Silver diamine fluoride

Silver diamine fluoride is a liquid painted onto a cavity to stop it getting worse, rather than drilling the decay away and repairing the tooth. It turns the treated area permanently black, which is the thing most families want to talk about, so this page does not save that for the end. It explains what the treatment is, what it does, what the staining means, and where it fits. It cannot tell you whether it is right for your child.

What silver diamine fluoride is

A colourless liquid, brushed onto the decayed part of a tooth. The AAPD describes the version sold in the United States as 38 per cent silver diamine fluoride, equivalent to 5 per cent fluoride. The two active parts do different jobs: the AAPD states that current studies indicate the fluoride ions act by remineralising enamel and dentin, while the silver ions have an antimicrobial effect mainly in the treated decayed dentin.

The AAPD notes that topical silver products have been used in Japan for over 40 years to arrest decay and reduce sensitivity, and that other countries have used them with similar success. In the United States the FDA has approved it as a device for reducing tooth sensitivity, and the AAPD states that off-label use for arresting caries is now permissible and appropriate for patients.

Cozy says

This one is a liquid that gets painted on with a tiny brush. There is no drill and no buzzing. The part that was poorly turns dark, a bit like how a cut apple goes brown — that dark patch is the sign it has stopped getting worse.

Crumbs explains

This is the one treatment on the site that does not repair the tooth. It stops the damage spreading and leaves the hole where it is. That is a real difference from a filling or a crown, and it is worth being clear about before the appointment rather than after it.

What it does, and what it does not do

What the AAPD says about it:

It arrests decay. The AAPD describes SDF as an antimicrobial and remineralisation agent used to arrest caries lesions after diagnosis and at the direction of the dentist of record. (AAPD)
It works better than fluoride varnish for this. The AAPD states that studies consistently conclude SDF is more effective for arresting dentinal caries than fluoride varnish. (AAPD)
It is minimally invasive. The AAPD recognises it as an approach that may prevent or delay the need for more extensive and expensive procedures. (AAPD)
It does not repair the tooth. The hole stays. Where the shape of the tooth needs rebuilding, that is a separate decision and a separate treatment.
It is not a substitute for being examined. The AAPD states it is essential that a child receives a comprehensive dental examination, diagnosis and plan of ongoing disease management before the material is placed. (AAPD)

The AAPD frames it as part of an ongoing caries management plan rather than a one-off fix — something used within a wider plan for controlling the disease, alongside everything on Smile Basics.

The staining

This is the part worth understanding before you agree to it. The AAPD lists it plainly as a side effect: permanent black discoloration of the demineralised or cavitated surface. Not a risk that might happen — an expected result of the treatment working.

The AAPD also notes that before-and-after images of treated teeth can be helpful in the consent process. Asking to see those images, and asking which teeth would be affected and how visible they are when your child smiles, is a reasonable thing to do before deciding.

It is permanent

The AAPD describes the discoloration as permanent. It does not fade, and brushing does not lift it. If the appearance of a particular tooth matters to your family, that is a conversation to have before the treatment rather than after.

It marks the damage

The AAPD describes the discoloration as affecting demineralised or cavitated surfaces — the damaged areas, not the whole tooth. How noticeable that is depends on how large the lesion is and which tooth it sits on.

It can be covered later

Treating with SDF does not rule out restoring the tooth afterwards. The AAPD states that SDF has not been shown to reduce the adhesion of resin or glass ionomer restorative materials, so a filling or crown can still be placed over a treated area.

Where it fits, and who decides

The AAPD is explicit that this decision is a shared one:

The decision is made together. The AAPD states the ultimate decision regarding disease management and application of SDF is to be made by the practitioner and the patient or parent, acknowledging individual differences in disease propensity, lifestyle and environment. (AAPD)
It sits inside a plan, not on its own. The AAPD supports its use as part of an ongoing caries management plan, consistent with the goals of a dental home. (AAPD)
It is optimally used where progress can be monitored. The AAPD describes it as best used within a chronic disease management protocol that allows the effectiveness of treatment, disease control and risk to be monitored. (AAPD)
Someone qualified applies it. The AAPD supports delegation to trained allied dental personnel where a state’s dental practice act permits, by prescription or order of a dentist and after a full examination and caries-risk assessment. (AAPD)

Does it need doing more than once?

It may. The AAPD states that follow-up to evaluate whether the decay has been arrested is advisable, and that reapplication of SDF may be necessary to achieve or sustain arrest. So a single visit is not necessarily the end of it, and the follow-up appointment is part of the treatment rather than an optional extra.

On safety, the AAPD states that SDF is safe when used in adults and children in accordance with dosing and application criteria, and that it does not appear to negatively affect oral health-related quality of life in young children. It also notes that SDF retains roughly two to three times more fluoride than the sodium, stannous or acidulated phosphate fluoride commonly found in varnishes, gels and foams.

This has been suggested for my child

Silver diamine fluoride has been suggested and I am not sure about the staining. Say so. Ask which teeth would be treated, how visible the dark areas would be, whether the tooth could be restored over afterwards, what the alternatives are for that tooth, and what happens if you wait. Ask to see before-and-after pictures — the AAPD itself notes these help in the consent process. There is a list of questions to ask a dentist in the For Parents section. Nothing here is a second opinion, and none of it is based on your child’s teeth.

Questions caregivers often ask

Will my child’s tooth really go black?

Yes, and permanently. The AAPD lists permanent black discoloration of the demineralised or cavitated surface as a side effect of the treatment. It affects the damaged area rather than the whole tooth, but on a large lesion or a front tooth that can be very visible. This is the main reason to ask to see before-and-after images before agreeing.

Why would we choose this instead of a filling?

Ask your dentist, since the reason will be specific to your child and that tooth. In general terms the AAPD recognises SDF as a minimally invasive approach that may prevent or delay the need for more extensive and expensive procedures, and describes barriers to traditional restorative treatment — including a child’s age or limited ability to cooperate, and financial constraints — as the reason alternative approaches are needed at all.

Is it safe?

The AAPD states that SDF is safe when used in adults and children in accordance with dosing and application criteria, and that it does not appear to negatively impact oral health-related quality of life in young children. It is applied by, or under the direction of, a dental professional who knows your child’s oral health status. Any specific concern — an allergy, or something in your child’s medical history — belongs in the conversation with them.

Can the tooth still be filled or crowned afterwards?

Yes. The AAPD states that SDF has not been shown to reduce the adhesion of resin or glass ionomer restorative materials, so a filling or a crown can still be placed over a treated area later. Whether that is the plan for a particular tooth is a question for your dentist.

Does it hurt?

This page deliberately does not describe what appointments feel like, because that varies and your dentist is the right person to set expectations for your child. What can be said is that the AAPD categorises SDF as a minimally invasive approach, and that the FDA originally approved it as a device for reducing tooth sensitivity. If your child is anxious about dental visits, Helping a nervous child may be more useful than this page.

Where this guidance comes from

Every clinical statement on this page comes from the American Academy of Pediatric Dentistry documents below.

More in Cavity Corner

This website is for education only and does not replace care from your dentist, physician, or emergency services.