Silver Diamine Fluoride in Caries Management

There are several ways to reverse or arrest decay (see our many posts on this topic), and the application of silver diamine fluoride has come up recently as a possible solution. In our office, the inquiries on silver diamine fluoride are mostly from parents of young children, hoping to avoid having fillings placed in their toddler’s teeth.

Silver diamine fluoride (SDF) is a colorless strongly alkaline liquid (pH 10) that is 24.4% to 28.8% (weight/volume) silver and 5.0% to 5.9% fluoride. Just as 5% sodium fluoride varnish has FDA clearance as a Class II medical device for the treatment of tooth hypersensitivity, FDA classified SDF as a fluoride and cleared its use as a Class II medical device for the same indication. SDF has been popular for many years in Europe and recently became available here in the United States.

Teeth Stained by Silver Diamine Fluoride

A recent article in the New York Times highlighted the use of silver diamine fluoride (SDF) as an alternative approach to treatment of cavities in children. The article highlighted that SDF was faster and cheaper than drilling and filling; and it mentioned the downside that when applied, SDF blackens the tooth. When applied to a carious lesion, SDF has been shown to lower caries risk of the tooth surface. This is most likely due to its fluoride content topically applied to the tooth. It will not stop decay from progressing deep within the tooth.

Here is a short list of the Pros and Cons:
Pros
• SDF has very low toxicity
• it is quick, painless, non-invasive
• it is less expensive than a filling, no drilling necessary
• it can stop tooth decay on the exterior surface of the cavity and help prevent recurrent decay making it effective in management of root caries in the elderly


Cons:
• permanently stains cavities black.
• does not restore tooth form or function, so large holes in teeth will remain and continue to trap food
• decay and bacteria will continue to exist buried within the tooth structure at the deep internal part of the cavity lesion. This means that the cavity is still active and growing at the part nearest the nerve
• requires repeat application for maximum efficacy
• cannot be used in the presence of infection or decay into the nerve
• metallic taste, funky smell
• potential to irritate gingival and mucosal surfaces

SDF is not a complete solution to caries risk. Single application has been reported to be insufficient for sustained benefit. SDF might be more accurately described as effective for caries control and management. It will not reverse decay.

It likely has additional applicability as an interim approach for managing problematic caries in individuals currently unable to tolerate more involved dental treatment.

A search of ClinicalTrials.gov for silver diamine fluoride returned 14 studies; 7 of which have been completed, 5 that are recruiting, and 2 that have not yet begun recruiting. This suggests that more scientific insight and news will likely be forthcoming about this product.

Silver Diamine Fluoride is not the panacea that many have been led to believe. Proper diet, good oral hygiene are still paramount to maintain a healthy dentition.