All About Silver Diamine Fluoride – the pros and cons

Hi Dr. Lauren, I heard about a product called “silver diamine fluoride.”  I heard it can stop cavities and prevent someone from needing fillings or crowns. Is this true?

Hi everyone!  This is a great question about a product that many pediatric dentists are using, including myself and my associates.  The product is known as silver diamine fluoride (SDF) and is sold as Advantage Arrest by Elevate Oral Care.  The product is composed of 4 ingredients: 25% silver, 5% fluoride, 8% ammonia and 62% water.  The FDA approved use for SDF is as a dentin desensitizing agent.  However, like many products on the medical market, SDF is being used off-label.  SDF is being used to treat dental caries; SDF is used to slow down or arrest dental caries.  SDF is a colorless and odorless liquid that is applied with a small brush to the affected tooth.  It is not painful and does not require local anesthesia.  It is believed that the silver ions kill the bacteria which causes dental caries and the fluoride ions help to remineralize and strengthen the tooth.

SDF isn’t for every tooth or every patient with dental caries and does not guarantee the need for surgical/restorative dental treatment.  Limited clinical studies have shown an effective rate of caries arrest in approximately 70%-90% of treated teeth.  SDF can be used on teeth and in patients in which restorative dental treatment is being delayed or avoided due to access of care or inability to tolerate conventional dental treatment, such as children who are very young (pre-cooperative), individuals that have intellectual and/or developmental disabilities, individuals that have health complications that prevent dental treatment, and elderly adults.  SDF should only be applied to asymptomatic (non-painful) carious lesions.  Treated teeth with SDF should be monitored by a dental professional as carious arrest is not guaranteed and SDF may need to be reapplied.  Improved success for caries arrest has been demonstrated when SDF is reapplied.

SDF is a great, non-invasive dental product, but does come with some side effects and risks.  The silver ions in SDF causes permanent black staining/discoloration to carious/unhealthy tooth structure.  The black discoloration is only removed if the affected tooth structure is removed.  This may be a concern to some patients, especially if the dental caries are in the front teeth.  Additionally, if SDF comes into contact with skin or oral mucosa, it will leave a temporary stain or “henna-like” tattoo for 14 days until the surface skin or mucosa cells shed.  Furthermore, if SDF comes into contact with sensitive skin or oral mucosa, irritation may occur due to the ammonia.  SDF permanently stains clothing, counters, floors and furniture.  A definitive contraindication for the use of SDF is a silver allergy.  SDF should not be used on teeth with very deep carious lesions or lesions extending to the pulp/nerve; these teeth require surgical/restorative intervention.

As stated above, SDF is an appropriate, temporary treatment option for some patients with dental caries. We must remember that SDF is not a cure-all and may not guarantee the arrest of dental caries and prevent the need for restorative treatment.  To aid in caries arrest, the application of SDF should be followed with good oral hygiene habits and proper diet.  SDF as a dental procedure is covered by some (not all) insurances and based upon per tooth to which it is applied.  If you have further questions about SDF, please call to schedule a consult with our office at (760) 320-7621 Palm Springs or (760) 365-4400 Yucca Valley.

Thanks again for the great questions.  Remember if you have a pediatric dental question you would like answered, please email the question to



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