Sir, current guidance from the RCS Recommendations for paediatric dentistry during the COVID-19 pandemic is very clear: 'Access to general anaesthesia will be significantly reduced for the foreseeable future'.1
As a foundation dentist, I have had little exposure to silver diamine fluoride (SDF) during my undergraduate studies and so was very interested by the recent BDJ paper highlighting its use in the management of dental caries.2 Through the utilisation of careful non-AGP application methods, it can prevent the progression of carious lesions and arrest them entirely although the most immediate issue is that it is currently not licensed to be used as a caries-arresting agent in the UK.
SDF has huge potential within community dentistry and general dental practices, more so at this unprecedented time. This would be particularly useful in coping with the reduced GA access and managing extensive carious lesions atraumatically, particularly in uncooperative patients. Considering all of the benefits, it begs the following questions - why is it still unlicensed as a caries-arresting agent in the UK? Where is the official guidance on its use? And finally, why has it not become a prevalent form of treatment considering its efficacy and appropriateness in the current climate?
References
- 1.Royal College of Surgeons of England. Recommendations for paediatric dentistry during the COVID-19 pandemic. 2020. Available at: https://www.rcseng.ac.uk/-/media/files/rcs/fds/guidelines/paediatric-dentistry-covid19.pdf (accessed June 2020).
- 2.Greenwall-Cohen J, Greenwall L, Barry S. Silver diamine fluoride - an overview of the literature and current clinical techniques. Br Dent J 2020; 228: 831-838. [DOI] [PubMed]