Silver Diamine Fluoride (SDF) is a simple, non-invasive intervention that arrests and controls caries. The SDF liquid consists of silver, ammonium and fluoride; the silver component is antibacterial, the ammonium has a high pH and the fluoride remineralizes the tooth. The SDF product has a fluoride content of 44,500 ppm F.
Use and Application
Carious teeth are cleaned with a toothbrush, isolated with cotton rolls, dried, and SDF is applied with a microbrush for 60 seconds. Excess material is removed by blotting. Optimally, treatment is repeated semi-annually.
Effectiveness and Efficacy
SDF is recommended for open cavities and for preventing and arresting root caries lesions. Systematic reviews have indicated that when applied periodically (every 6-12 months), SDF is effective at preventing or deactivating approximately 80% of caries lesions [1,2].
The use of topical SDF has been shown to be safe for use and no severe adverse effects have been reported connected with its use. Care should be taken during application because the silver component may stain soft tissues for one-two weeks. SDF stains carious dentine and enamel incipient lesions (white spots), making them brownish/black, but doesn’t sound enamel. The staining may be of concern for parents or patients depending on the location of lesions .
Health-economic models indicate that SDF is cost effective compared to other professional preventive measures.
Application of SDF can be recommended as a simple and inexpensive treatment for arresting open dentine caries lesions in crowns and roots.
Key Further Reading
1- The Effect of Silver Diamine Fluoride in Preventing Caries in the Primary Dentition: A Systematic Review and Meta-Analysis.
Oliveira BH, Rajendra A, Veitz-Keenan A, Niederman R. The Effect of Silver Diamine Fluoride in Preventing Caries in the Primary Dentition: A Systematic Review and Meta-Analysis. Caries Res. 2019;53(1):24-32.
2- Is Silver Diamine Fluoride Effective in Preventing and Arresting Caries in Elderly Adults? A Systematic Review.
Subbiah GK, Gopinathan NM. Is Silver Diamine Fluoride Effective in Preventing and Arresting Caries in Elderly Adults? A Systematic Review. J Int Soc Prev Community Dent. 2018 May-Jun;8(3):191-199.
3- Parental Expressed Concerns about Silver Diamine Fluoride (SDF) Treatment.
Crystal YO, Kreider B, Raveis VH. Parental Expressed Concerns about Silver Diamine Fluoride (SDF) Treatment. J Clin Pediatr Dent. 2019;43(3):155-160.
ACFF Members can download the full reference document for Silver Diamine Fluoride.