What is Silver Diamine Fluoride (SDF) and is it an option for your child?
1. What is Silver Diamine Fluoride (SDF)?
Silver diamine fluoride is an antimicrobial topical medicament used to slow down or arrest
dental caries in both primary and permanent teeth. At this time, Advantage Arrest™
(Elevate Oral Care, L.L.C.) is the only commercially available SDF product in the U.S. It is
cleared by the FDA as a medical device to treat dentin hypersensitivity and used “off label” to
treat dental caries.
2. How does it work?
SDF is currently a colorless liquid applied directly on exposed carious dentin with a
microbrush or other technique. Caries arrestment occurs through the free silver ion
inactivation of bacterial metabolism and remineralization occurs through topical fluoride
3. How effective is SDF?
Limited clinical studies indicate that SDF is effective in 70% – 90% of treated teeth and
reapplication at predetermined intervals increase effectiveness. Since SDF is not effective,
however, in all teeth in all circumstances, follow-up evaluation by the dentist is necessary to
determine when other interventions are indicated.
4. What are the benefits?
The benefits of SDF include its ease of application, effectiveness, low placement cost and
avoidance of intense interventions such as administration of local anesthesia, pharmacologic
sedative management, and protective restraint in very young and special needs populations.
5. What are the side effects, risks and other considerations?
SDF will turn carious dentinal lesions a dark black color. This may be a concern to patients
or parents, especially in the anterior dentition. As with all procedures, an informed consent
should be obtained containing this information and the risks/benefits/alternatives to SDF. If
SDF comes in contact with the skin or oral mucosa, it will leave a temporary superficial stain
or “tattoo” which will resolve in two to 14 days with the exfoliation of the superficial cell
layer. Definite contraindication is a silver allergy. Relative contraindications include
significant desquamative gingivitis, mucositis, or open mucosal lesion. Of concern is the
potential assumption by the patient or parent that SDF is definitive care. Treated areas must
be actively monitored by a dentist following SDF application.
More information about SDF can be found at AAPD.org