Dental hygienist Jennifer Geiselhofer often cleans the teeth of senior patients who can’t easily get to a dentist’s office. But until recently, if she found a cavity, there was little she could do.
“So, visit after visit, I would come back and there would be more decay.”
But now, Geiselhofer has a weapon to obliterate a cavity with a few brushstrokes.
Silver diamine fluoride is a liquid that can be painted on teeth to stop decay. Fast, low-cost, and pain-free, the treatment is rapidly gaining momentum nationwide as the cavity treatment of choice for patients who can’t easily get a filling, such as the very young or the very old.
“It has been life-changing for my patients,” said Geiselhofer, who has been using the treatment for about 18 months.
Geiselhofer hasn’t been able to go into nursing homes during the COVID-19 pandemic, but she uses the liquid on the older adults she visits in private homes. She also uses it to treat the cavities of patients in homeless shelters, jails, and Head Start programs―now wearing greater protective gear, including gloves, a surgical mask, an N95 mask, and a face shield.
The topical medication is an especially good option for seniors, dental industry experts say, because dental care has remained a major gap in health insurance coverage despite poor dental hygiene being linked to heart disease and other health problems such as diabetes and pneumonia. Medicare doesn’t cover most dental care, and patients on a fixed income often can’t afford treatment. But because of the effectiveness and low cost of silver diamine fluoride, more state Medicaid programs now cover it—and older adults who pay out-of-pocket can afford it outright.
Silver diamine fluoride has been used in other countries for decades, and studies have proved it safe. Its biggest downside is that it permanently turns the decayed area black—a turnoff, in particular, for people with decay on a front tooth.
Oral Care a Problem for Older Adults
Silver diamine fluoride was approved by the Food and Drug Administration in 2014 for reducing tooth sensitivity. But its off-label use to treat cavities was quickly adopted. It made headlines as a trauma-free treatment for tooth decay in children under age 5.Pediatric dentists have embraced it as a solution for kids who can’t sit still for treatment and whose parents want to avoid general anesthesia.
Dental Hygienists Lead the Way
Take 87-year-old Ron Hanscom, for example. A patient of Geiselhofer’s, he’s been in a Denver nursing home since having a stroke six years ago, and needs a mechanical lift to get into and out of his wheelchair.On a visit to Hanscom’s nursing home earlier this year, before the pandemic, Geiselhofer spotted a cavity under one of his crowns. After checking in with his dentist, she used a small brush to paint on the silver treatment.
“It’s a good thing she had the silver, because I couldn’t get to a dentist’s office—no way,” Hanscom said. “She did it right in my room.”
Across the country, dental hygienists provide much of the care to patients like Hanscom who otherwise might never see a dentist. They also see patients in homeless shelters, schools, jails, and low-cost medical clinics. Since the pandemic hit, Geiselhofer said she has received a flood of requests for in-home care from seniors who are too nervous to go into a dentist’s office, but she has turned them down because she is too busy caring for underserved populations.
Many states allow hygienists to work directly with patients in public health settings without a dentist’s supervision, and Colorado is one of a few that allows them to set up a completely independent practice.
Because the silver treatment is relatively new in this country and can leave a stain, the Colorado state legislature passed a law in 2018 that says hygienists must have an agreement with a supervising dentist to apply it. The law also requires them to get special training on how to use the liquid, which at least 700 hygienists from across the state have completed.
Preventing New Cavities, Too
Studies show silver diamine fluoride stops decay in 60 percent to 70 percent of cases with one application. A second application six months later boosts the treatment’s long-term effectiveness to more than 90 percent.Previously, a dentist would have had to remove the crown, drill out the cavity and make a new crown—a traumatic, time-consuming procedure with a typical cost of $1,000 or more, Vacha said. Unable to afford the cost, many patients would instead have the tooth pulled.
The paint-on liquid is significantly cheaper than traditional treatment. Estimates vary, but a private dentist may charge $10 to $75 for one application, compared with $150 to $200 for a filling. Hygienists often have lower fees. At Vacha’s community clinics, the cost is $10 a tooth.
Coming Soon to a Dentist Near You?
A small but growing number of mainstream dentists have begun to offer the treatment to all patients, not just the youngest and oldest.It’s a good option for those who have anxiety about dental work or concerns about cost, said Dr. Janet Yellowitz, director of geriatric and special care dentistry at the University of Maryland School of Dentistry.
Yellowitz noted that dentists still have a financial incentive to drill and fill. She has made presentations highlighting the benefits of the silver solution at national conferences.
“We’re trying to get everyone to use it,” she said. “It’s a slow process because we’re asking dentists who have been trained for their whole careers to do things one way to completely change their mentality. It’s like asking them to go to another country and drive on the other side of the road.”
