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Silver Diamine Fluoride

photo of smiling boy in a dental chair

  Share these facts to help improve the oral health of children and their families.

Key Facts

  • Topical silver diamine fluoride (SDF) is a liquid that is painted on a tooth surface with an active caries lesion and arrests the lesion. SDF was cleared by the Food and Drug Administration in 2014 as a treatment for sensitive teeth and has been used off-label to treat tooth decay in the United States since 2015. 1
  • Topical 38 percent SDF arrests tooth decay and is effective for the short-term treatment of tooth decay in preschool-age children. The effect is rapid and safe. 1
  • The American Academy of Pediatric Dentistry’s SDF panel supports the use of 38 percent SDF for the arrest of cavitated caries lesions in primary teeth as part of a comprehensive caries management program. 2
  • The American Dental Association’s expert panel strongly recommends the use of 38 percent SDF solution to arrest advanced cavitated carious lesions on any coronal surface of primary teeth and to arrest or reverse non-cavitated carious lesions on occlusal surfaces of primary teeth using sealants and a 5 percent solution of sodium fluoride varnish or sealants alone. 3
  • The effectiveness of SDF for treating tooth decay in children has implication for pediatric dentistry. The cost of SDF treatment is lower than the cost of conventional treatment. Also, because SDF is easy to apply, its use could result in more children with untreated tooth decay receiving treatment. 4,5
  • To arrest advanced cavitated carious lesions on any coronal surface of primary teeth, clinicians should consider the use of 38 percent SDF solution biannually. 6
  • SDF is more effective than fluoride varnish in arresting advanced cavitated carious lesions on any tooth surface. 7
  • Estimations of SDF effectiveness in arresting dental caries lesions range from 47 to 90 percent with one-time application depending on size of the cavity and tooth location. 3 Anterior teeth have higher rates of arrest than posterior teeth. 8 Therefore, follow-up for evaluation of caries arrest is advised, including reapplication. Reapplication shows increased caries arrest rate versus a single application. 3
  • Parents are more likely to accept SDF-associated black staining on their child’s posterior teeth than on anterior teeth. Although staining on anterior teeth is undesirable, most parents prefer this option to advanced behavioral techniques such as general anesthesia or sedation. 9

References

  1. Milgrom P, Horst JA, Ludwig S, Rothen M, Chaffeee BW, Lyalina S, Pollard KF, DeRisib JL, Mancla L. 2018. Topical silver diamine fluoride for dental caries arrest in preschool children: A randomized controlled trial and microbiological analysis of caries associated microbes and resistance gene expression. Journal of Dentistry 68:72–78.
  2. American Academy of Pediatric Dentistry, Council on Clinical Affairs. 2017. Use of Silver Diamine Fluoride for Dental Caries Management in Children and Adolescents, Including Those with Special Health Care Needs.
  3. American Dental Association. 2018. Evidence-Based Clinical Practice Guideline on Nonrestorative Treatments for Carious Lesions: Summary of Clinical Recommendations for the Nonrestorative Treatment of Caries on Primary Teeth. Chicago, IL: American Dental Association.
  4. Hansen RN, Shirtcliff RM, Dysert J, Milgrom PM. 2017. Costs and resource use among child patients receiving silver nitrate/fluoride varnish caries arrest. Pediatric Dentistry 39(4):304–307.
  5. Trieu A, Mohamed A, Lynch E. 2019. Silver diamine fluoride versus sodium fluoride for arresting dentine caries in children: a systematic review and metaanalysis. Scientific Reports 9(1):2115.
  6. Slayton RL, Urquhart O, Araujo MWB, Fontana M, Guzmán-Armstrong S, Nascimento MN, Nový BB, Tinanoff N, Weyant RJ, Wolff MS, Young DA, Zero DT, Tampi MP, Pilcher L, Banfi L, Carrasco-Labra A. 2018. Evidence-based clinical practice guideline on nonrestorative treatments for carious lesions: A report from the American Dental Association. Journal of the American Dental Association 149(10):837–849.
  7. Urquhart O, Tampi1 MP, Pilcher L, Slayton RL, Araujo MWB, Fontana M, Guzmán-Armstrong S, Nascimento MM, Nový BB, Tinanoff N, Weyant RJ, Wolff MS, Young DA, Zero DT, Brignardello-Petersen R, Banfield L, Parikh A, Joshi G, and Carrasco-Labra A. 2019. Nonrestorative treatments for caries: Systematic review and network meta-analysis. Journal of Dental Research 98(1):14–26.
  8. Fung M, Duangthip D, Wong M, Lo E, Chu C. 2018. Randomized clinical trial of 12% and 38% silver diamine fluoride treatment. Journal of Dental Research 97(2):171–178.
  9. Crystal YO, Janai MN, Hamilton DS, Niederman R. 2017. Parental perceptions and acceptance of silver diamine fluoride staining. Journal of the American Dental Association 138(7):510–518.

OHRC Publications

This section contains OHRC-produced materials.


Details

Barzel R, Holt K. 2020. Fluoride varnish and silver diamine fluoride: A resource guide. Washington, DC: National Maternal and Child Oral Health Resource Center, 15 pp

National Maternal and Child Oral Health Resource Center
Georgetown University Box 571272
Washington, DC 20057-1272

Telephone: (202) 784-9771
E-mail: OHRCinfo@georgetown.edu
Website: https://www.mchoralhealth.org
Available from the website.

This guide provides an annotated list of resources on the use and application of fluoride varnish and silver diamine fluoride, including materials on data and surveillance, professional education and training, and public education. Descriptions of and contact information for relevant organizations are included. [Funded by the Maternal and Child Health Bureau]

Details

Barzel R, Holt K, eds. 2019. Promoting oral health in schools: A resource guide (4th ed.). Washington, DC: National Maternal and Child Oral Health Resource Center, 35 pp

National Maternal and Child Oral Health Resource Center
Georgetown University Box 571272
Washington, DC 20057-1272

Telephone: (202) 784-9771
E-mail: OHRCinfo@georgetown.edu
Website: https://www.mchoralhealth.org
Available from the website.

This guide provides resources to help health professionals, educators, parents, and others promote oral health and prevent oral disease in school-age children and adolescents. The guide is divided into two sections. The first section describes materials such as brochures, fact sheets, guidelines, curricula, and reports. The second section lists federal agencies and national organizations that may serve as resources. [Funded by the Maternal and Child Health Bureau]

     

OHRC Library

This section contains recent materials, not including OHRC-produced materials.


Details

American Dental Association. 2018. Silver diamine fluoride (SDF) application: Evidence-based recommendations. Chicago, IL: American Dental Association.

American Dental Association
211 East Chicago Avenue
Chicago, IL 60611-2678

Telephone: (312) 440-2500
Fax: (312) 440-7494
E-mail: info@ada.org
Website: http://www.ada.org
Available from the website.

This video presents recommendations from the 2018 American Dental Association clinical practice guideline on nonrestorative treatments, including silver diamine fluoride (SDF), for carious lesions. The safety of SDF is discussed, along with scientific evidence and recommendations for its use. Guidance for dentists on how to use a risk-assessment approach to determine whether the use of SDF is appropriate for patients is provided, along with guidance on how to talk to patients about use of SDF and other treatment options. A four-step process for applying SDF is included, along with guidance on how to determine whether reapplication is needed.


Details

Apple Tree Dental. [2017]. Silver diamine fluoride . [Rochester, MN]: Apple Tree Dental, 1 p

Apple Tree Dental
Website: https://www.appletreedental.org
Available from the website.

This fact sheet for consumers provides information about silver diamine fluoride (SDF). It explains what SDF is, how it is applied, and who should and should not receive SDF treatment. Photographs of teeth before and after SDF application are included.


Details

Apple Tree Dental. [2017]. Consent for treatment of tooth decay (cavities) with silver diamine fluoride (SDF). [Rochester, MN]: Apple Tree Dental, 1 p

Apple Tree Dental
Website: https://www.appletreedental.org
Available from the website.

This form is designed for oral health professionals to give parents or guardians to obtain consent for treating a child’s tooth decay with silver diamine fluoride (SDF). The form provides information about what SDF is and how it works, limitations and side effects of SDF treatment, reasons to avoid SDF treatment, and other options for treating tooth decay. Photographs showing teeth before and after SDF treatment are included. The form includes space for the child’s name, tooth numbers to be treated, and the name and signature of the parent or guardian.


Details

Association of State and Territorial Dental Directors. 2017. Silver diamine fluoride (SDF) fact sheet. Reno, NV: Association of State and Territorial Dental Directors, 2 pp

Association of State and Territorial Dental Directors
3858 Cashill Boulevard
Reno, NV 89509

Telephone: (775) 626-5008
Fax: (775) 626-9268
E-mail: info@astdd.org
Website: http://www.astdd.org
Available from the website.

This fact sheet presents recommendations from the 2018 American Dental Association clinical practice guideline on nonrestorative treatments, including silver diamine fluoride (SDF), for carious lesions. The safety of SDF is discussed, along with scientific evidence and recommendations for its use. Guidance for dentists on how to use a risk-assessment approach to determine whether the use of SDF is appropriate for patients is provided, along with guidance on how to talk to patients about use of SDF and other treatment options. A four-step process for applying SDF is included, along with guidance on how to determine whether reapplication is needed.


Details

Iowa Department of Public Health. 2018. Silver diamine fluoride protocol. [Des Moines, IA]: Iowa Department of Public Health, 3 pp

Iowa Department of Public Health
321 East 12th Street
Des Moines, IA 50319-0075

Telephone: (515) 281-7689
Secondary Telephone: (866) 227-9878
E-mail: https://www.idph.iowa.gov/Contact-Us
Website: http://www.idph.iowa.gov
Available from the website.

This document provides information about silver diamine fluoride (SDF) and how to use it. The document presents background and discusses the efficacy and safety of SDF, requirements for applying it in Iowa, indications and contraindications for application in children and adults, how to apply SDF, and frequency of application for best results.

     

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