Silver Diamine Fluoride: NO DRILLING and NO SHOT…Too Good To Be True?!

SDF before after

Recently, the New York Times published an article about the NO DRILLING, cavity fighting liquid silver diamine fluoride (SDF).  This got everyone talking! Is it true…yes. Does it work for all cavities…no.  We love SDF at Chestnut Dental, but only use this magic bullet for very specific cases.

Let’s back up and talk about cavities.  Cavities are a preventable, chronic, infectious, transmissible disease.  That’s right – infectious!! Bacteria in our mouth, in combination with sugars in the diet, and home care, create a dynamic balance which can be tipped towards or away from forming cavities.  Right now, dental decay is the most common disease of childhood, 5x more common than asthma! 60% of children experience dental decay in primary teeth by age 5.  By 17 years of age, 78% of children have experienced caries.

There is a changing paradigm in dentistry away from the traditional drill and fill (surgical) approach.  Drilling and filling alone does not prevent future decay so we are moving towards a medical approach.  This means prevention of decay with education.  We teach the importance of home care and proper technique for brushing and flossing, we establish a personalized plan for the risk level of each patient and encourage all patients to see a dentist by age 1, in the office we provide fluoride treatments and sealants, and we view a healthy diet as central to the long-term oral health of patients.

Let’s back up again…did you say age 1 is the first dental visit!  What?!  It is true.  The American Academy of Pediatrics and American Academy of Pediatric Dentistry both recommend children see the dentist by age 1.  This isn’t for a traditional cleaning.  We consider this more of a “well baby check”.  We teach parents how to brush their child’s teeth, how much toothpaste and fluoride to use, we discuss diet, and we establish a safe, comfortable dental home to set your child up for a lifetime of dental success.  By delivering the important oral health information early the goal is to get ahead of decay and help to decrease the rising rate of cavities in this country.

Back to silver diamine fluoride.  SDF has been used for over 80 years all over the world.  It is a quick, affordable, cost effective and easy way to arrest decay…but ONLY for limited situations. For example, it is an excellent interim solution for patients with rampant caries, the young and pre-cooperative patient, those with impaired cognition or physical limitations, the geriatric population, those with salivary dysfunction, and immunocompromised patients. It doesn’t last forever.  The silver arrests (stops) the decay from progressing and is antibacterial and the fluoride remineralizes (strengthens) tooth structure for a finite period of time.  It buys time for a permanent filling in the future.  For children, if maintained, sometimes it can last the lifetime of a baby tooth.  When SDF is applied it turns the decayed part of the tooth BLACK.  The healthy part of the tooth does not discolor. It can only work on certain parts of teeth that are accessible to the application brush.  We recommend it is applied by a dental professional.

SDF is a medicine that can temporarily ‘fix’ a tooth while we work towards the bigger issue of how a cavity got there and how to prevent future decay from forming. It is an amazing tool for specific situations. We will continue to use SDF when appropriate!


Dr. Anne Hertzberg
Pediatric Dentist, Needham & Bedford offices

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