Silver Diamine Fluoride

In this section, we will cover:

What is silver diamine fluoride?
What is it used for?
What does the procedure involve?
What are the risks?
What are the alternatives?

What is silver diamine fluoride?

Silver diamine fluoride (SDF) is a liquid containing silver and a high concentration (38%) of fluoride. These work together to stop decay (holes in the teeth) getting larger.

What is it used for?

SDF is used to slow down or stop the progression of tooth decay*. This reduces the chance of toothache or infection. It is more commonly used in baby teeth and in patients who can't tolerate much/any dental treatment.

Combined with a healthy diet and good oral hygiene, SDF can save decayed baby teeth until they fall out naturally OR until your child builds up enough cooperation to allow other forms of treatment (such as a filling or metal cap).

SDF is NOT suitable if there are already signs of an infection, such as toothache or an abscess on the gum.

Your dentist will tell you if SDF is a suitable option for you or your child. It can only be used where there is a physical hole in the tooth that you can see.

*SDF has been used safely across the world to manage tooth decay for decades. In the UK, SDF is only licensed for treating sensitive teeth. It is now being widely used "off-label" for managing tooth decay.

What does the procedure involve?

Treating decayed teeth with SDF is a very simple procedure which takes just a few minutes and requires no drilling, filling or injections. This makes it a great option for tooth decay in children with limited cooperation at the dentist.

A thin layer of petroleum jelly is applied to the lips and gums to and some cotton wool placed around the tooth to protect the soft tissues. The tooth is then dried.
The SDF liquid is painted onto the decayed teeth and brushed in for at least 1 minute. The teeth are dried again. Sometimes, another layer of liquid will be placed on top to reduce the staining. There may be a metallic taste which can be off-putting for some children.
Another liquid can be brushed onto the decayed teeth to reduce the staining - but there is limited evidence that this works! The teeth are dried again.
This may need to be repeated in 2-4 weeks and then every 6 months.

What are the risks?

Staining
The biggest risk with SDF is staining. The decayed portion of the tooth will stain black if the treatment has worked.
SDF can also stain the soft tissues (lips, gums, cheek) but this is temporary and will disappear by itself - usually within 3 weeks.
If SDF gets onto the clothes, it cannot be removed. Your dentist will take extra care when applying the liquid but it is best to wear something you don't mind getting ruined!

Decay
SDF has an 81% success rate for stopping the spread of decay. This means 8 out of 10 decayed teeth treated with SDF will not need further treatment. However there is still a chance the decay continues to spread. This may result in you/your child needing further treatment such as fillings, metal caps or tooth extractions.

Allergy
In very rare cases, you may have an allergic reaction. You should let your dentist know if you have any allergies - including materials such as metals.

What are the alternatives?

Other options for managing tooth decay are:

Fluoride varnish
Fluoride varnish is applied at least twice a year for children in the UK. Fluoride varnish is more effective at preventing new decay rather than slowing the spread of existing decay.
Dental filling
You can find out more about dental fillings here. Local anaesthetic (a small injection to numb the tooth) is often needed to make this procedure more comfortable. The decayed tooth is cleaned with a special handpiece (dental drill) which buzzes and sprays a lot of water. Once the tooth is clean, a tooth-coloured filling material is placed in the hole to seal it.
Metal cap
You can find out more about metal caps here. A metal cap usually takes only 2 visits to place.
In most cases, there is no need for local anaesthetic or drilling to remove decay. For larger areas of decay (where more than one surface of a tooth is affected), metal caps are the preferred choice to a filling.
At the first visit, your dentist will place small blue elastic bands between the teeth - this can be a bit uncomfortable, like there is popcorn stuck between the teeth. These blue bands push the teeth apart slightly to make space for the metal cap. A few days later, the blue bands are removed and a silver cap is "glued" on to the tooth with a special dental cement.
The silver cap will stop the teeth biting together normally but your child will get used to this within a few days and the teeth should naturally come together again after about 2 weeks.