Silver diamine fluoride covered under Denti-Cal with CDA-sponsored bill

CDA is sponsoring new legislation that will allow dentists who provide care in the Medi-Cal dental program to be reimbursed when using silver diamine fluoride as a caries arresting agent.

With the passage of Senate Bill 1148 (Richard Pan, D-Sacramento), SDF will be placed in dentists’ tool belts as an evidence-based option to manage dental caries when used as part of a comprehensive treatment plan, particularly beneficial with patients who present challenges to receiving traditional treatment because of their age, behavioral issues or medical conditions.

“The Medi-Cal dental program is testing SDF now in one of the Dental Transformation Initiative domains. While that program will provide good information when the pilot ends, we know that SDF is very effective and we should make it more widely available now,” said John Blake, DDS, CDA Government Affairs Council chair.

SDF is a topical medication used to slow down or stop dental decay in primary and permanent teeth. The colorless liquid contains both silver, which has antibacterial properties, and fluoride, which has the ability to remineralize damaged tooth enamel. Together, silver and fluoride can be used to stop the progression of tooth decay and stabilize the tooth until the dentist determines further dental treatment is needed.

The topical medication became available in the United States in 2014 when it was approved by the U.S. Food and Drug Administration to be used as a desensitizing agent, paving the way for its introduction to the U.S. dental market. The main advantages of SDF include its ability to kill the cariogenic bacteria, to provide caries arrest without requiring the use of local anesthesia or caries excavation and to promote remineralization, according to an article published in the January 2018 issue of the Journal of the California Dental Association. (Read part 1 of the two-issue series on SDF.)

These advantages are particularly appealing in the care of people with disabilities, frail elderly patients, young children and children with special health care needs who are not able to receive traditional restorative treatment. Gary D. Sabbadini, DDS, explains in his February 2018 CDA Journal article “Silver Diamine Fluoride: A Clinical Perspective From a Pediatric Dentist” how he incorporated SDF into his practice. He has used SDF to treat patients of all ages, including an adult with Down syndrome who was not a good candidate for oral conscious sedation or in-office IV sedation due to her poor airway.

“The public is looking for low-cost, safe, nonsurgical methods to treat children’s teeth. While SDF is not a remedy for all dental caries, I am glad that I have a nonsurgical option to offer to parents,” stated Sabbadini.

CDA will update members on the status of this legislation on cda.org and in the CDA Update. For more information about SDF, see the January and February 2018 CDA Journal.

Related Items

New legislation sponsored by CDA and introduced by Sen. Nancy Skinner (D-Berkeley) is working to increase value and transparency of dental benefit plans. Senate Bill 1008 calls for the establishment of a minimum dental loss ratio for individual, small and large group dental benefit products and requires increased transparency for consumers who purchase dental savings or dental discount products by requiring standardized disclosures of what a dental benefit plan does or does not provide.

In the first of a two-issue series, the January issue of the Journal of the California Dental Association explores silver diamine fluoride. Articles include a review of the history and use of silver diamine fluoride in dentistry, a discussion about the role silver diamine fluoride plays in the chronic disease management of caries in children and more.