Silver Diamine Fluoride - An Old Remedy Finds Its Way Back to Dentistry

Silver Diamine Fluoride

There’s been a lot of buzz lately about a “new” product in dentistry. Maybe you’ve read the New York Times article or seen a friend post it on Facebook lately- it’s called Silver Diamine Fluoride (or SDF). We’ve put together a little FAQ for you.

• So what’s this miracle stuff all about?
• Well, for one thing, it’s kind of retro! It’s been around for decades, but somehow been forgotten by modern dentistry in the US. It’s actually been used in Japan for over 80 years! It’s a great medication to apply to cavities as an interim procedure so we can delay treatment of cavities as well as prevent new ones from forming.
• What is it and what does it do?
• SDF is a clear colored liquid containing silver ions & fluoride that, when applied to a cavity, binds with the tooth material and can stop the cavity from growing. It also actively kills the cavity causing bacteria, so it can help prevent new cavities from forming elsewhere in the mouth.
• How do you use it?
• The dentist applies it on a dry cavity surface (tooth) with a little tiny puffy brush, waits a minute, then rinses with water. It’s recommended to repeat the procedure again after 2-4 weeks, and possibly a 3rd time another 2-4 weeks later. Reapplication at subsequent cleaning appointments is also recommended.  Pretty cool stuff!
• Awesome! Any downsides?
• This clear liquid, when bound to a cavity, turns BLACK. So where you once had a brown spot (cavity), you now have a black spot (stopped cavity). Also, if a drop of it gets on the skin or clothing, it could darken a spot on the skin (temporarily- like a henna tattoo). Or your clothes. We are really careful not to let that happen, but it could!

• Well that sounds great! We should be using it on everyone! I don’t want my kids getting cavities!  
• It is pretty great, BUT….(there’s always a but!) say we put it on a cavity- that’s a big open hole. Food is constantly getting pushed down into that hole every time we eat, which can be painful! Additionally, that remaining tooth structure is weakened because it is thinner and has a higher chance of cracking- which can lead to further problems. Also, black holes in teeth aren’t the look most of us are going for, so most people will want to restore eventually for esthetic reasons.
• Ok, so who is this best for?
• In both the current literature & practice, we are finding it best for very young children who have cavities but are too young to sit through longer dental procedures, as well as overall lowering of cavity risk in those who have very high cavity rates. It’s also great for our medically compromised & behaviorally challenged patients for both treatment and prevention. Remember, ultimately we still plan to restore these teeth for reasons we mentioned previously. This is still just an interim treatment for most patients!

UCSF article:  UCSF Protocol for Carries Arrest Using SDF

Guatemala Dental Mission September 2015!

WE ARE RETURNING TO GUATEMALA!

Thanks to a very generous sponsor, we are returning to Guatemala September 26th for our 3rd dental mission!  Armed with all three doctors this year, (Dr Lin, Dr. James and Dr. Yu),  5 dental assistants, 2 admin staff and other volunteers, we are making the trek to Peronia, Guatemala to see patients in need of our expert dental care.  Last year we treated over 159 children between the ages of 3-12 and performed 331 dental procedures - we hope to be able to extend our care to even more communities this year.   As a result of our trip, the office will be CLOSED the week of September 28ththrough October 2nd.  There will be staff here answering the phones and of course, there will be coverage for our patients’ emergencies with the trusted group of dentists that we share on-call with.  As part of our trip, we are also spending our first day in Guatemala at an orphanage which houses approximately 80 children with HIV, their ages ranging from 0 to 18.

Would you like to help?  On behalf of the children in the orphanage, we are taking donations of clean and gently used baby and children’s clothing, blankets, and also clothing for teenagers.  If you would like to make a monetary donation to help cover the cost of some of our supplies for the clinic, please make a check out to The Lillian C. Spencer Fund and mail to our office.  Donations of any kind are greatly appreciated. 

If you would like to read about our experience in Guatemala last year, the Open Wide Foundation wrote a nice summary of the impact on the community and the great need these children have for pediatric dental care:

http://openwidefoundation.org/second-annual-pediatrics-week-peronia-guatemala-clinic/

.. And also an article on the impact the volunteers and clinics make on the Guatemalan communities, as they work their way to sustainability:  http://www.dentaltown.com/Dentaltown/Article.aspx?i=390&aid=5359&inf_contact_key=eaa188b1a917903f0721231406d7beb55517ff078e256922806df602c9338a8e

Questions?  Please do not hesitate to contact our office.  We look forward to seeing all of your bright smiling faces this summer! 

Have a great day!

Dr. Lin-Song, Dr. James and Dr. Yu

Covered California Update January 2014

Covered California Update

As a result of a major change in the Covered California Health plans, this is an update on the pediatric dental coverage you can expect to receive for enrollment.

As of January 1, 2014 Covered California must include these 10 categories of essential health benefits (vision and dental were not mandatory in the previous round)

• ambulatory patient care

• emergency services

• hospitalization

• maternity and newborn care

• mental health and substance abuse disorder treatment

• prescription drugs

• rehabilitation and habilitation services and devices

• lab services

• preventive and wellness services and chronic disease support

• children’s services, including dental and vision care

In a previous blog we had stated that the state of California had only the burden of offering some of these services – including pediatric dental coverage – but as of the new year, the coverage is now mandatory.  The good news is that Anthem Blue Cross, one of the larger health insurance companies, is one of the dental insurance companies that we are in-network with, as long as it is a PPO plan (can choose your own dentist).  Also, check your policy so that you are aware of visit frequencies and possible deductibles for preventative care.  As always, we are available to help with any questions, so please do not hesitate to call the office.  

COVERED CALIFORNIA

For those of our patients who are still considering the various Covered California healthcare plans, the deadline is December 23rd to get healthcare coverage starting January 1, 2014.  We know that this has been a confusing process for many of our patients' families, but hope that we can clarify a few things that will make your decision a little easier - at least when it comes to dental coverage.

-    The State of California only mandates that Pediatric Dental Care be OFFERED as coverage.  It does not mandate that each health care plan have the coverage as a part of the bundle, or package.

-    The bundled healthcare plans that do include pediatric dental coverage may not include a PPO dental plan (a plan that enables you to choose your own dentist), but rather an HMO plan (you will have to go to a dentist in their network). We do not accept HMO plans here at One Parker.

-    Supplemental Pediatric Dental Plans are available for purchase through Covered California but beware - they can be expensive and not worth the investment.  Monthly premiums can run as high as $47 per month per person with most plans just covering a percentage of preventative care and have maximums of $1,000 or $1,500.  If your child generally has cavity-free check-ups, and is not in orthodontia in the near future, your monthly premiums could cost more than two annual visits.  Read the individual plan descriptions carefully.

-    Our office is a Delta Dental Premier provider and we also participate with Anthem Blue Cross PPO dental plans - we are considered in-network with these plans.  With all other PPO carriers we are considered out of network - you can still choose us as your dentist, but you will reimbursed directly from your insurance company. 

Mouthguards - Protecting Your Child During High Impact Sports

According to the American Academy of Pediatric Dentistry (AAPD), approximately 30 million children in the US participate in some sort of organized sports program, which is very good news for the youth of our country.  However, as pediatric dentists, we see the only downside to having our young patients out there playing team sports – the dental trauma from sporting accidents. The AAPD reports that about 32% of serious dental trauma occurs during sporting activities, with baseball and basketball leading the pack as having the highest rates of sports-related dental injuries.  Mandating and updating gear such as helmets and facemasks in sports like lacrosse and football have greatly reduced the number of dental trauma injuries to our children, but we lag behind greatly in the areas of protecting kids in other sports that do not mandate protective facial gear.

As parents and professionals, what do we do?  The consequences of orofacial trauma can often go on for months or years, in terms of pain, expense, loss of time at school (and parents’ work) and can psychologically affect children and teenagers who may have to cope with broken or lost teeth.   There are some recommendations we can make to our patients which will hopefully lower the risk of a serious injury to your child’s mouth and teeth – but they do involve wearing a protective mouthguard consistently.

There are three types of mouthguards available:

-     -      “Stock” mouthguards can be purchased over-the-counter at any sporting goods store.  They are designed for use without any modification and must be held in place by clenching the teeth together.  Positives: They are a good option for those patients whose mouths are rapidly changing because of orthodontic brackets and appliances. Negatives: These mouthguards can be cumbersome and can interfere with breathing or speaking. They may also provide less protection than custom mouthguards, as their retention can be poor.

-       -    Mouth-formed “boil-and-bite” mouthguards are adapted to the mouth by immersing the appliance into hot water and then applying biting pressure to the mouthguard for fit.  Positives: These mouthguards are most commonly used by athletes because they are more comfortable than the “stock” mouthguards, can be purchased at most sporting good stores, and can be fitted in the convenience of your own home. Negatives:  They can vary greatly in size, protection, retention, comfort and cost.

-        -   Custom-fabricated mouthguards are the most highly recommended type of mouthguards – these are produced from a dental model of the patient’s mouth and delivered with the supervision of a dentist. Positives: Superior because they are designed for maximum protection, cushioning and retention by ensuring all the teeth are covered, as it is fabricated with a highly detailed dental impression.  Negatives: In children and teenagers, their mouths change so rapidly that often a custom-fabricated mouthguard may not last more than one sports season (3-6 months), and it can also be the most expensive option. This process involves 2 appointments – the 1st is to take a dental impression and the 2nd appointment is to deliver the final mouthguard. When a custom mouthguard is not available or feasable, the Academy for Sports Dentistry (ASD) prefers the mouth-formed or “boil-and-bite” mouthguard.

It’s always best to talk to your dentist during your child’s exam as to the best course of action to take when protecting them from high-impact sports. We have trained our children to make the automatic move to click their seat belt when they get into the car, or put on a bike helmet, so it is time to take the first step in training them to become adults who consider a mouthguard a crucial part of their sporting equipment.  Together we can all do our best to make sure the beautiful smiles we work so hard to keep are there for their lifetime!

An Ounce of Prevention

When looking at some of the health issues that face our children today in the United States, what seem the most pressing?  Obesity definitely tops most lists for both children and adults.  However, right up at the top along side of obesity is tooth decay.  Poor diet choices, sweet drinks, over-consumption of bottled (non-fluoridated) water, and a lack of affordable dental care for millions of children in this country has contributed to what has now reached a crisis point.

Pediatricians recommend (as do Pediatric Dentists) a visit to the dentist around the first birthday - when those first baby teeth start to peek through the gums.  Early education for parents on caring for these teeth has proven to be the most beneficial and effective form of prevention of tooth decay.  Some of the bacteria that can cause cavities is actually "contagious".  Many well-meaning parents share utensils and toothbrushes with their young children, with the mindset that the germs will help boost their baby's immune system.  In reality, they are actually contributing to the greater potential of their child developing cavities in the near future.  Visiting the dentist early will also educate the family on many other factors such as weaning off the bottle or breast, teething, habits and other dental health issues faced in the early years.

Diet plays such a crucial role in dental health. On our recent dental mission to Peronia, Guatemala, we saw firsthand how much damage sodas and sugar can do to children's teeth.  In areas of Guatemala like Peronia, where there is no central water system, water is trucked in and put in large containers for purchase. Shockingly, this water is more expensive than soda, and consequently the children there consume more soda than water.  We saw severe decay in the teeth of children who only had their teeth a couple of years - some children could have had all of their teeth removed with the amount of decay they had.  Of course a lack of preventative measures like brushing and flossing (some had never had a toothbrush) contributed to the decay, but the acid and sugar from the soda was part of the perfect recipe for the demise of their teeth.

Don't panic if you have a two year old and have yet to see a dentist, but your child's dental health is a crucial part of the overall big picture of their well being.  It is always good to establish yourself with a dentist you trust early in your child's life for their regular checkups and cleanings - as well as any emergencies that may arise - just as you do a pediatrician.  Together, you can make decisions about his or her diet and care that will benefit them for a lifetime.

One Parker Team Goes to Guatemala

ONE PARKER  TEAM GOES TO GUATEMALA

This July some of the team members from One Parker are volunteering their time to help children in need in Guatamala. The non-profit organization Open Wide Foundation (openwidefoundation.org) operates a fully-equipped dental clinic in the refugee city of Peronia to serve this impoverished community. We expect that Dr. James, Jessica, Lidia, Carla & her daughter Sydney will be seeing hundreds (if not more!) children over the course of a week. How can you help? Glad you asked! We are gratefully accepting donations to help facilitate this important mission. Please call our office at 668-3500 if you would like to pitch in.