A Pediatric Dentist’s Personal Journey with SDF
My middle child is loud (like me), she’s joyful and bold and has a smile that goes from ear to ear. Her four front teeth were treated with a medicine called Silver Diamine Fluoride (SDF) when she was only 4 months old.
As a pediatric dentist, I use SDF all of the time. It’s amazing- permeating into an early cavity, fluoride strengthening tooth structure and silver decreasing microbial activity, blocking up the inside structure and… turning it black. When I recommend the use of SDF on BACK teeth, I have almost no difficulty convincing parents of the merits of SDF- it’s minimally invasive. But when a patient is pre-cooperative and has a cavity on their front teeth? That’s another story. It’s really hard to suggest painting their child’s front teeth black but I think I have the best evidence to show them that I believe it is in their child’s best interests because I believed it was in the best interests of mine.
When she was 4 months old, her front teeth came up and as a dentist, I noticed immediately there were white speckles on them. Whether developmental or not, I can’t be sure but within a few months, despite my diligent brushing, she got little cavities on the backs of her front teeth.
I’ve seen early childhood caries. I’ve seen teeth break down, get infected and need to be extracted- I didn’t want that for my child. She was not capable of undergoing traditional treatment at that age and the risks of sedation for a child her age were too high for me. I was left with the question that many parents are left with- what do I do for these teeth? I didn’t want her in pain, I wanted her to be safe, and I’d placed SDF on the front teeth of other children- shouldn’t I do the same for her?
It did give me pause- black teeth? How would this affect her self-esteem? I’m a dentist and I’m going to have a kid with black teeth. But knowing SDF would give me the opportunity to keep her teeth healthy, have them never break down or cause her pain and allow us to avoid sedation? 100% worth it.
That’s how my 9 month old got black teeth. We’ve gotten a few questions as she’s gotten older - other kids are curious and most grown-ups don’t even notice or think she ate oreos. We didn’t make a big deal about it, so neither did she. When she was old enough to ask we told her her teeth were sick when she was small and we put on medicine to make them strong again; that her teeth are healthy and strong; it worked for us so it worked for her.
She’s about to start kindergarten. I was able to desensitize her to the dental chair any time I wanted. She loves the dentist because of the prize at the end. She smiles all the time and has sky-high confidence so the risks of sedation to make her teeth white weren’t worth it for us. We waited. Our amazing girl grew up never having pain on her teeth, eating carrots and apples with abandon and a few weeks ago, I removed the black while she was wide awake in the dental chair and added a white resin to make sure they didn’t get sensitive. She was ready for safe treatment in the chair so that’s what we did. The funny thing is: she didn’t mention her teeth were white after we treated them- all she cared about was her prize at the end.
Minimally invasive treatment works; meeting a child at their comfort level and developmental level works. You can trust the recommendations I make for your children are the same I would make for my own and always in their best interests.
