Drill-Free Cavity Procedure Includes Alternative to Sedation

This could reduce risks involved when children undergo sedation


Sedation and anaesthesia as a means to calm young patients before dental procedures carries a large risk and, in the worst cases, it can lead to the death of a child. As an alternative to having to sedate a patient, some dentists are turning to a painless and less expensive alternative treatment for cavities.

The product called Silver Diamine Fluoride was approved by the Food and Drug Administration in 2014 but has been used in other countries for decades. Cavities are traditionally remedied by drilling out the area of decay and filing it in. The alternative treatment requires no drilling and works by just painting a few drops of liquid onto the area of decay. Since it is painless, odourless and relatively quick, there is no need for an injection of a local anaesthetic like Novocain or for an oral sedative to be administered before the procedure begins. The treatment has to be re-applied every six months, which can happen during a patient’s routine cleaning appointments. The downside is that the liquid turns the area of the tooth where it was applied a dark brown colour within a short period of time after application. But for children who are having it applied on baby teeth that will eventually fall out, it provides a safer alternative to having to drill a cavity and sedate the child.

“Sedation carries a lot of risk.  With this product, there is no risk,” said Dr. Ron Hickerson, who uses the product on both adult and child patients.

The risk of sedating young patients, particularly with oral cocktails is one that malpractice attorneys see play out in civil lawsuits and dental board orders.

“They are strapping these kids down and sedating them, and that’s where you run into trouble,” said Greg Myers, a former dentist turned attorney.

Myers said in his 20 years practicing law, he’s seen a handful of cases where a child has died after being administered an oral sedative cocktail. An example of this recently happened in the Dallas area. The Texas Board of Dental Examiners disciplined a dentist in March of 2014 who gave a sedative cocktail to a four-year-old. That child died after an unexpected reaction to the drugs.

“Sedation is a continuum that goes from minimal to deep and you never can predict how a child in particular is going to react to such medication,” said Myers.

Dr. Hickerson says it’s just another tool he has in his tool belt. “It is a not a panacea cure to caries (decay) or cavities,” he said.

The procedure is far less expensive than having a cavity filled. Dr. Hickerson estimated the treatment only costs about $20. News 6 called around to local dentists to find out if the procedure is being used in the area, and was told it’s not being widely offered at the moment because the product is so new in the US, but if more patients started asking about it, more dentists may consider offering the option.