Silver diamine fluoride, usually called SDF, is a liquid a dental professional brushes onto a cavity to help stop it from getting worse, with no drilling or numbing shot. It has become popular for young children, older adults and people who can’t easily get traditional fillings. The trade-off is that it turns the decayed area permanently black. This guide is based on the American Dental Association’s (ADA) summary of the research.
What SDF is
The ADA describes SDF as a colorless or blue-tinted liquid made with silver, fluoride and ammonia. The silver acts as an antimicrobial, the fluoride helps remineralize the tooth, and the ammonia stabilizes the solution.
FDA status
The U.S. Food and Drug Administration has cleared SDF as a Class II medical device for treating tooth sensitivity, the same type of clearance as fluoride varnish, and it must be professionally applied. The ADA notes that using SDF to arrest cavities is an “off-label” use. Even so, the ADA’s position is that SDF may be used in certain circumstances as a non-restorative treatment to arrest cavities on baby and permanent teeth, with diagnosis and monitoring by a dentist.
What SDF can do
- Arrest or slow cavities in baby and permanent teeth without removing healthy tooth structure.
- Help with root cavities in older adults.
- Serve as an interim approach for people who can’t currently tolerate more involved treatment, including people with special needs.
- Stabilize several cavities that can’t all be treated at one visit before fillings.
- Treat tooth sensitivity. See sensitive teeth.
The ADA lists its main benefits as control of pain and infection, easy and quick application, low cost and a noninvasive approach. Because cavity treatment in young children or people with special care needs may otherwise require advanced sedation, SDF may be an option when sedation isn’t desirable or available. See dental sedation options and dental care for special needs.
Downsides
- Permanent black staining of the treated decay. Healthy, mature enamel isn’t stained. Staining limits its use on visible front teeth.
- An unpleasant metallic taste.
- Possible irritation of the gums and mouth tissues, so care is taken to avoid contact with the gums.
- In one trial in children, occasional mild diarrhea and stomach ache resolved within two days.
The ADA notes the American Academy of Pediatric Dentistry reports no known serious adverse effects when SDF is used according to manufacturer directions. There is less fluoride in the amount of SDF used to treat a tooth than in fluoride varnish.
How often it’s applied
The ADA says a single application isn’t enough for lasting benefit. Its clinical guideline panel recommended 38% SDF applied twice a year (biannually) to arrest advanced cavities on the crowns (coronal surfaces) of baby teeth, and said clinicians could also use it this way on permanent teeth.
Will the tooth still need a filling?
Sometimes. The ADA says a filling may still be needed to restore the shape and function of a tooth with a hole in it, which also reduces the discoloration. Compare materials in dental filling materials compared.
What to ask your dentist
ADA policy says patients or guardians should be told about all treatment options, possible side effects and the need for follow-up when giving consent. Ask:
- Which teeth would be treated, and will the black stain be visible?
- How often will it need reapplying?
- Will the teeth need fillings later?
Insurance
The ADA supports SDF as a covered benefit by insurers, and supports coverage for later fillings or extraction too. Coverage depends on your plan. See understanding dental insurance.
Frequently asked questions
Does SDF hurt?
The ADA describes it as noninvasive. It’s painted on and doesn’t require removing tooth structure.
Will it stain my child’s teeth?
It stains the decayed areas black permanently. Healthy enamel isn’t stained.
Sources
By the Dentist Review Editorial Team.
This article is for general information only and is not medical advice. Talk to a licensed dentist about your own situation. See our disclaimer.
Featured image: “Defense.gov News Photo 970903-F-5131S-002” by Senior Airman Jerome Suson, U.S. Air Force, via Wikimedia Commons, licensed Public domain. Resized and compressed for the web.
Our guides are written and reviewed by the Dentist Review editorial team. We research each topic using public, authoritative sources such as the CDC, the National Institutes of Health (NIH/NIDCR), the American Dental Association (ADA) and CMS, and we update guides when guidance changes. Guides are for general information only and are not dental or medical advice; please read our disclaimer and learn more about us.