Application of Silver Diamine Fluoride (SDF) by Dental Hygienists

This infographic describes specific requirements in state laws and regulation that impact the ability of dental hygienists to apply silver diamine fluoride (SDF). SDF is a topical medicament that can be used to treat dental caries across the age spectrum.1 Research supports the use of SDF in pediatric dentistry and in the elderly population as a simple, inexpensive and effective way of preventing dental caries initiation and progression.2,3

State dental boards and regulators have recognized SDF in various ways, impacting the ability of dental hygienists (DHs) to apply it. Many have directly addressed the topic in regulations or board opinions. Some indicate that SDF is a fluoride, a desensitizing agent, etc. falling under those DH scope of practice permissions and limitations, while others have remained silent on SDF. A recent US study of SDF safety was completed by Expanded Practice Dental Hygienists providing services in Head Start programs in Oregon.4

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NORTHEAST

TEST, test, test

Lowest Level of Supervision Under Which a DH can Apply SDF
D Direct
I Indirect
G General
P Public Health/Collaborative
Scope of Practice for DHs May Allow SDF Under Permission for Application of:
A Antimicrobial/Anticariogenic Agents F Topical Fluoride/Preventative Agents
M Medicament DA Desensitizing Agent DD Delegable Duty
State Medicaid Has Frequency Limitations on Payment for Fluoride or SDF
SDF Clearly Within Scope of Practice (Statute, Regulation, or Board Opinion)
Dental Board Recommendations or Requirements for Specific Education for a DH to Apply SDF Under All or Specific Conditions
Age Limitation in Medicaid Guidance for Payment of Fluoride or SDF Applications
Children Only
Children & Some or All Adults
State Medicaid Program Covers CDT 1354 (Interim Caries arresting Medicament Application)
Yes
No
Pilot Program Only
Clear Filters

References: 1. Horst JA, Ellenikiotis H, Milgrom PM. USCF Protocol for caries arrest using silver diamine fluoride: rationale, indications, and consent. J Calif Dent Assoc. 2016;44(1):16-28. 2. Crystal YO, Marghalani AA, Ureles SD, et al. Use of silver diamine fluoride for dental caries management in children and adolescents, including those with special health care needs. Pediatr Dent. 2017;39(5):E135-E145. 3. Oliveira BH, Cunha-Cruz J, Rajendra A, Niederman R. Controlling dental caries in exposed root surfaces with silver diamine fluoride: a systematic review with meta-analysis. J Am Dent Assoc. 2018;149(8):671-679. 4. Milgroma P, Horst JA, Ludwig S, et al. Topical silver diamine fluoride for dental caries arrest in preschool children: a randomized controlled trial and microbiological analysis of caries associated microbes and resistance gene expression. J Dent. 2018;68:72-78.

This graphic is for informational purposes only. State silver diamine fluoride (SDF) requirements are subject to change and can impact the ability of dental hygienists in that state to apply SDF. Contact the applicable dental board or an attorney for specific legal advice.

This graphic was developed by the Oral Health Workforce Research Center (OHWRC), Center for Health Workforce Studies at the University at Albany’s School of Public Health. This work is supported by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services (HHS) as part of an award totaling $449,943 with 0% financed with non-governmental sources. The information presented in this infographic is based on research conducted by the authors and does not necessarily represent the official views of, nor an endorsement, by, HRSA, HHS, or the US government. For more information, please visit HRSA.gov.

This infographic is the property of the OHWRC and may not be modified in any way. It may be shared publicly in its current form in its entirety, including the attribution stated above.

Last Updated September 2020.