Silver Diamine Fluoride: What Is It?

Silver diamine fluoride (SDF) is an innovative material that can be used to stop tooth decay without using a drill or anesthesia. The Food and Drug Administration approved SDF for treating dentinal hypersensitivity, or sensitive teeth, in 2014. And in 2020, the American Dental Association recommended it as a non-restorative treatment for both permanent (adult) and primary (baby) teeth to stop the progress of tooth decay, also known as dental caries.

Beyond its use in the U.S., silver diamine fluoride has been a popular treatment in other countries, especially Japan, for decades. It's both inexpensive and non-invasive, making it a great alternative to traditional dental decay treatment for many people! Children, nursing home residents, and people who have difficulty managing traditional dental treatments, (e.g. those with developmental disabilities or dental phobia) in particular can benefit immensely from SDF.

35% SDF comprises a silver fluoride salt with added ammonia, and is soluble in water. Once your dental professional locates the demineralized or decayed surface of your tooth, they will paint a minimal amount of liquid SDF onto the affected area. Working on both the crown and root surfaces, the silver content of the material will kill the bacteria responsible for tooth decay, stop it from progressing, and provide lasting protection against the growth of new decay-causing bacteria. Meanwhile, the fluoride content of SDF will remineralize the tooth to help restore its strength.

Like most treatments, SDF has both pros and cons. Some very positive aspects of SDF include the following:

• Accessibility. Because SDF is easy to apply, it can be used in various settings outside of the dental office if needed. For example, it can be performed on-site in nursing homes, public health clinics, and daycare centers, making it accessible to high-risk populations who might otherwise not be able to access it.
• Affordability. As an inexpensive and minor treatment that doesn’t require any specialist tools or equipment, SDF is affordable to most people and dental practices. According to Health Affairs, while a traditional restorative treatment for tooth decay can cost hundreds of dollars, the amount of SDF needed for one person's treatment is only ninety-one cents! An article published in the Journal of the California Dental Association (JCDA) notes that sealants would be 10 times the cost of SDF and would require additional monitoring. Its affordability makes it an excellent option for people who don't have dental insurance or the ability to pay out-of-pocket for an expensive treatment.
• Effectiveness. SDF is safe and effective for many demographics and, as noted in the JCDA article, is second only to sealants as the most effective primary prevention for cavities. SDF is especially useful for treating tooth decay in baby teeth, helping to save the baby tooth as a placeholder for the child's developing permanent teeth. A dental professional may also decide SDF is a good option for you if you have cavities throughout your mouth or in areas that are difficult to view (so staining won't be noticeable). 

SDF has a few drawbacks, too, such as:

• Limited use. While SDF is an excellent minimally invasive treatment for children and those who cannot access or tolerate traditional care, it is not a substitute for more advanced restorations. For example, it wouldn’t be used in place of a restoration for a severely decayed tooth. 
• Taste. SDF can leave a poor taste in your mouth that may not be tolerable to some people, especially children. Your dental professional will address this by carefully isolating the tooth needing treatment, and taking extra care to avoid spilling SDF.
• Allergies. You should let your dental professional know if you are or your child is allergic to silver or silver compounds before getting this treatment.
• Staining. SDF darkens the decayed area of a tooth and can also stain the gums, so you may be hesitant to use it, especially if you’re having a visible tooth treated. We don't blame you for wanting to avoid this! However, depending on your treatment needs, this may be a side effect you're willing to accept if it means avoiding more invasive dental care.

The American Academy of Pediatric Dentistry's Chairside Guide: Silver Diamine Fluoride in the Management of Dental Caries Lesions notes the reapplication of SDF and the addition of a fluoride varnish may be necessary for successful treatment. It states that SDF can be applied as needed at regularly scheduled dental check-up appointments. Your child's dental professional will decide to reapply SDF based on the hardness and color of the affected area and if there's any evidence the decay or lesion has progressed. A biannual reapplication of SDF has also shown to be successful versus a one-time application.

To prevent additional caries, a dental professional may also apply a five percent sodium fluoride varnish to your child's entire smile after SDF treatment. As noted by the American Academy of Pediatrics, your child's dental professional can apply fluoride varnish to their teeth two to four times per year. While fluoride varnish can help mitigate the chances of your child getting cavities, as well as slow them down, it's not a standalone preventive measure. Your child will still need a top-notch oral care routine, to attend regularly scheduled professional dental appointments, and eat a healthy diet.

Use fluoride toothpaste when brushing your teeth twice a day and clean between your teeth once a day with floss, a water flosser, or another interdental tool. 

Along with a strong oral care routine, keeping a healthy diet is essential to not only your body but your mouth too! Limit sugary foods and beverages, as the bacteria in your mouth produce acids that weaken the tooth structure when they feed on these sugars.

We also recommend you stay on top of your scheduled dental appointments, as your dental professional can help you avoid severe tooth decay or infection. They can spot early issues, reapply SDF when they see fit, instruct you on dental care best practices, and inform you about dental treatments that can fit your family's unique needs.

It's not every day you learn about an intriguing "painted on" solution that treats and stops the growth of cavities! We hope this knowledge has equipped you with an understanding of both the pros and cons of SDF when you attend your next dental appointment, so that you can feel confident discussing the best tooth decay treatment and prevention options for you and your family.

What is silver diamine fluoride (SDF)?

Silver diamine fluoride is a liquid made from silver and fluoride, mixed with ammonia. It is painted onto decayed or demineralized teeth in order to stop tooth decay and prevent it from progressing further. 

Is silver diamine fluoride suitable for children?

Yes, SDF is safe and effective in children. However, it is not suitable for children with allergies or sensitivities to silver or silver compounds. Be sure to let your dentist know if this applies to your child so that they can find a safe alternative treatment. 

How is silver diamine fluoride applied?

Your dentist will simply paint the liquid onto the decayed or demineralized area of the tooth. 

What are the benefits of silver diamine fluoride for kids?

SDF is an effective, affordable and minimally invasive treatment for tooth decay in children. It can be applied painlessly with no needles, making it a perfect treatment for children who might struggle with more invasive procedures. 

Does silver diamine fluoride stain teeth?

Yes, unfortunately silver diamine fluoride does cause dark staining on the teeth, so it may not be the ideal choice if the tooth to be treated is a visible front tooth.

Oral Care Center articles are reviewed by an oral health medical professional. This information is for educational purposes only. This content is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your dentist, physician or other qualified healthcare provider.