Silver Diamine Fluoride (SDF)

Silver Diamine Fluoride (SDF) is an antimicrobial medicament that helps to slow down or stop cavities that are forming. It kills cavity bugs, and makes it harder for new bugs to grow.

Who should use SDF?

SDF is safe for toddlers and children. It is used as a holdover medication to delay treatment until the child is old enough to receive dental treatment without being scary.  SDF is used for:

-Very young children with shallow cavities that are visible in the mouth – SDF will help to stop the cavity from progressing, and delay the need for invasive treatment.

-Children of all ages that have pit/fissure cavities located on the chewing surfaces of the molars

-Front teeth that have deep cavities, but that might fall out in the next 2 years

-Cavities in between the teeth (interproximal cavities)

SDF is NOT for:

-Cavities that are very deep – SDF cannot rebuild tooth structure needed for function- it can only slow down/stop the progression of cavities.

-Teeth that need to be treated with crowns, baby root canals, or extractions

How is it applied?

SDF is applied twice- at least 1 week apart - on teeth that have cavities.   Once the child is comfortable, the teeth are dried with a gauze or air and isolation is maintained.  SDF is applied by using a small paintbrush dabbed in the liquid. We will scrub/brush your child’s tooth for up to two minutes to make sure that the liquid is able to penetrate as deeply into the cavity as possible. In more cooperative kids, we will first drill out as much of the cavity as your child will allow with no anesthetic or nitrous oxide. This allows for deeper penetration of the SDF.

Is it safe for my child? Does it hurt?

SDF has been consistently used in Europe and Asia for over 80 years. It is generally considered safe for use in toddlers and children. It is NOT for use in children who have a silver allergy. Application is done with a plastic paintbrush that doesn’t hurt, and is applied twice within a short period of time.  Subsequent applications can occur.  Our technique allows for a 500 fold safety margin for application, making it one of the easiest and safest ways to treat cavities.

Back Teeth - Molars

SDF can be applied to cavites on the tops of teeth, or in between teeth.  Parent acceptance of this treatment is usually high, because esthetic considerations are low, and SDF is very effective at preventing further decay.

Front Teeth - Incisors

SDF can be applied to front teeth, however parent acceptance varies due to the obvious discoloration in between the teeth.  SDF is highly effective at preventing cavities on fron teeth.  Alternatives may be to treat the child under sedation or general anesthesia to place crowns. .  

What are the disadvantages of using SDF?

There are very few drawbacks to using SDF! Here is the rundown of the disadvantages:

- Black teeth - The biggest disadvantage is that SDF will turn the cavity black. While this may be unappealing visually, this actually indicates that the SDF has slowed the cavity from progressing.

- Does not repair broken/lost tooth structure.  In some instances, it is important to restore or put crowns on teeth that are badly damaged to prevent further decay until treatment can be completed safely and succesfully.

- Cannot be used for all cavities. SDF does not work for all cavities, most notably for those that are very deep or close to the nerve of the tooth. In these cases, the dentist will explain alternative treatment options.

Cost and Insurance Coverage

SDF application is billed out as a per tooth procedure. We do not currently apply SDF to teeth that are cavity-free. Most insurances allow this procedure to be performed, but coverage may vary.  However, the relatively low cost of the treatment, and the non-invasive nature of the treatments are the benefits that parents are most interested in.