Episode 4: Silver Fluoride in minimal intervention dental care. Looking back and moving forward with Dr. Graham Craig.
In the early 1970’s Sydney University’s Dr Graham Craig was asked to assist a regional health service district in Australia with the dental treatment of their child population. The children had a heightened fear of all dental procedures and a significant fear of needles. These children refused to attend for dental visits and were becoming violent towards the health workers who were charged with helping them with their dental problems.
Dr Graham Craig travelled to Bourke, NSW and with the help of a colleague Dr Keith Powell assessed the situation and decided to use a sample of a silver diamine fluoride product which was available at that time in Japan. So successful was the venture that the production of an Australian version was required for extended use however the manufacturer did not want to make a product with an ammonia base. Dr Craig, a dentist and chemist with interest in the use of metal fluorides, set about making a water-based material which did not have the strong ammonia smell but also offered long term product stability. This material and its accompanying stannous (tin) fluoride were used successfully and widely in Australia from that time onwards until the manufacturer passed away in the late 1980s and the company Creighton Pharacetucals folded. During this time, Dr Craig was a well-respected lecturer of preventive dentistry and began guiding new dental therapists in the use of silver fluoride, and, was a member of Cathy’s final examination panel.
This same product is available once again following Dr Craig and Dr Silvano D’Ambrisio’s decade long venture to perfect the production of commercial quantities of an ammonia-free silver fluoride material once again. This became available commercially in October 2017 and is known as CSDS (Caries Status Disclosing Solution).
Cathy and Dr Craig discuss the use of silver fluorides in modern dental settings and the impact that his early work has had across the world. Cathy is experiencing a second opportunity to incorporate silver fluoride into clinical care and they discuss the positive impact is it making for her patients and for fellow clinicians who are also using it, many for the first time, and the scope for use in the future.
They describe the rationale behind using a minimally invasive approach to managing dental caries (decay) and tooth sensitivity, and the ‘ARM-ER approach’ a clinical pathway and resource centre for clinicians and their clients to aid in the understanding of the option to offer silver fluoride materials in both forms, CSDS and SDF (silver diamine fluoride).
Cathy and Dr Craig now team up to educate dental clinicians across Australia, and Cathy also speaks at professional development seminars conducted by professional dental organisations to ensure that clinicians understand the clinical applications and advantages for their own clients.
Dr Craig and Dr Powell’s original book ‘A handbook of expanded atraumatic techniques for the apprehensive child patient’ continues to be a valuable resource for dental clinicians across the globe, and is available from Dr Craig’s dental clinician’s resource centre Dental Outlook Publications.
Upcoming seminars, case histories and other information can be found on the Black.diamonds.rock Facebook page.
More information :
Clinicians resources can be found on the ARM-ER approach at http://www.armer.com.au
The Black.diamionds.rock Facebook page www.facebook.Black.diamonds.rock
Dental Outlook Publications http://www.dentaloutlook.com.au
Creighton Dental (CSDS) https://www.silverfluorideammoniafree.com/