Monitoring Disease Progression After SDF Treatment

Regular follow-up appointments are crucial for maintaining healthy teeth after SDF treatment. Proper screening and identification will help determine the need for SDF reapplication.

Disease Progression Following SDF Treatment: Screening and Identification 

Worsening dental health can be identified based on the following:

• New caries on previously healthy teeth
• Progression of previously identified caries or visual deterioration of tooth structure
• Report of new or worsening dental symptoms
• Localized swelling directly adjacent to a single tooth
• Diminished quality of life such as changes in mood/behavior, nutrition intake, sleep patterns, etc. 

If children treated with SDF show signs of deterioration at follow-up appointments, document and communicate to the family and support their efforts to find a dental home. (If, despite provider attempts to refer to a dental home, treatment is not sought, and in cases of significant dental pain or infection affecting the wellbeing of the child, consider whether the child might be subject to neglect.) 

Considerations for Reapplication Frequency of SDF 

• Lesions are arrested when the surface of the lesion is stable and hard. Black color of the entire lesion indicates successful caries arrest, but color change alone does not confirm it. Hardness is detected with a dental probe on the cavity surface and may need to be performed by a dental professional. An alternative tool such as a wooden swab can be used by medical professionals.
• Standard dental guidance is to reapply every 6 months (ADA report, AAPD, UCSF protocol), but more frequent reapplication may be necessary and is not contraindicated.
• Anterior (front) lesions have a higher arrest rate. Posterior (back) lesions have a lower arrest rate.
• There is not clear guidance on an endpoint for SDF reapplication. Available evidence indicates 2 years of reapplication. Confirmation that a patient has established and accessed a dental home would be the endpoint for reapplication.
• In instances where there is little likelihood of follow up, a second application at a shorter interval increases the chance of caries arrest compared to a single application.
• Since scheduling and achieving a dental appointment may take months, follow-up appointments are an opportunity to reapply SDF, reassess and support dental access, and reinforce oral health promotion practices. Months, rather than weeks, may be more realistic timing for progress to be made.
• Confirmation that a patient has established a dental home would be the endpoint for reapplication. 

Confirming Arrest of Decay 

Confirming arrest of tooth decay can be challenging. It is not expected that pediatricians and other primary care professionals will be able to fully assess hardness of tooth decay to confirm or deny the success of applied SDF.