Silver Diamine Fluoride

Medically Reviewed By William C. Lloyd III, MD, FACS

What is silver diamine fluoride?

Silver diamine fluoride is a substance used to stop dental cavities from progressing. It has been available in other parts of the world for several decades after first being used in Japan 80 years ago. The product was approved for use in the United States by the Food and Drug Administration (FDA) in 2014. The colorless liquid is applied directly to the tooth or teeth that have cavities. The biggest advantage of using silver diamine fluoride, particularly for children, is the person keeps the tooth; it does not have to be removed.

Silver diamine fluoride is not a sealant. Instead, silver diamine fluoride creates a seal over an existing cavity. Silver has antibiotic properties and fluoride helps strengthen teeth. Sealants are applied to children’s teeth to protect them from cavities.

Why is silver diamine fluoride used?

Silver diamine fluoride treatment keeps cavities from worsening and from being a site for a potential infection. As it protects the damaged tooth, silver diamine fluoride also protects the surrounding teeth.

Dentists also may use it on exposed root surfaces in older adults to prevent cavities.

Dentists can use silver diamine fluoride on most of their patients, but it is particularly helpful for children and for those who cannot get to a traditional dentist office or clinic. This procedure is much faster than fillings and extractions and it is easier to tolerate. Other people who could benefit from silver diamine fluoride treatment include those who:

  • Are seniors 

  • Have several cavities that would require more than one appointment to fix

  • Have medical issues that could make it difficult to tolerate traditional cavity treatments (fillings or extraction)

  • Cannot sit still in a dentist chair for extended periods

  • Cannot follow commands

  • Cannot afford more expensive treatments

Who applies silver diamine fluoride?

Dental and medical professionals can apply silver diamine fluoride after receiving special training on how to use the product. This includes dentists, dental hygienists (in many states), doctors, and nurses.

If you have dental insurance, check with your insurance company to verify which professionals they will reimburse for this treatment.

How is silver diamine fluoride applied?

The biggest advantage to using silver diamine fluoride is the ease and speed of the treatment. Here are the steps:

  • The tooth or teeth are cleaned to ensure there is no debris that will get caught under the product.

  • Depending on the practice and the patient, the practitioner may apply special coating to the lips and skin around the mouth, to keep the product from staining them.

  • Protective ointment is applied to the gums around the affected tooth and gauze or cotton rolls will isolate the tooth or teeth from the gums and inside of the mouth.

  • The practitioner then uses a very fine brush or applicator to apply the liquid to the tooth surface, being careful to remove any that touches the gum or any other tissue.

  • Ideally, the process should take about one full minute, although it can be for a shorter period if the patient finds it hard to manage.

  • The practitioner aims a gentle spray of compressed air, for about three minutes, to dry the area. 

The practitioner may apply a varnish treatment on all the teeth.

There should be a follow-up visit 2 to 4 weeks after the treatment. The practitioner examines the teeth and may decide to apply more silver diamine fluoride. Alternatively, the product can be reapplied twice a year until the cavity is fixed or the tooth is extracted.

What are the risks and potential complications of silver diamine fluoride?

Overall, silver diamine fluoride is relatively safe, but it is a medical product and there is a chance of a side effect.

Potential side effects or adverse effects of silver diamine fluoride

Although side effects are not common, some potential side effects include:

  • Gum irritation

  • Stains on the gums and skin, which usually fade away after a few days

  • Permanent black stains on the treated tooth or teeth

  • Metallic taste (temporary)

  • Allergic reaction

How do I prepare for silver diamine fluoride?

Preparing for silver diamine fluoride treatment is the same as for a routine dental appointment. Be sure to brush and floss your teeth before your appointment if you can, although the dental hygienist or dentist will ensure your teeth are clean before proceeding.

Questions to ask your dentist

To prepare for your appointment, you may choose to ask questions about the treatment, such as:

  • What do I need to do before I come for my appointment?

  • How long will the procedure last?

  • How many teeth will receive the silver diamine fluoride?

  • How long do I have to wait before I can eat or drink?

  • Is there anything I should avoid eating or drinking?

  • What are the known side effects of silver diamine fluoride?

  • When do I need to return for a checkup?

  • Is there anything I should watch out for that may tell me that the product is not working?

What can I expect after silver diamine fluoride?

You may notice your cavities are now stained black. This is normal. If you see the stain on your skin or gums, it will wear off in 1 to 3 weeks.

Before you leave the office, you should have an appointment for a follow-up visit so the dentist can see if the silver diamine fluoride is working. If not, you might have a repeat application. If all looks well, your dentist will recommend and possibly schedule you for repeat applications, which is usually twice a year.

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  1. Oliveira BH, Cunha-Cruz J, Rajendra A, Niederman R. Controlling caries in exposed root surfaces with silver diamine fluoride: a systematic review with meta-analysis. JADA. 2019;150(1):e3. https://jada.ada.org/article/S0002-8177(18)30460-4/fulltext
  2. Silver Diamine Fluoride. American Dental Association. https://www.ada.org/resources/research/science-and-research-institute/oral-health-topics/silver-diamine-fluoride
  3. Silver diamine fluoride arrests untreated dental caries but has drawbacks. AAP News & Journals. https://www.aappublications.org/news/2016/08/05/SilverDiamine080516
  4. Crystal YO, Niederman R. Evidence-Based Dentistry Update on Silver Diamine Fluoride. Dental Clinics of North America. 2019;63(1):45–68. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6500430/
  5. Kerns KA. What You Should Know About Silver Diamine Fluoride. Northwest Bulletin, family and child health; School of Public Health. https://depts.washington.edu/nwbfch/silver-diamine-fluoride-SDF-for-children-cavities
  6. Seifo N, Robertson M, MacLean J, et al. The use of silver diamine fluoride (SDF) in dental practice. Br Dent J 2020;228:75–81. https://doi.org/10.1038/s41415-020-1203-9 https://www.nature.com/articles/s41415-020-1203-9
  7. 510(k) Premarket Notification. U.S. Food and Drug Administration. https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?ID=K102973
  8. UW dental research team receives breakthrough therapy designation from the FDA. Institute of Translational Health Sciences; University of Washington. https://www.iths.org/news/iths-research-units/uw-dental-research-team-receives-breakthrough-therapy-designation-from-the-fda/
  9. Dental Sealants. American Dental Association. https://www.ada.org/resources/research/science-and-research-institute/oral-health-topics/dental-sealants
  10. Horst JA, Ellenikiotis H, Milgrom PL. UCSF Protocol for Caries Arrest Using Silver Diamine Fluoride: Rationale, Indications and Consent. Journal of the California Dental Association. 2016;44(1):16–28. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4778976/
  11. State Specific Information on Silver Diamine Fluoride. American Academy of Dental Hygienists. https://www.adha.org/resources-docs/Silver_Diamine_Fluoride_State_by_State_Information.pdf
  12. Barras F, Aussel L, Ezraty B. Silver and Antibiotic, New Facts to an Old Story. Antibiotics (Basel, Switzerland), 2018;7(3):79. https://doi.org/10.3390/antibiotics7030079 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6163818/
  13. Chairside Guide: Silver Diamine Fluoride in the Management of Dental Caries Lesions. American Academy of Pediatric Dentistry. https://www.aapd.org/media/Policies_Guidelines/R_ChairsideGuide.pdf
Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Dec 15
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