A wise man once said, “Every tooth in a man’s mind is worth more than diamonds”. Although the sentiment is earnest, each tooth is worth about the same as a little diamond to you. If you lose a tooth due to a lack of care, the amount of money you will have to pay to restore the future damage will be approximately the price of a diamond. I had a patient who asked me which tooth they should floss more, and my reply was, “Whichever that you plan to keep”. Oral care is a commitment made from womb to tomb. That being said, as a paediatric dentist, my job mostly revolves around deciduous teeth and their care.
Whatever you name them—primary teeth, milk teeth, baby teeth, first teeth, or deciduous teeth—children’s teeth are important! Primary dentition is crucial to our children's growth and development, helping them to have a healthy, confident smile, chew and eat nutritious food, and thrive. Deciduous teeth hold space for their permanent successors, allowing for healthy speech development. Despite all these crucial roles, there is simply little regard for primary dentition.
So, once upon a time, during a tea break, a group of dentists assembled and thought if a non-invasive, economical, and successful way to treat caries would be beneficial. “There is significant evidence from a meta-analysis that adopting Atraumatic Restorative Therapy procedures with high viscosity glass ionomer cements has value as single surface temporary restoration for both primary and permanent teeth," according to the American Academy of Paediatric Dentistry (AAPD).
Clinically, we meet scenarios in which an Atraumatic Restorative Therapy procedures cannot be completed. This could be due to poor patient participation, the speed required to treat many children who may have limited access to care or financial constraints. In these cases, we must seek a more potent tool. Hence, the brilliant dentists found a smart solution with the invention of the Silver Modified Atraumatic Restorative Therapy or SMART.
By sealing the restoration and increasing pulp vitality and remineralisation of the carious lesion, the SMART method aids in the elimination of cariogenic germs. This treatment uses two products in a single session to stop decay and seal teeth: silver diamond fluoride (SDF) sealant/restoration and glass ionomer cement (GIC) sealant/restoration.
The carious lesion is first treated with SDF before being repaired with a glass ionomer cement. This efficiently arrests cavities without removing extra tooth structure before restoring tooth form with a glass ionomer. The glass ionomer will also conceal the black stain left by the SDF, which is an extra bonus. This SMART approach can be performed with the GIC placed immediately after the SDF in a single appointment, or after two administrations of the SDF, as indicated biannually to halt the lesion, and then the GIC placed. SDF (silver diamine fluoride) is that potent instrument.
SDF is a topical medication used to prevent tooth cavities. It is delivered as a colourless or blue liquid that can be applied with the ease of a drop of liquid. It is capable of arresting caries to a depth of 25 m into enamel and 200 to 300 m into dentin when left in touch with the carious tissue for one minute. SDF application does not necessitate the use of local anaesthetic, nor does it necessitate the drilling or removal of tooth structure. Silver ion works as an antibacterial by denaturing proteins and breaking down cell walls, limiting DNA replication, and as a coagulant by blocking dentinal tubules.
With this, we can smartly conclude that SMART may be a valuable strategy for successfully treating caries lesions, especially when working with a patient population that may struggle to manage several appointments and lacks regular access to care.