Advantage Arrest

Welcome to the Caring & Able web series and today we are featuring two people from the Elevate Oral Care company. Steve Pardew is a Managing Member of Elevate Oral Care and helped launch the company roughly 10 years ago, he brings 20 years of product development and technical experience, focused exclusively on preventive dentistry. Hayley Buckner is the professional relations manager and preventive care supervisor for Elevate Oral Care. Hayley enjoys combining her dental hygiene background and experience to share, up to date information on SDF prevention, better known as Arrest, patient-centered communication, and cavity risk assessment protocol to dental offices and patients.

 Alisa: Today we’re going to talk about my favorite topic in dentistry, and why is it my favorite topic? Because when I introduce it to patients, they want to know why they’ve never heard of it before. So for me, it’s exciting. We’re talking about Advantage Arrest, and the generic name for Arrest is Silver Diamond Fluoride. And although it’s called that I don’t know another company that’s just me that even makes SDF. Besides, Elevate Oral Care. So I purchase it from Elevate and I call it Arrest. 

So we’re going to talk about how to arrest cavities. I’m assuming that’s why it’s called Arrest and that’s a brilliant name for it. I wish I had thought of it myself. And we have two professionals from Elevate Oral Care here today to tell you how to arrest the decay, and it’s an extremely interesting topic, we didn’t learn about it in dental school. Hopefully, if any dentists are watching this, you are learning about it in dental school and hopefully, it will be more widely used in the future. 

Now everyone knows that I do geriatric housecall dentistry, and most of my patients have dementia or some cognitive issues or mobility issues. And one of the things that they hate the most are unable to understand is drilling into the teeth. So Advantage Arrest is something that you use that will take away the drilling process and we’re going to talk about that today. So let’s start with the first question, and I’m going to give it to Hayley, what is advantage arrest? 

 

What Is Advantage Arrest?

Hayley: Yeah, so Dr. Kaufman, as you said Advantage Arrest is also known as silver diamond fluoride it’s a 38% solution. And it’s a liquid that has really a number of different uses in the patient’s oral cavity. You mentioned arrest, that’s probably the most commonly known way to use silver diamond fluoride or Advantage Arrest is to apply it to a carious lesion or a cavity and it will arrest the infection that’s in that patient’s tooth, and it will harden and remineralize the tooth surface as well. 

So that can be used as the definitive treatment for that patient’s cavity, or it can also be restored over at a later date as well. It’s actually FDA cleared as a dentinal hypersensitivity treatment, so it can also be used for dental hypersensitivity anytime you have some patients that are experiencing any kind of sensitivity. The advantage or S can be applied to those sensitive areas, and they’ll experience sensitivity relief fairly quickly.

Also, there’s a lot of great research out on the preventive benefits of advantage dressed as well. So it can be site-specifically applied to any areas where a patient may be at a higher risk for developing a cavity in their tooth. It can be applied to that site, similar to how we use fluoride varnish and other preventive measures. However, the silver diamond fluoride is going to offer much greater prevention to these high-risk sites into the patient’s mouth so it can be used really for a number of different uses for patients. 

Alisa: Well I have to add on to that because I just can’t help myself. When you said dental sensitivity, I don’t think people listening might understand what that means so I often get complaints about, like, a groove at the bottom at the base of the tooth where the tooth meets the gum, where when they brush or drink something cold that they think that they need to have the tooth extracted. So I’ll go in there and say oh let me take care of this. Oh, is it going to hurt? No, no you know right away. No, it’s going to feel fine, you are going to love me. And you just apply the Advantage Arrest, right into where the sensitivity starts. And literally, in one minute. They can take a drink of cold water, and they feel relief so that’s number one. 

Number two, as part of my service as a household dentist, I will put Advantage Arrest, everywhere where I think there’s a possibility that they’re going to have decay, almost like a sealant, like a fluoride, like a fluoride treatment this is, this goes first, and then I will give them a fluoride treatment on top so this has changed the way I look at dentistry, especially for the geriatric population and the pediatric population because we don’t want children to be afraid of the dentist if we could solve a problem before it starts. That makes a lot of sense, right. So let’s, let’s you guys tell me, who do you think benefits the most from Advantage Arrest? 

 

Who Benefits Most From Advantage Arrest?

Hayley: Again, I think, most every patient would benefit from advantage arrest. A lot of patients as you experience have that sensitivity, where maybe they worn away their gum tissue over the years from brushing too hard and just in that aging population so anytime the patient has those sensitive areas. They’re a great candidate for advantage risk. Same thing for patients that have active decay or cavities in those teeth. They’re also a great candidate for Advantage Arrest and that doesn’t just come from us. The American Dental Association released a few years back in 2018, offering the non-restorative so if a patient is looking for a different treatment, as opposed to traditional drill and bill dentistry. 

Silver diamond fluoride and Advantage Arrest gives that patient an option to treat their active cavities, with something other than traditional drilling and filling that patients are used to. And then also, like we talked about for those patients that have areas of concern. It’s a great option to be able to apply this to keep those areas healthy and prevent them from getting cavities. 

Alisa: I have a question, why is it that the consumer population does not know about this treatment? That’s what I want to know.

 

 Why Don’t A Lot of People Know About This Treatment?

Hayley: Well silver diamond fluoride is still pretty new here in the United States, it became available here in 2015, but other countries have been using it for several decades. So it’s still something that’s just a little bit on the newer side here, but it’s definitely taking off and more and more patients are becoming aware of it, and they’re hearing about it from friends who maybe have undergone a silver diamond fluoride treatment, and more and more dental professionals are starting to utilize it as well. 

Alisa: Right. So folks, you heard it here first, or maybe you haven’t but maybe you have, but if you have a loved one with dementia or any cognitive issues where you know drilling is going to be an issue if you have a child who cannot handle going to the dentist but you know has some small cavity that may spread and become an issue. 

Advantage Arrest is the answer to your prayers, it’s the answer to mine and I literally, thank you guys every day when I treat a patient and do seven or eight sealants, I place it on a patient at the first visit as part of the first visit experience because no dentist really does that. I feel like you’ve changed the way I practice.

Alisa: Question, can someone see what did what soft teeth? 

 

What is Soft Teeth?

Alisa: “Oh I have soft teeth.” I don’t even know what that means, do you guys get that question ever can someone answer what is Soft Teeth? 

Steve: Yes, soft teeth is one of those misnomers one of those old wives’ tales that we’ve heard for years and years that oh I just I’m gonna get, I’m gonna get cavities I’ve got soft teeth. Yeah, unfortunately, it’s not true. 

The average patient, most patients across the country, all have the same enamel, all have the same makeup in their tooth, so their teeth are all the same. It’s the other factors in the patient’s life that really affect what type of tooth decay or the lack of tooth decay that that patient might get. It’s what you eat, it’s more frequent are is how frequently you eat, it’s actually more of a concern. It’s how well you brush, it’s whether you floss or don’t floss it’s all of those other factors that are combined, that really determine if you’re going to have to pay or not so soft teeth is one of those things that we’ve heard about it, it’s been passed down from generation but it’s really just to tale. 

Yeah, in the theory silver diamond fluoride, yes it will work on soft teeth just as well as it will work on normal teeth because they’re the same.

Alisa: Right. I could tell you that the one issue that I see that everyone out there should be really aware of is that food sticks to the front of your teeth. And eventually, that food will cause a white spot on the tooth right Hayley you know this is a hygienist and eventually that white spot will spread into the tooth and cause decay, and this is where I find that the arrest treatment really helps because it literally arrests the decay in its tracks. And a lot of people think that it’s going to hurt. Does it hurt? Do you need an injection?

What do you tell your patients Hayley? 

 

Does Advantage Arrest Hurt? Do You Need an Injection?

Hayley: No it does not hurt at all that’s the neat thing about Advantage Arrest, It’s just a liquid. It contains silver diamine fluoride, a little bit of blue dye to tip the solution and water and it’s just painted on and it soaks into the tooth surface, and that’s it. 

So no, it’s a painless procedure.

 

Can It Be a Definitive Treatment?

Alisa: Can it be a definitive treatment or do you have to fill the tooth? 

Hayley: No yeah it does not have to, you do not have to fill the tooth, it can be the definitive treatment. Now if bad dress is being used on an actual cavity or infection in the tooth. Then one of what happens to that is not only does it arrest that infection and remineralize a tooth surface but it will stain that little area dark, so some patients prefer to eventually get some restorative work done over it just to kind of cover up that black stain, but also depending on where it’s at in the patient’s mouth. Some patients are completely okay with that stain in there. And so no, you do not have to restore over it. 

Alisa: Yeah, sometimes I do and sometimes I don’t I mean, for certain patients that don’t care about aesthetics at all, I leave it alone. I always warn the patient that it’s going to stain the tooth, but that’s how you know that it’s hard when you see that it’s black, it means that it worked. I often go back two weeks later and do it again but let’s talk about, is it a permanent type of thing or do you need to repeatedly do it.

 

Is This Permanent Or Do You Need To Repeat It?

Hayley: Yeah, ideally, you do repeatedly do it if you’re not restoring over it. The dentist will reapply it usually intervals of one to two times a year, regularly. 

And one thing to point out we talked about using it for sensitivity and for prevention on some areas that are high risk, the Advantage Arrest will not discolor those surfaces, it’s only turns the cavity or that infection in the tooth black, but it will not discolor sensitive areas and high risk areas that are still healthy. 

Alisa: Right. And I’m going to add to that because if the patient is very active and they’re moving around when I do it. And if the small tip applicator should touch the gum, it gives you like a little henna dye temporary tattoo that lasts two to three days but that totally goes away, just like if it drops on your finger, just a stain that goes away, only permanently stains, the area that you were treating correct just where active decay was present.

 

Can You Reformulate It So It Doesn’t Stain?

Steve: Yes, we get that question a lot, and it’s something that is being looked at in a number of different ways, but it’s not an easy thing to do because silver is actually what causes that dark stain in the cavity, and silver, just like your silverware at home will tarnish this tarnishes or rusts and it gives you that color so we’re trying to find a way to make that happen but it’s not an easy thing to do. I hope that somebody can help you figure that out in the future because that would be the only thing about it that is not the cure all for everything. 

Let’s even though we’ve talked mostly about aging adults in this series, I want to still talk about how amazing this is for children because I can just imagine how great 25-30 years ago, this was around how great it is not to have to send some kids into the operating room because you worry that the k is going to progress so you have to start doing all that treatment under anesthesia.

 

How Great Is This For Children?

Steve: It’s fantastic for children, in fact, that was one of the first groups in dentistry to jump on board and using silver diamond fluoride, pediatric dentists were lining up at our booth in the pediatric dental meeting in Seattle, Washington when we originally launched it to purchase it and so they’ve jumped on board quickly, and it specifically started with that reasons alone. The fact that young children often can’t sit through the procedure to have a filling done, they have to have general anesthesia is a concern and a couple of different ways. Silver diamond fluoride can treat those cavities, they don’t have to go through general anesthesia, in many cases, sometimes they still do, but in many cases, this can prevent it.

We actually filed with Food and Drug Administration for breakthrough therapy status to transfer this product and become a full-on drug, and they granted our breakthrough therapy status because we have the ability to prevent general anesthesia in children, and normally this type of designation of an accelerated path through the Food and Drug Administration is something that the agency reserves for vaccines, life-saving devices life-saving drugs, but they’re given that they gave it to us because unfortunately every year under general anesthesia, there are a small number of children that don’t wake back up. So the fact that we can help reduce that number was enough to get us the Breakthrough Therapy status to become a drug for caries arrest. So we’re very pleased with that and we’re very pleased with what it’s been able to do in the pediatric dentistry world.

Are There Any Other Side Effects To Talk About?

Alisa: Are there any other side effects that we have to talk about, I mean I’ve never had an issue ever I can promise you, I’ve used it on 1000 patients, probably by now, and I’ve never had anyone complain that later there was something, whatever, a side effect could be other any other side effects, besides the staining of the tooth in the area that was treated.

Steve: The only contra indications that there are for the product or you don’t want to use it on a patient that has a silver allergy, and you don’t want to place it on a site where there’s an open wound near it, so Ulcerative gingivitis or something that’s going to basically cause it to sting.

So those are the really the two contraindications for the product. As far as other side effects. It has a metallic taste. It gives you that dark stain on the cavity or a henna tattoo on the soft tissue. But other than that there really are no other side effects to the material.

What If You Don’t Know How Deep The Decay Is? Is It Safe?

Alisa: From my point of view question that I always want to ask. If you’re not sure how close or how deep the decay is but you know you’re not in the nerve, is it still safe to take a chance and use?

Steve: The answer is yes. So you can do it, a number of different things you can apply it directly to the cavity, and it will normally harden up or arrest a lesion, up to about two to two and a half millimeters deep anything deeper than that. It’ll cut it off from the oral environment, and gradually that deeper portion will arrest, as well. But if it’s too close to the pope during the time where that lower portion is resting on its own, which can take several months, we may get some pulpal involvement at that time. So there’s a, there’s a small risk the closer you get to the pole, but in many cases that can arrest, very, very deep. Right.

You can also have the opportunity to do some hand or spoon excavation of some of that top layer of the lesion, and then paint silver diamond fluoride out of the deeper parts and then pack over top of that with a glass Ionomer other restorative material so there’s lots of different options.

Alisa: Yeah that’s what I do. I think it’s just like I call it my miracle drug, and I have to repeat because it’s so important that when I tell patients or the families or the caregivers or whoever I’m actually talking to you about this type of treatment plan. They always say the same thing. I’ve never heard of it, why doesn’t the public know about this, so I am so excited that we’ve had this discussion today and I really thank you guys for helping me make my practice more successful, and it’s been great talking to you.

I really appreciate Elevate Oral Care for this product, and so well you as a patient, if you have a loved one, or someone that you’re taking care of who you know has decay, who you’re afraid to take to the dentist because you know that they’re not going to be able to handle the treatment. This is a great treatment modality for that type of patient, and believe you me and I treat the most difficult patients, the elderly and the frail who cannot handle drilling and filling. This is the answer to your prayers because it’s answered mine as a dentist. So thank you guys again, and I look forward to talking with you again soon.

Steve: Thank you very much we appreciate being here today.
Hayley: Thank you.