A female patient smiling and a dentist in the dental office

Silver Diamine Fluoride: What Is It?

As someone who cares about you and your family's oral hygiene, you're probably pretty familiar with what habits can help curb dental decay. You understand that regular preventive dental care and daily oral hygiene help keep teeth healthy. But you may be unfamiliar with silver diamine fluoride, a dental compound that's safe and easy to use for minor cavities.

Silver diamine fluoride (SDF) is an innovative material to stop tooth decay without using a drill or anesthesia. But what exactly is silver diamine fluoride, and why haven't you heard of it before? Let's go over its history, how it works, and the pros and cons of its use.

The Food and Drug Administration approved SDF for treating dentinal hypersensitivity in 2014. And in 2020, the American Dental Association recommended it as a non-restorative treatment for both permanent and primary teeth to arrest caries. Beyond its use in the U.S., it's been a popular treatment in other countries, especially Japan, for decades. It's both inexpensive and non-invasive, a great alternative to traditional dental decay treatment for many people! Children, nursing home residents, and people who have difficulty managing traditional dental treatments, for example, those with developmental disabilities or people who are extremely afraid of a drill, can all immensely benefit from SDF.

How Silver Diamine Fluoride Works

SDF is a safe material to use inside of your mouth. 35% SDF comprises a silver fluoride salt that, with added ammonia, 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. After SDF application, it permanently hardens the surface and stains the damaged area a dark gray or black color.

SDF does not affect healthy tooth surfaces, so it will not discolor teeth that are next to the tooth with decay. Working on both the crown and root surfaces, this unique solution not only stops tooth decay but provides residual protection against the growth of new bacteria.

Pros and Cons of Silver Diamine Fluoride

Like most treatments, SDF isn't a perfect miracle. Silver diamine fluoride has both pros and cons. Note that it's not a substitute for a more definitive restorative treatment. It's intended as a minimally invasive treatment intervention in pediatrics, the elderly, and those who cannot access and/or tolerate care. Some very positive aspects of SDF include the following:

  • Various settings use SDF, such as traditional dental offices, public health clinics, daycare centers, and nursing homes. It's also a good option for people who have difficulty accessing or receiving conventional care.
  • As an inexpensive and small treatment, SDF is affordable to most people and dental practices. No expensive tools or heavy equipment are needed. All a facility needs is a small bottle of this solution to take advantage of its full benefits! 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! 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.
  • SDF is safe and effective for many demographics but is extremely useful for treating tooth decay in baby teeth as a minimally invasive procedure. This helps 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 have cavities in areas that are difficult to view (so staining won't be noticeable). What's more, an article published in the Journal of the California Dental Association notes that SDF is second only to sealants as the most effective primary prevention for cavities, and sealants are 10 times more expensive than SDF and require monitoring.

SDF has few drawbacks, and you and your dental professional can find ways to prepare for them. For example, the compound can cause a poor taste in your mouth or stain the surrounding gum tissue if it makes contact. However, dental professionals take extra care to decrease the chances of spilling SDF, and they pay close attention to isolating the teeth needing treatment. You should also let your dental professional know if you are or your child is allergic to silver or silver compounds before getting this treatment.

For cosmetic reasons, because SDF does darken the decayed area of a tooth, you may be hesitant to use it. We don't blame you for wanting to avoid permanent darkened areas of you or your child's smile! SDF can also stain other surfaces it touches, such as skin, clothing, toys, and countertops. While you could view the dark staining of a decayed area as a drawback of SDF, it may be a side effect you're willing to accept rather than undergoing 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, as noted below.

Further Cavity Prevention

The most effective way to prevent future cavities is to continue a rigorous oral care routine. 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! Avoid eating sugary foods and drinking sugary 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 will be essential in mitigating your chances of experiencing 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.

While it's not every day you learn about an intriguing "painted on" solution that treats and stops the growth of cavities, we hope you take this knowledge with you to your next dental visit. You should feel equipped with an understanding of both the pros and cons of SDF when you attend your next dental appointment to discuss your and your family's potential treatments for tooth decay.

This article is intended to promote understanding of and knowledge about general oral health topics. It is not intended to be a substitute for professional advice, diagnosis or treatment. Always seek the advice of your dentist or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.

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