When it comes to your child’s dental health, drilling and filling cavities is a process most parents and kids want to avoid. Now there’s an alternative that many parents and dentists are opting for to treat tooth decay in kids — silver diamine fluoride. As with any emerging type of treatment, there are questions and concerns about silver diamine fluoride. Understanding more about this non-invasive intervention is the first step to evaluating whether it’s right for your child’s teeth.

How SDF Works? | Are there risks to SDF? | How is SDF applied? | When do dentists recommend SDF? | SDF vs Drilling and Filling | Is SDF right for my child?

What Is Silver Diamine Fluoride?

Silver diamine fluoride (SDF) is a liquid medication that’s applied topically to the teeth with a small brush or a special type of floss. The silver fluoride formula is 38 percent silver fluoride salt, which is made water-soluble by the addition of small amounts of ammonia. The result is a liquid that dentists can easily paint onto teeth in a matter of seconds!

SDF has been used extensively around the world for decades, although it only received approval from the Food and Drug Administration (FDA) in 2014. The FDA actually approved SDF for use in the treatment of dentin sensitivity. For dentists to use it as a way to treat cavities means that, as with its predecessor fluoride varnish, dentists using SDF to treat cavities are doing so “off-label.”

How Does SDF Work?

SDF’s ability to slow down or stop dental decay comes from its two main ingredients. Silver’s antibacterial properties have been known for centuries, and its low toxicity makes it ideal for use in humans. Fluoride significantly increases the rate at which tooth enamel can be remineralized by saliva, and at the same time increases the enamel’s resistance to future degradation due to acids. Fluoride has antimicrobial properties as well.

The uses of silver fluoride include stopping tooth decay from progressing and keeping the affected teeth stable until a dentist determines if further action is necessary to preserve the health of the teeth. SDF helps harden the tooth structure softened by decay.

Are There Risks or Side Effects to SDF?

One of the greatest benefits of silver diamine fluoride treatment is that it carries very little risks and is generally free of side effects. The most prominent risk is a completely aesthetic one — blackening of the treated teeth. When the silver in SDF is applied to a tooth, it oxidizes and leaves a black stain on the damaged cavity portion of the tooth (it does not stain healthy enamel). It can also temporarily stain any tissue surfaces it contacts (for example, lips or gums).

For gums and tissue in the mouth, the staining is temporary. The cells in these soft tissues shed and are replaced quickly, so stains may persist for a few days up to a couple of weeks. When applied by a skilled dentist, the chances of tissue staining are fairly low.

The blackening is permanent on the teeth, however, which may be enough to deter adults from choosing this form of treatment. For children with baby teeth, however, the stains are effectively temporary because the teeth will fall out on their own. Even so, some parents opt to hide the staining with crowns, which is why some kids have silver teeth.

There is a chance that SDF that comes in contact with oral tissues will cause some irritation, but this is quite mild as well as temporary. It should not be used on patients who have a silver allergy. Other than that, silver diamine fluoride safety is a key part of the treatment’s appeal.

How Is SDF Applied?

The actual application of SDF is incredibly quick and painless. While a universally-recognized process for applying SDF has not been developed, the simplicity of the procedure means that most dentists follow the steps recommended in the Chairside Guide by the American Academy of Pediatric Dentistry (AAPD) when performing SDF dental treatment.

1. Cleaning the Area

All dental procedures need a clean mouth to be safe and effective. SDF is no different. The dentist removes any debris from the tooth’s cavitation to ensure the solution makes the best possible contact with the affected area. This includes plaque, food debris, or possibly even some of the cavity.

2. Isolating the Area

Because the lips and skin are so susceptible to staining, dentists may apply a protective coating of Vaseline to these areas. Dentists will also isolate the treatment area using cotton rolls or other methods. The gums are usually protected with petroleum jelly or cocoa butter.

3. Applying the SDF

When the mouth is properly prepped, it’s time for the dentist to dry the tooth with compressed air or dry gauze and apply the SDF with a microbrush. They simply dip the brush into the solution, remove any excess liquid and paint the SDF directly to the affected surface. A single drop of the solution is enough to treat up to eight teeth at once.

The application itself takes about a minute but can be shorter for young patients who may be less able to keep still for sustained periods. To allow the SDF to set, the dentist may apply gentle airflow until the solution is dry. Optimally, the affected teeth are then covered with a fluoride varnish which acts as a top coat and seals in the SDF over the cavity portion of the tooth.


Patients should follow up with their dentist two to four weeks after the initial treatment to make sure the SDF is doing its job. Many people see their cavities arrested with just one treatment. According to the Chairside Guide, estimates of SDF treatment effectiveness range between 47 and 90 percent for a single application. If a single treatment doesn’t fully stop the cavity from growing, a dentist may recommend further applications.

When and Why Do Dentists Recommend SDF?

There are several situations in which SDF treatment is an effective choice. Many of them have to do with the treatment’s low financial impact. While drilling and filling a cavity can cost a couple hundred dollars on average, treatment with silver diamine fluoride will usually cost less than $100 out of pocket, and may even be covered by your insurance! Its affordability makes SDF a great option for people on strict budgets, or who have trouble finding or accessing dental care.

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In particular, SDF is a promising cavity treatment for children. Because their teeth aren’t yet permanent, the aesthetic issue of staining is far outweighed by the benefits of getting cavities treated. SDF is also a highly effective preventative measure that may stop teeth from decaying in the first place. This form of treatment is growing in popularity as a pediatric dental treatment.

The Problem of Kids and Cavities

Cavities are alarmingly common in children. Data from the AAPD’s “The State of Little Teeth” report shows the problem is substantial and growing.

  • In children aged 2 to 5 years, rates of tooth decay increased almost 17 percent between the ranges of 1988 to 1994 and 1999 to 2004.
  • Of children 2 to 5 years old, 28 percent are affected by tooth decay.
  • Among children entering kindergarten, 40 percent have cavities.
  • By the age of 5, around 60 percent of children have had at least one cavity.

Underestimating the danger of cavities in childhood can lead parents not to seek treatment. The impacts of cavities on kids are both short-term and far-reaching even when it’s only baby teeth that are affected. Some of the short-term issues include:

  • Significant pain
  • Chewing difficulty
  • Poor speech articulation
  • Poor sleep habits
  • Lowered self-esteem
  • Poor school performance

Cavities can even increase the chances of a child getting an infection in a different part of the body, like the ears and sinuses. If left untreated, cavities can lead to infections that damage emerging permanent teeth. Cavities in kids now make it more likely for the child to suffer poorer dental health later.

SDF vs. Drilling and Filling

Silver diamine fluoride treatment is one of the best alternatives to filling cavities in baby teeth. Of all the options for treating cavities and tooth decay in toddlers and children, SDF is the least invasive. Consider the alternative — classic fillings. The process requires around an hour at the dentist’s office. The dentist first numbs the teeth, gums, and skin surrounding the mouth to prevent pain during the procedure. The dentist then drills the decay out of the affected teeth and replaces it with a dental paste for cavities made of silver amalgam, composite resin or other materials.

While the process of getting a filling is relatively short, it can be a scary ordeal for a child. The sound of the drill in combination with the strange sensation of mouth-numbing can throw kids into a panic. Because the drilling process must be precise, especially when handling smaller teeth, there is a certain level of cooperation that must be met in order to do fillings on young children.

The complete filling procedure can be stressful, but it’s necessary to restore teeth in the long term. If the affected teeth are baby teeth, however, it may not be worth it to restore them. SDF works as an alternative cavity treatment by stopping tooth decay from getting worse. It doesn’t restore the teeth — it works as a stop-gap solution while you’re waiting for baby teeth to fall out.

Is Silver Diamine Fluoride Treatment Right for My Child?

Is SDF Treatment Right for My Child

As a parent, you likely have more questions about silver treatment for cavities and wonder if it really is right for your child. Here are some of the specific situations in which SDF makes the ideal child tooth cavity treatment:

  • Babies and toddlers: Many parents aren’t sure about baby tooth decay treatment and don’t know how to treat cavities in toddlers. Their teeth are tiny, they don’t hold still and the younger the child, the greater the risk associated with sedation. SDF can keep teeth from decaying further until they fall out.
  • Multiple cavities: When a child has a significant number of cavities, the filling process only becomes longer and leads to more discomfort after the fact. Since an SDF treatment can cover up to about eight teeth at once, it’s an effective solution for children with several affected teeth.
  • Special needs: Children of all ages with special needs may not have the ability to restrict their own movement enough to receive numbing, and may not be able to understand the process enough to remain calm. SDF can treat their cavities in just minutes, without causing undue distress.
  • Older kids: Baby teeth don’t fall out all at once, and kids up to age 12 or 13 may be dealing with tooth decay in baby teeth as their permanent teeth come in. With a skilled application, SDF can keep decaying baby teeth from negatively impacting surrounding permanent teeth as they emerge and develop.
  • Genetic predisposition: If you have a family history of cavities, it’s wise to use SDF to lower your child’s risk of developing them. The internationally-recognized safety of silver diamine fluoride makes it an excellent tool for preventing cavities, not just treating them after they have occurred.

Overall, SDF is a highly effective child tooth decay treatment option for infants all the way through the loss of the last baby tooth. It also gives a boost to the health of permanent teeth and can set your child up for better dental health throughout their lifetime. With the low cost and minimal downtime, SDF is a powerful solution in almost any scenario where baby teeth are decaying or at risk of decay. There are, however, a few situations where SDF is not recommended. Patients who shouldn’t undergo SDF include:

  • Those who are allergic to silver
  • Those who have an oral ulcerative condition like gingivitis or lichen planus
  • Those who have significant damage to front teeth or who don’t want to have stained teeth at all

For many parents who consider SDF for kids, the biggest worry is how the black staining will affect their child’s smile. It’s important to remember that the extent of the staining is tied to the extent of the tooth decay. If the damage extensive enough that using SDF would create a large area of black, the pediatric dentist may recommend removing the tooth instead. SDF is usually only recommended in cases where the extent of tooth decay will not result in an excessive blackening of the teeth.

Talk With Your Pediatric Dentist About SDF

Ultimately, the only way to determine whether silver diamine fluoride treatment is right for your child is to ask your pediatric dentist about it. Not every dental practice offers this form of treatment, and it’s important to choose a dental team that’s trained and knowledgeable about this relatively new solution.

If you’re looking for quality dental care and SDF treatment for your child in Portland, you’ll find the best of the best at Sprout Pediatric Dentistry. Our dental team is well-versed in every recognized treatment and prevention program for cavities. In Oregon, dental hygienists and dentists can apply an SDF treatment so your child can receive effective treatment with little waiting time.

We invite you to learn more about what sets Sprout Pediatric Dentistry apart by requesting an appointment. Based on the information you share about your child and their current needs, we’re happy to answer any and all questions you have about silver diamine fluoride and other pediatric dental treatments.

About Us

We are a specialty practice providing pediatric dental care & children's orthodontics, including braces and Invisalign, in the Portland area.

Call 503-477-9911 to make an appointment.

We look forward to meeting you.

Sprout Pediatric Dentistry & Orthodontics
1401 SE Morrison St. Ste 120, Portland, OR 97214

Phone: 503.477.9911

Email: info@sproutpediatricdentistry.com

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