Silver Diamine Fluoride

What is silver diamine fluoride?


Silver Diamine Fluoride (SDF) is a colorless liquid containing silver particles, fluoride, ammonia and water. SDF has been used extensively outside the U.S for many years as a caries (cavity) control and treatment. SDF has clearance by the Food and Drug Administration as a desensitizing treatment. It is used off-label for caries arrest.


How does SDF work?


The silver in SDF acts as a natural antimicrobial agent that strengthens the tooth structure. Fluoride is the ingredient that arrests (stops) the tooth decay and helps to prevent any additional decay from developing.


Does SDF replace fillings or crowns (restorative dentistry)?


The ideal treatment for decayed teeth is to remove most or all of the decay and place a filling or crown. SDF does not always prevent the need for a filling or crown (a restoration).  However, it provides a non-invasive way to prevent the decay from progressing so that the immediate need for restorative treatment may be delayed, or in SOME cases, eliminated.


So, when is SDF recommended?


Each child's presentation and needs are different, and not all cavities are candidates for SDF treatment. If your child has a cavity that may be a candidate for SDF, Dr. Harmon, Dr. Owensby or Dr. Shaw will discuss this with you at the examination.


SDF may be recommended for teeth in which avoiding restorative treatment ("drilling and filling") is desired. This may included, but not be limited to:

        very young children who cannot be expected to cooperate for fillings

        children with special medical needs

        children with extensive decay (severe early childhood caries)


SDF is beneficial in that it is:



        quick and painless

        effective caries prevention

        may arrest (stop) decay

        may relieve sensitivity


Are there any risks associated with SDF treatment?


One of the most important things for parents to consider with SDF treatment is that ANY DECAYED AREAS WILL STAIN BLACK. Healthy tooth structure will not stain. Stained tooth structure MAY be able to be covered when appropriate at a later time with a filling or crown.


If SDF touches the gums or skin, a temporary brown stain may appear that cannot typically be washed off. Any soft tissue or skin staining usually resolves in 1-3 weeks.


The child may notice a metallic taste that will go away rapidly.


Despite very good success rate of caries arrest, SDF may NOT arrest decay in every case and no guarantee of success is suggested. The decay may progress and further treatment such as additional SDF applications, filling, crown or extraction may be indicated.