Silver Diamine Fluoride (SDF) Aftercare

All patients who receive SDF treatment in the primary care setting should leave the visit with the following, whenever possible in a language they understand:

• Written aftercare instructions for families that include the necessary information for fluoride varnish, if applied.  (Adapt this template for your patients!)
• Handout: Frequently Asked Questions for Families
• Oral health anticipatory guidance and goal setting using a self-management goal sheet (also available in Spanish).
• Referral to a dental professional, assistance to establish a dental home and/or instructionsto follow up with existing dental professional.

Schedule a visit in 3 months to evaluate disease progression. (Also see Disease Progression, Reapplication and Confirming Arrest) If decay has progressed or new caries are present, consider reapplication of SDF followed by fluoride varnish, per AAP recommendations for patients at high risk for severe caries. Schedule another visit 6 months from initial SDF application for reapplication if patient has not been to or received care in a dental home.

Aftercare Instructions to Share with Families

Modify the steps below for use in your practice and send printed copies home with patients:

• If the patient received SDF and fluoride varnish, they should not eat or drink for 30 minutes after treatment. For SDF alone, there is no restriction.
• Explain that any soreness of gums or metallic taste in the mouth is normal and should resolve by the next day. Staining on gums or skin will disappear in 1-2 weeks. Black staining on the treated tooth is permanent.
• Reinforce good oral health habits at home.
• Do everything possible to refer, connect, and track treatment in a dental home.