Colloidal Silver,Silver Diamine Flouride or Green Tea?

I must admit that Zarah’s tooth decay, weighs almost the same as Nanay’s breast cancer in my worry list. Today, it the local dentist replied to my email about my request for a less invasive treatment plan for Zarah.

What if there were a treatment what would arrest caries and prevent further dental infection without traditional drilling and filling?

Well, the local dentist did not give me the answer, without an effort. I literally have to pull the information out of him. Finally, he sent me a powerpoint deck, complete with photos of a child who received Silver Diamine Flouride as a treatment to halt the decay. I was expecting laser or ozone treatment though. Since, he was good enough to entertain my concerns, I thanked him for his time and effort and also tried to be objective enough to see the merits of SDF or silver diamine flouride the way he sees it.

First, I have to lay down all my worries about flouride.
Here is the conventional view:
1.) It is clinically recognised by the AMerical Dental Association (ADA) as a good alternative to drilling, extraction and pulpotmy.

2.) It contains the highest level of flouride. see table below.

Refer to ADA’s view here:

3.) It is touted by some dentists as the new silver bullet that can halt tooth decay. The only caveat is that it leaves a black stain on the teeth (which is OK for me– since Zarah’s decayed teeth are baby teeth so it will be all replaced in the next few years)

For a layman’s version of the clinical study read here
For the more scientific version of the clinical study read here

4.) A few things that caught my attention:

Arresting Caries Treatment (ACT) has been proposed to manage untreated dental caries in children. This prospective randomized clinical trial investigated the caries-arresting effectiveness of a single spot application of: (1) 38% silver diamine fluoride (SDF) with tannic acid as a reducing agent; (2) 38% SDF alone; (3) 12% SDF alone; and (4) no SDF application in primary teeth of 976 Nepalese schoolchildren.

Tannic acid (tea) as a reducing agent? I was totally confused. What is it there to reduce? Apparently tea contains high levels of flouride as well. Though not sure if they are imploring the use of tea/tannic acid for its flouride content or something else. What is interesting is that SDF (Silver Diamine Flouride with tannic acid as a reducing agent worked better than SDF alone. It was also interesting that this study is conducted in a 3rd world country (Nepal). Why is it not done in a more developed country like Singapore? Reading further, I found the answer here:

This is the first clinical trial to evaluate the effectiveness of a one-time application of SDF with 2 different concentrations of SDF and the effect of a reducing agent. The use of a reducing agent such as 10% stannous fluoride (Craig et al., 1981) has been advocated to accelerate the deposition of silver phosphate, which results in the instantaneous black discoloration of the area. This indicates that a successful reaction has occurred and minimizes the risk of SDF being washed away or contaminated by saliva. However, stannous fluoride is difficult to obtain in low-income countries, and tannic acid from boiled tea has been suggested as an inexpensive substitute.

Apparently they also tried to test a diluted version of SDF. They considered adding stannous flouride to SDF to dilute it. But since Nepal is a 3rd world country, stannous flouride is difficult to obtain, so they boild tea to get tannic acid and used the boiled tea to dilute SDF. The study showed that the diluted SDF (with boiled tea/tannic acid), works the same way as the undiluted version of SDF. The way they wrote this article though seems to under estimate the efficacy of a natural substance (tea/tannic acid), by saying tea/tannic acid did not provide added benefits. Does it mean they do not want us to think that drinking green tea or gargling with tea– will also deliver the much needed flouride to our teeth? If it is true that flouride helps to halt tooth decay, then why do they not educate people about flouride in tea?

Ahhh just thinking out loud.
Now the alternative or non-conventional view.
1. Most alternative sites state that Flouride is bad when ingested or swallowed or it does not even help our teeth at all.
2. However, an alternative site, that conducts research and studies, decided to be in the middle, it seems they are saying Flouride seems to help in halting tooth decay, but it must be applied directly to the teeth, not swallowed or ingested internally.
Read more here
3. Some forums/internet sites claim that Colloidal silver (natural) works the same way as silver diamine flouride or other forms of liquid silver
Long history

The first medicinal use for silver dates to 1,000 B.C., when it was used for storing potable water. The antimicrobial use of silver compounds has been demonstrated over the past century for preventing and treating ocular, surgical, and dental infections. In addition to caries prevention, silver’s bacteria-killing effectiveness is used in a range of applications, including acute burn coverings, catheter linings, water purification, and hospital gowns.

Read more here

So silver and flouride actually exist in natural forms (Colloidal silver and tannic acid in green tea), why then do we have to use the synthetic versions of it?

Do I have to make another compromise? The dental treatment plan from this local dentist includes sealing the cavities with glass ionomer, after applying SDF. I like the idea of sealing with glass ionomer (instead of resin), but am particurlaly worried about the high-levels of flouride.

Should I be worried about the flouride? Can I live with the consequences of risking Zarah’s overall health? Does using (swishing/brushing with) Colloidal Silver and Green Tea mid- to long-term provide the same effect as Silver Diamine Flouride? If yes, will the dentist support this approach? If he agrees, how can we be sure that it is safe to cover the cavities with glass ionomer?

Will keep praying for the right decision for Zarah.