Silver Diamine Fluoride (SDF) is an antimicrobial liquid that can be used to treat cavities to help stop tooth decay. SDF can also be used to treat tooth sensitivity.
Riva Star is a Silver Diamine Fluoride (SDF) solution system used to immediately desensitise tooth pain.
This original SDF treatment delivers Minimal Intervention Dentistry that adopts the philosophy of integrating prevention, remineralisation and minimal intervention.
Riva Star Aqua (AgF) is the next generation water based silver fluoride solution that is also effective as an SDF solution, with additional patient benefits.
Similar to Riva Star (SDF), Riva Star Aqua (AgF) is also a non-invasive 2 step patented system used to desensitise tooth pain in a few drops. Riva Star Aqua is an aqueous silver fluoride solution without the Ammonia base, providing a low irritation and low odour formulation.
*Source : Silver Diamine Fluoride : A practical guide – Louis Mackenzie
Indications vary, so please consult the instructions for use in your country. These may include:
Yes.
The World Health Organization model list of essential medicines 2021 update includes SDF as an essential medicine.
The American Dental Association has released Evidence-based clinical practice guidelines on nonrestorative treatments for carious lesions. These guidelines include SDF recommendations for various clinical cases.
The American Academy of Paediatric Dentistry has also released, “Use of Silver diamine fluoride for Dental Caries Management in Children and Adolescents Including those with Special Health Care Needs.
http://www.aapd.org/media/policies_guidelines/g_sdf.pdf
UCSF Protocol for Caries Arrest Using Silver Diamine Fluoride: Rationale, Indications, and Consent.
Capsules
Bottles
Yes, it can. Riva Star and Riva Star Aqua will not discolour sound enamel or dentin. SDF & AgF can discolour demineralised tooth structure brown/black. Some of this discolouration may shadow a restoration and can create less than optimal aesthetic restorations.
It has been suggested that by applying a saturated solution of potassium iodide (KI) (Step 2 of Riva Star – green capsule / bottle) immediately after the application of silver fluoride, staining of the dentin carious lesion can be minimized while the caries arrest effect of silver fluoride is not affected. Iodide ions from the KI solution will react with the excess silver ions from the silver fluoride solution to form a precipitate of silver iodide.
The KI does not cancel the effect of silver fluoride, the silver fluoride acts immediately on the treatment site before the KI is applied. The function of KI is to remove any free silver ions beyond the affected site. Another important role of the KI is in the prevention of staining beyond the treatment zone such as transferring to aesthetic materials.
Desensitising indication is for use on sound tooth structure. Riva Star range may cause some discoloration if used on carious lesions.
Systematic reviews suggest that clinicians could expect between 50% and 70% arrest rates after two applications of silver fluoride in preschool or primary school-aged children, respectively (Seifo et al., 2019). Arrest rates with two applications is higher. With this evidence, the use of silver fluoride products has been recommended as a key technique in the nonrestorative management of carious lesions in primary teeth. (Duangthip et al, 2015; Slayton et al, 2018; Urquhart et al, 2019).
Source : Turton B, Horn R, Durward C. Caries arrest and lesion appearance using two different silver fluoride therapies on primary teeth with and without potassium iodide : 12-month results. Clin Exp Dent res 2020;1-11
Riva Star & Riva Star Aqua are not restorative materials and does not require light curing.
Please refer to the procedure recommendation for more information.
The use of potassium iodide (KI) can be used when Silver Diammine Fluoride (SDF & AgF) is used on a prepared tooth cavity during a restorative procedure in an attempt to limit silver oxides from shadowing through restorative materials. When restoring with composites it is recommended to first line cavity with Conventional GIC or use RMGIC bonding agent prior to placement, ensure that the cavity is washed out with copious amounts of water and follow the etching protocols. See the procedures recommendations below on Protocol 4 .
KI binds the silver portion of SDF forming a white precipitate of silver iodide. Repetitive, applications of KI are used to scrub, wash, rinse and repeat on cavity floors and walls to remove the free silver.
Yes, if Riva Star or Riva Star Aqua is used during a diagnostic appointment to arrest active disease, during the restorative visit the treated site can be evaluated for caries arrest providing you and the patient several options.
You could choose to:
Contact to skin may cause temporary skin discoloration. With discoloration, the effect is not immediate, rather it will be noticed within hours. The speed of discoloration is accelerated with light contact.
Patients should be protected with bibs and safety glasses as in any clinical procedure. If you believe you have touched the applicator to the skin of a patient, it is good to advise them of possible temporary discoloration, and to wash or wipe the surface with water.
Yes. Desensitising agents have been shown to be protective of the pulp when placed on crown preparations to reduce dentin permeability. Riva Star & Riva Star Aqua, as a tooth desensitiser, has been shown to be safe to the pulp when placed on exposed dentin. In addition, studies have shown desensitisation and efficacy in treating softened dentin before placing direct restorations. This provides the benefit of sealing tubules plus the antimicrobial benefits of both silver and fluoride.
Applying Riva Star Step 2 Potassium Iodide (KI) solution. immediately after the application of SDF or AgF, provides instant desensitization and hemps minimize staining of any carious lesions that may be present.
A clinical evaluation of diamine silver fluoride/potassium iodide as a dentine desensitising agent showed that at 2 years desensitising is still effective.
Source : Clinical evaluation of a diamine silver fluoride/potassium iodide as a dentine desensitizing agent: 2-year follow up. Craig G G – 2014.
Cool location
Store: 2-25°C (35-77°F)
Use: 20-25°C (68-77°F)
Refrigerate
Store: 2-8°C (35-45°F)
Use: 20-25°C (68-77°F)
Cool location
Store: 2-25°C (35-77°F)
Use: 20-25°C (68-77°F)
It is recommended not to repeat treatment on pregnant or lactating women.
Yes, it does.
Clothing: Soak in any fabric stain remover overnight and wash per normal.
Hard surfaces: Immediately apply household bleach (sodium hypochlorite) then wipe off with water. For stubborn stains, saturate a paper napkin with household bleach and place over affected area. Leave overnight and mop up with water.
The use of Riva Star range results in a reduced likelihood of black staining compared to that associated with the use of traditional SDF treatments. It is vital that the IFU is followed correctly to ensure application techniques are performed correctly to reduce the likelihood of black staining. For lesions that are covered / restored with a conventional Glass ionomer cement after treating with Riva Star, no staining should be visible if the IFU is followed correctly. Naturally arrested caries typically presents with a brown colour, this is also true for those arrested with Riva Star or Riva Star Aqua.
According to the research from the School of Dental Medicine of Tufts University in Observational Staining Properties of Silver Fluoride on Dental Materials (2009), intrinsic staining by silver fluoride on dental materials (GIC, RMGIC, TMC and Com) appeared to be reduced by addition of KI Step 2 of Riva Star capsules solution). This would prove useful to dentists hoping to use the benefits of silver diammine fluoride on surfaces adjacent to these materials, but who are worried about aesthetics. Although the orthodontic adhesive and composite samples did not show any discoloration, clinically the use of KI could provide protection against staining of the patient’s mucosa by the silver fluoride.
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