Silver Diamine Fluoride

Caries are when teeth begin to decay and get soft. As decay gets deeper, it can lead to tooth aches and broken teeth. Many times getting a filling as a child can be a traumatic experience when the child needs to be numbed and then the cavity needs to be cleaned out and filled. For some children that may not be able to tolerate that procedure, other options are needed.

Silver Diamine Fluoride, or SDF, is a solution that is painted on to the decayed portion of a tooth. It kills the bacteria causing the cavity and actually can cause the soft portion to get hard again and “arrest” the caries. This is a good option for children or elderly patients that may not be able to tolerate the procedure of restoring a tooth in the traditional way.

One of the downsides is obviously the dark black staining. The black means that the SDF has worked, but it can be alarming to many parents and patients. Sometimes on posterior teeth this may be a more appropriate option and then anterior teeth may still need to be restored in the traditional sense. Other times it may be appropriate to apply this, especially to baby teeth with the understanding that it can stop the caries from progressing until the child loses the tooth naturally.

How is SDF Used?

Silver Diamine Fluoride (SDF)

38% Silver Diamine Fluoride is an FDA-approved

liquid antibiotic that helps with:

  • Active Tooth Decay
  • Tooth Sensitivity

It does not require numbing or drilling.

Why do we use this medicine?

SDF is a liquid antibiotic that can be applied to teeth with certain kinds of cavities or sensitivity. SDF kills the bacteria causing the cavity and strengthens that part of the tooth. It makes the cavity hard like concrete, so the cavity does not get bigger and the tooth becomes less sensitive. Using SDF “buys time” to fix the cavities – especially if your child is young or anxious and cannot cooperate for fillings or crowns.

How do we do the treatment?

  1. The dentist will dry the affected tooth or teeth.
  2. The dentist will paint a small drop of SDF on the tooth with a small brush.
  3. The dentist will allow the SDF to dry for up to one minute.
  4. The dentist will rinse the area or apply fluoride varnish or foam on top of the SDF.
  5. The dentist will re-evaluate the tooth in about a month and then may re-apply this medicine to the teeth in the dental office every 6-12 months after that.

Things you should know:

  • This medicine will stain the cavity dark black. The healthy parts of the tooth will not be stained. The black color indicates the SDF is working. Stained areas can later be covered with fillings or crowns. Tooth-colored fillings that are exposed to SDF may change color. These may be able to polish off.
  • This medicine will not put back tooth structure that has been lost because of the cavity. Thus, if your child has a hole in the tooth, we may still recommend a filling or crown (cap) for the tooth.
  • Not all tooth decay can be treated with SDF, and tooth decay treated with SDF is not guaranteed to stop. It is possible that multiple applications of SDF may be required. Decay that continues to progress will require further treatment with SDF and/or fillings, crowns, root canal treatment or extraction.
  • Tell other doctors or dentists treating your child that SDF has been used. They may wonder why the cavities are stained black.
  • We do not use SDF in patients with a silver allergy or with painful sores or cuts anywhere in the mouth.
  • If SDF accidentally gets on the skin, tongue, gums, cheek or lip, you will see a stain that causes no harm, like a temporary tattoo. This stain should disappear on its own within one to three weeks.
  • SDF may cause a temporary metallic taste. This is why we rinse or apply a fluoride varnish afterwards.
  • Additional side effects are possible. Please let us know if you have concerns.

Alternatives to SDF Include:

  • No treatment, which may lead to progression of tooth decay.
  • Alternative treatments depend on location and extent of tooth decay and may include fluoride varnish, fillings/crowns, extractions, or referral for advanced treatment.

If you have questions about if SDF is right for you or your loved one, please give us a call to set up an appointment today!

a) Rampant caries across multiple anterior baby teeth.

b) After application of SDF, the black stain sticks to the decayed parts of the teeth.

c) A cavity that had formed on a pediatric molar.

d) After application of SDF, the cavity will remain, but will be hard and should not get bigger.

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If you have any questions, feel free to reach out to us.




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