SMART Treatment

What is SMART Treatment?

It is a minmally invasive technique where Silver Diamine Fluoride is applied to a tooth with a cavity to arrest and remineralize the cavity and then the tooth is restored 2-4 weeks later with a tooth colored glass ionomer filling.

Video on SMART Treatment: https://www.youtube.com/watch?v=XT3doMnS050 (Shown with permission by Dr. Jeanette MacLean)

Indications for SMART Treatment:

In young or fearful patients (such as children and special needs patients), this treatment can help avoid shots, drills, sedation and/or general anesthesia for patients with cavities. This minimally invasive treatment is standard of care in the United Kingdom and other countries around the world.

Contraindications for SMART Treatment: 

This technique cannot be used on teeth that are painful or have infection.

Technique:

• Apply SDF at the exam
• Patient returns in 2-4 weeks for a reevaluation and possible restoration
• Minimal preparation of the tooth is done as needed
• Polyacrylic acid is applied for 10 seconds and then rinsed and lightly dried
• The tooth is isolated and glass ionomer is placed in the cavity and allowed to set for a few minutes 

Pros:
• Minimally invasive (no shots)
• Aesthetic
• Durable
• Biocompatible (mimics the tooth)
• Antimicrobial effect

• Glass ionomer absorbs and releases fluoride

Cons:
• Glass ionomer alone may not mask the entire SDF black scar
• Large cavities may require a full coverage restoration (Hall Crown Treatment)
• SMART is a treatment for cavities but not a cure

A proper diet and good oral hygiene (including daily flossing) are critical for long term success

SMART Treatment Handout