What Is Silver Diamine Fluoride, SDF?

What is Silver Diamine Fluoride (SDF)?

Silver diamine fluoride (SDF) is a topical liquid that is approved by the FDA for treatment of tooth sensitivity. An off-label use is to arrest, or slow the progression, of tooth decay.  

Tooth decay, also called dental caries or carious lesions, are caused by bacteria and can result in macroscopic breakdown of the teeth. 

Other topical substances, such as toothpaste, aim to prevent the possibility of decay and disease in the future. SDF, however, is used on teeth that already have visible decay. 

Dental professionals often use SDF on children with cavities in their primary teeth, as it is easy to apply and does not require anesthesia. Applying SDF to both primary and permanent teeth slows down decay progression. 

Benefits of SDF for Tooth Decay

There are many benefits of using silver diamine fluoride on tooth decay. For example, SDF:

• Has been shown to slow the progression of cavities and reduce the spread of the bacteria to other teeth (caries resonance)
• Can be a great alternative to restorative treatments in children or adults who are uncooperative and/ or cannot medically tolerate more extensive treatment
• Kills harmful bacteria and prevents them from spreading to other teeth
• Helps relieve tooth sensitivity
• Is less expensive than other products

Risks and Side Effects of SDF

Although dentists consider SDF safe, there are some side effects. 

You should avoid SDF treatment if you have:

• Oral ulcerations
• A silver allergy
• Advanced gum disease
• Canker sores
• Major tooth decay

Some of these conditions often expose soft tissue, which can have a painful reaction to the ammonia in SDF.

SDF can result in a temporary black staining around the gums, skin, or other areas it comes into contact with.³ These stains should disappear within a couple weeks. The SDF will also permanently stain the area of the tooth with the cavity.

SDF’s success is not guaranteed and requires good oral hygiene and a healthy diet to work. If the SDF fails, the decay will continue. In this case, the need for repeated SDF applications, fillings, crowns, root canals, and extractions are all possible.

Who Benefits From SDF?

There are a number of situations where SDF can help. Those include, but aren’t limited to:

• People with special medical needs
• Children who are unable to sit through an extended procedure 

SDF Alternatives

Whether SDF is the right option for you depends on the tooth’s location and the state of decay. 

If silver diamine fluoride isn’t the right choice, there are alternatives to consider:

• Extraction
• Fillings or crowns
• Root canal 
• Sodium fluoride varnish, which can help remineralize enamel 

Sodium fluoride varnish works similarly to SDF and can also decrease tooth sensitivity. SDF has been proven to be more effective than sodium fluoride varnish in treating pediatric dentinal caries.⁷

How Does Silver Diamine Fluoride Work?

Silver diamine fluoride is made up of four components:

1. Silver — treats bacteria 
2. Fluoride — remineralizes enamel
3. Water — acts as a base liquid for the substance
4. Ammonia — keeps the substance concentrated for best results

This combination is applied directly to the teeth, most commonly on cavities. Some studies show it can also prevent tooth decay in healthy teeth.¹

Silver Diamine Fluoride Tooth Application in 7 Steps

When silver diamine fluoride is applied to dental caries, it stops the decay from worsening. Often, SDF will make the lesion turn black and hard. 

There are seven steps that dentists follow when applying SDF:²

1. Remove excess debris on the teeth’s surfaces for better contact with SDF
2. Apply a protective layer, such as vaseline, to the lips and skin around the mouth to avoid any staining from SDF
3. Isolate the decayed teeth with gauze or cotton balls
4. Dry dental caries with compressed air
5. Dip a microbrush into SDF and brush off excess before applying
6. Carefully apply SDF onto tooth decay and surfaces
7. Remove excess with gauze
8. Allow gentle air flow to dry the affected area for at least 3 minutes

Dental professionals usually apply SDF at least once a year, though the frequency can vary. SDF does not eliminate the need for further procedures, like dental fillings or crowns. If SDF is unsuccessful, reapplication or other procedures may follow.

How Much Does Silver Diamine Fluoride Cost?

On average, expect to pay about $75 per session or $20 to $25 per tooth. 

Some dentists charge per tooth, while others charge per session.

Silver diamine fluoride is relatively inexpensive compared to other treatments. The prices vary from dentist to dentist. 

Summary

Silver diamine fluoride is a preventative treatment to help stop tooth decay. Dental professionals often use it on children’s primary teeth or for people who cannot tolerate dental procedures. 

SDF will not necessarily eliminate the need for further dental care. But, it can help reduce sensitivity and prevent the spread of bacteria.

The risks of using SDF are minimal and usually cosmetic. In all cases, SDF will permanently stain the cavities that are treated.