Can Silver Diamine Fluoride Stop Tooth Decay?

So, your kid has a cavity. You know you need to do something – if left untreated, cavities can lead to serious infections – but, whether due to your child’s age or special needs or dental anxiety, your kid is unable to tolerate a filling. You have considered pediatric dental sedation, but maybe your child is not a good candidate for sedation dentistry, or maybe you just want to know whether there are any reasonable alternatives. What should you do? Talk to a pediatric dentist about whether silver diamine fluoride is a good option for treating your child’s cavity.

What Is Silver Diamine Fluoride?

Silver diammine fluoride – more commonly spelled “silver diamine fluoride” or simply referred to as “SDF” (and occasionally miswritten as “silver diamond fluoride”) – is a liquid solution that is applied directly onto a child’s cavities to inhibit the growth of cavity-causing bacteria and prevent further decay.

Recall that cavities form in kids’ teeth as a result of harmful cariogenic bacteria. These bacteria consume sugars inside the child’s mouth and then produce an acidic waste product that damages teeth.

Exactly how silver diamine fluoride arrests cavities is a subject of ongoing research, but, as its name suggests, SDF contains both silver, which has antibacterial properties, and fluoride, which is known to strengthen teeth and protect them against decay. Researchers believe that when silver and fluorides are combined, they have the ability to simultaneously halt the progression of existing cavities and prevent the development of new cavities.

Does Silver Diamine Fluoride Stop Tooth Decay in Children?

Often, yes. According to the American Academy of Pediatric Dentistry, a single application of silver diamine fluoride will arrest between 47% and 90% of cavities, with the level of effectiveness depending on the size and location of the cavity.

The U.S. Food and Drug Administration has designated SDF as a “breakthrough therapy,” a designation reserved for treatments that “are intended to treat a serious condition” and that have demonstrated a “substantial improvement over available therapy” options in preliminary clinical evidence.

However, silver diamine fluoride may only provide a temporary fix. In one study, researchers looked at how many cavities had been arrested as a result of a single application of SDF after six months and again after 24 months. They found that, of the cavities that had been successfully arrested at the six-month mark, 50% had reverted back to active cavities by the 24-month mark.

What does this mean for your child? It means that silver diamine fluoride can be an excellent option to use as part of an ongoing plan for cavity management, but that SDF is not a substitute for traditional drilling and filling.

If your child likely won’t be able to tolerate drilling at present due to young age, SDF could be a fantastic tool for buying some extra time. If your child has special health care needs that make it difficult to understand and cooperate with restorative treatments and has a cavity in a baby tooth that will likely fall out on its own in a year, SDF treatment might be the perfect way to avoid the need for a drill while protecting your child against a spreading infection. In contrast, if your child has significant tooth decay that is already causing pain and you’re hoping that SDF will allow your child to avoid more invasive treatments indefinitely, we’re sorry to say that a conversation with your child’s pediatric dentist is going to leave you disappointed.

How Does a Pediatric Dentist Administer Silver Diamine Fluoride?

Silver diamine fluoride is applied topically in a quick, painless, and non-invasive procedure. Your child’s pediatric dentist will

• cover the surrounding gums with cotton or petroleum jelly (to help prevent staining and irritation of the gums),
• dry the affected tooth,
• dab silver diamine fluoride over the decayed tooth surface or apply it to the side of a tooth using a cotton-like floss, and
• use compressed air to dry the SDF.

Note that the application of SDF does nothing to restore the original shape and function of the tooth. Furthermore, a rough, decayed tooth surface can easily trap food particles, inviting future tooth decay. Consequently, in some cases a white filling or pediatric dental crown may be required after treatment with SDF in order to restore the shape and functionality of a tooth and/or smooth out a rough surface. Unlike the drilling of a cavity, these procedures are well tolerated by most children.

Is Silver Diamine Fluoride Safe for Children?

The use of silver diamine fluoride for treating cavities in kids is considered very safe. The U.S. Food and Drug Administration approved SDF as a device for treating tooth hypersensitivity in 2014, and in 2016 the FDA also granted silver diamine fluoride its “breakthrough therapy designation” for use in arresting cavities.

Importantly, although its introduction to the U.S. market is relatively recent, SDF has been used internationally for much longer. In fact, dentists in Japan have been using it to arrest cavities for more than 40 years.

In all this time, no severe reactions to silver diamine fluoride have been reported.

Does Silver Diamine Fluoride Cause Staining on Children’s Teeth?

Yes. One of the primary drawbacks of treating cavities with SDF is that it results in permanent black staining on the decayed portion of the child’s tooth. This staining is significant and generally cannot be completely masked by any white filling material that is subsequently applied over the cavity. As a result, SDF is most often used to treat cavities on children’s back teeth (molars), where staining is less noticeable.

If SDF touches a child’s skin or gums during the procedure, it will temporarily stain the skin or gums, as well. However, staining on the skin and gums typically wears off in a matter of days.

Is Silver Diamine Fluoride a Good Option for Treating My Child’s Cavities?

Although silver diamine fluoride may be an excellent option for temporarily treating tooth decay in many children, it is not the right choice for everyone. For example, patients with ulcerative gingivitis, stomatitis or a known sensitivity to silver should not receive SDF treatments. Additionally, SDF may not be an appropriate treatment option for cavities that are very deep.

If you are interested in SDF, discuss with your child’s pediatric dentist whether it is a suitable treatment option for your child.

Silver Diamine Fluoride Treatments for Kids in Hurst, TX

If you are interested in learning more about silver diamine fluoride and whether it could be a valuable component of your child’s cavity management plan, contact Hurst Pediatric Dentistry at (817) 510-6400 or request an appointment online.

Dr. Lin is a board-certified pediatric dentist and the owner of Hurst Pediatric Dentistry. He provides preventative and restorative dental services, including silver diamine fluoride treatments, to pediatric patients from Hurst, Euless, Bedford, North Richland Hills, Keller, Colleyville, Southlake, Arlington, Irving, and the surrounding areas.

This article is intended to provide general information about oral health topics. It should not be used to diagnose or treat any medical condition or as a substitute for the advice of a healthcare professional who is fully aware of and familiar with the specifics of your case. Always seek the advice of your dentist or other qualified healthcare provider with regard to any questions you may have relating to a medical condition or treatment.