Question: I am really interested in adopting silver diamine fluoride into my hygiene practice. I have a lot of patients whom I feel would benefit from this treatment. I have an elderly patient in her 90s who has an old, defective crown margin that is starting to break down. I also have a few pediatric patients who are quite squirmy in the chair with initial lesions. I have been applying a fluoride varnish for these patients and discussing home care and diet; however, I know that I could be doing more by utilizing silver diamine fluoride since these lesions are advancing.
My question is, why is my doctor seemingly resistant to this? I’ve brought it up a few times but feel like the topic is being pushed to the wayside. I wouldn’t say my doctor is against new products or technology, since he is currently in the market for a new cone beam x-ray machine. How do I make the SDF topic—and the hygiene department altogether—top of mind for him, and something he wants to invest in?
Answer from Sarah Crow, RDH: This is such an important and incredibly common question right now. I don’t believe this is only about SDF, but possibly a bigger overarching topic. I do believe this is a reflection of how dentistry has historically prioritized treatment-driven care over prevention-driven care.
Here’s what I mean.
Your doctor is actively investing in a cone beam system, which tells us something important: he values technology that supports diagnosis, treatment planning, and procedural excellence. Those investments are not only tangible and highly visible, but they are also traditionally tied to revenue generation.
SDF, on the other hand, lives in a different lane. It’s preventive and minimally invasive. It’s often perceived as less urgent, because it doesn’t fit the traditional restorative model. But that perception is exactly where your opportunity lies.
What you’re really advocating for is a shift in philosophy from “drill and fill” to medical management of caries. Organizations such as the American Dental Association and the American Academy of Pediatric Dentistry have both recognized SDF as an evidence-based option for arresting carious lesions. This is mainstream, highly studied, and supported science. The challenge is translating that into something that resonates with your doctor specifically. Instead of continuing to just “bring it up,” try repositioning the conversation like this:
Speak in outcomes, not products
Rather than leading with “I want to use SDF,” lead your discussion with specific patient cases like the 90-year-old with the failing crown margin or the pediatric patients who cannot tolerate restorative care. Frame it like this: “I’m seeing disease progression in patients where traditional treatment isn’t ideal. I’d like to implement a protocol to arrest these lesions noninvasively.” This shifts the focus of your request.
Connect it to practice growth and efficiency
SDF isn’t just good for patients; it’s good for the business. It can help reduce emergency visits, build trust with high-anxiety patients and parents, create a pathway for phased treatment planning, and differentiate your practice as prevention focused while increasing hygiene production. If your doctor is investing in advanced imaging, he likely values staying competitive and standing out among his peers. Position SDF as part of that same identity.
Make it easy for your dentist to say yes
Doctors are busy. The more friction involved, the more likely a new idea gets shelved. Come prepared with a simple implementation plan. You may want to provide treatment indications and case selection criteria, consent forms, suggested fees and coding, and even a short team training outline. When you present a fully formed solution, you help take an idea to an implementation strategy.
Demonstrate your impact
Now, let’s address something bigger because in my opinion, it’s really at the heart of your question. You also asked how to make the hygiene department “top of mind.” The truth is, that doesn’t happen by asking for attention; it happens by demonstrating your impact.
When hygienists begin tracking outcomes such as caries risk, arrest rates, patient satisfaction, case acceptance, etc., those metrics tell a powerful story. They elevate hygiene from a “loss leader” to a preventive and diagnostic engine within the practice. When you are armed with that data, that’s where your voice becomes impossible to ignore.
I really admire the fact that you are already thinking at a higher level. You are clearly assessing risk, recognizing disease progression, and looking for better solutions. That’s exactly where our profession is heading. The next step is bringing your doctor along not by pushing harder, but by aligning your vision with what matters to him: excellent care, efficiency, and sustainable growth. SDF is not just a material. I believe it is a gateway to a more modern model of preventive care.
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Editor’s note: This article first appeared in RDH eVillage newsletter, a publication of the Endeavor Business Media Dental Group. Read more articles and subscribe.
