Modern preventive dentistry increasingly turns to minimally invasive methods for controlling the carious process, especially in patient groups with high risk, limited cooperation, or the inability to receive immediate restorative treatment. One such tool in recent years has been silver diamine fluoride (SDF), whose effectiveness in arresting caries progression is well-documented in scientific literature.
Amid growing clinical interest in SDF, significant attention is being paid not only to its chemical composition but also to its formulation, which directly impacts controllability, safety, and ease of application. This topic was the focus of a presentation at the Greater New York Dental Meeting 2024, where dental hygienist Haley Buckner, RDH, BS, discussed the new gel form of SDF from Elevate Oral Care — Advantage Arrest Silver Diamine Fluoride Gel.
In her presentation, Haley Buckner emphasized that silver diamine fluoride is already familiar to most clinicians and is used in practice to control active caries. However, traditional liquid forms of SDF can pose certain application challenges, particularly in clinical situations requiring high precision.
This is precisely why Elevate Oral Care developed a gel form of SDF with higher viscosity. As noted in the presentation, the primary goal of this approach was to enhance clinician control and reduce the risk of uncontrolled spreading of the agent.
The presented summary did not include data on the specific composition, concentrations, or results of clinical studies for this formulation, which highlights the need to view the presentation as an introductory product overview rather than a comprehensive scientific report.
Silver diamine fluoride combines two key mechanisms that define its clinical value. Silver ions exhibit pronounced antimicrobial action, suppressing the growth of cariogenic microflora and reducing bacterial activity in affected tissues. Fluoride, in turn, promotes remineralization by contributing to the formation of mineral structures more resistant to acid attack.
Because of this, SDF is regarded as an agent for arresting active caries, rather than as a restorative material in the traditional sense.
During the presentation, it was emphasized that the gel consistency provides clinicians with additional control during application. The increased viscosity reduces the likelihood of the agent dripping onto the mucous membrane, soft tissues, or adjacent surfaces, which is particularly important when working in hard-to-reach areas.
It was separately noted that this form may be convenient for treating root caries, as well as when working with young children, including patients who struggle to remain still during the procedure. The denser texture potentially allows the agent to be confined strictly within the intended treatment area.
Despite its potential benefits, the use of SDF — regardless of its formulation — requires consideration of several clinical aspects. A classic and expected effect is the darkening of carious tissues, which may have aesthetic implications and must be discussed with the patient or legal guardians before initiating treatment.
Furthermore, contact with soft tissues may cause irritation, underscoring the importance of adequate isolation of the operating field. The presented materials lack data from comparative studies of the gel form versus liquid analogues; therefore, clinical protocols should be developed based on the manufacturer’s information and current scientific literature.
Since the presentation did not provide detailed instructions for the specific product’s use, clinicians are advised to follow the generally accepted principles for working with SDF. These include obtaining informed consent, thorough isolation, controlled application of a minimal amount of the agent, and mandatory documentation of the procedure.
Follow-up visits remain a critical component of patient management, allowing for the assessment of caries arrest and the determination of further treatment strategies.
Particular attention deserves the emphasis placed by Elevate Oral Care on the educational component. During the presentation, it was proposed to complete a free continuing education course with AGD PACE certification for doctors and their teams, highlighting the company’s commitment to supporting product adoption through educational initiatives.
Haley Buckner’s presentation at the Greater New York Dental Meeting 2024 introduced the gel form of silver diamine fluoride by Elevate Oral Care as a potential expansion of tools for conservative caries control. The increased viscosity of the agent may enhance manageability and reduce the risks of uncontrolled spreading, which is particularly important when treating root lesions and working with children.
At the same time, integrating the new SDF formulation into clinical practice requires familiarity with the manufacturer’s complete technical and clinical documentation, as well as reliance on evidence-based data. When standard safety protocols and informed consent are observed, the gel form of SDF may find its place in the toolkit of preventive and minimally invasive dentistry.
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