The story focuses on the use of silver diamine fluoride (SDF) to treat and prevent dental cavities, particularly in children. The story does a good job of addressing cost, discussing benefits in context, and drawing on input from a variety of independent sources.
But the article seems to be somewhat one sided, praising the therapy much more strongly than discussing the downsides of the treatment or the potential need for ongoing repeat treatment. And it sidesteps a solid discussion of what the medical evidence says about SDF.
As well, we found this headline problematic. “A cavity-fighting liquid lets kids avoid dentists’ drills.” Yes, SDF could help many kids avoid dentists’ drills for some cavities– but, due to lack of availability, a lot of kids won’t be able to use SDF, and even kids who can use SDF won’t be able to use it if they have particularly large cavities. “A cavity-fighting liquid lets some kids avoid dentists’ drills” would have been more accurate and informative.
According to the CDC, cavities are extremely common in young children: 19.5 percent of children aged 2-5, and 20 percent of children aged 5-11, have cavities. SDF offers a relatively faster, less painful, low-cost alternative to the traditional “drilling and filling” treatment of cavities. There has also been news coverage of an increase in the use of general anesthesia on young children in order to treat cavities, though we were unable to find any research on the subject.
If SDF can be used to address cavities, allowing children to avoid treatment that requires general anesthesia — and related risks — that’s certainly worth covering. As with medical stories, it’s vital that dental stories like these take a look at the research/evidence for a particular intervention and discuss it with readers, which this one didn’t.
The story addresses cost in multiple places. One dentist notes that using SDF “comes out to pennies per tooth.” Elsewhere, the story refers to the overall treatment as costing $25 — and notes that getting a cavity filled at the same dentist’s office costs $151. We were glad to see the cost of a traditional filling included, since it gives readers useful context. The story also notes that Oregon is, so far, the only state to reimburse Medicaid providers for treating cavities with SDF.
One factor not noted is that some cavities may need to be repeatedly treated, raising the cost.
In many ways, the story does a very nice job of explaining the benefits of SDF. It addresses cost, the ability to avoid anesthesia, and the ease with which it can be applied. It even discusses the limits of those benefits, noting that patients with mouth sores or a silver allergy can’t use SDF — and that patients with “severe” cavities still need fillings. The story also includes links to supporting materials, which we like to see.
However, this criterion is very specifically focused on whether a story quantifies benefits, and this story does not do that–we’re given little information on the status of the medical evidence for this procedure overall.
A 2009 paper, linked to from this story, looked at two clinical trials of SDF and found that it “arrested” at least 96.1 percent of cavities (i.e., prevented them from getting worse). If the story had noted that, it would have gotten an enthusiastic thumbs up here.
The story clearly discusses what is, by far, the most common side effect of SDF treatment — which is that the area of the tooth affected by the cavity becomes darkened after treatment. There are, however, other potential harms. A 2016 paper noted that 3 out of 1,493 patients in studies they reviewed developed “a small, mildly painful white lesion in the mucosa,” which disappeared after 48 hours. However, that’s such a small effect size, that it’s not clear whether the lesions were caused by SDF, so we don’t fault this story for not mentioning it. There can be more significant adverse health effects if SDF is inhaled or swallowed — including respiratory problems, vomiting and diarrhea. But those effects are only relevant if SDF is not handled properly, so, again, we don’t fault the story for not mentioning it.
The story includes links to supporting material — which is great — but offers little discussion of the quality of evidence in the text of the story itself. For people who are reading this story in the printed newspaper, for example, this means that there is no immediate way to determine what evidence there is for the claims being made in the story. From what we can tell, there are very few solid trials on this intervention, and think this should have been discussed in the story.
No disease mongering here.
This is a real strong point. The story draws on input from a variety of experts, and clearly marks their relevant affiliations. What’s missing, though, is commentary from an expert on the research behind the method.
The story is effectively a comparison between the use of SDF and the use of drilling and filling to treat cavities. The story does not address the use of laser technology, in lieu of drilling, but that technique still requires the use of fillings — and would still require the patient to be still during potentially lengthy treatment (which is one reason for the use of general anesthesia in young patients). Alternatives of using nitrous oxide in the office or procedural sedation with the proper safeguards were not discussed, either.
The story makes clear that the use of SDF is not widespread in the U.S., but that it is becoming increasingly available.
The story makes clear that SDF is not new, focusing instead on the fact that it is increasing in popularity (and why).
The story doesn’t appear to be based on a news release. And even if it were, its use of independent sources goes well beyond what would have appeared in any news release.