervision of practice while the dentist is not present.  Additionally, the Board will accept courses wherein the clinical hands-on instruction is completed by utilization of live patients (where possible) or by utilizing typodonts or partial/full dentures.  The Board will only accept courses utilizing typodonts or partial/full dentures through December 31, 2021.

Are there any additional requirements that must be met before I can apply SDF?

Dental hygienists and EFDAs must be observed and determined to be competent by the supervising dentist or dentist holding a Teledentistry Permit prior to performing the application of SDF.  

Informed Consent must be obtained by the patient or by the parent or legal guardian if the patient is under the age of eighteen (18) prior to the application of SDF by any dentist or dental auxiliary. 

What are the requirements for obtaining informed consent? 

To obtain informed consent, the authorizing dentist must:

1) Determine that the patient is mentally capable of giving informed consent to the provision of the diagnosis, care, or treatment and is not subject to duress or under undue influence,

2) For the application of silver diamine fluoride,

a) Inform the patient of the potential for staining teeth by providing color photos of the result of application,

b) Inform the patient that application is permanent and may only be reversed through loss or restoration of the tooth,

c) Inquire whether the patient has an allergy to silver, and d) Inform the patient that the treatment will require active monitoring and possible reapplication.

See - OAC 4715-23-03 for additional information on informed consent via Teledentistry.