Science in the News
Silver Diamine Fluoride in Caries Management
July 12, 2016
A recent article in the New York Times
highlighted use of silver diamine fluoride (SDF) as an alternative approach to treatment of cavities in children.1
The article highlighted that SDF was faster and cheaper than drilling and filling; and it mentioned the downside that when applied, SDF blackens the tooth.
Silver diamine fluoride (SDF) is a colorless liquid that at pH 10 is 24.4% to 28.8% (weight/volume) silver and 5.0% to 5.9% fluoride.2
Just as 5% sodium fluoride varnish has FDA clearance as a Class II medical device for the treatment of tooth hypersensitivity, FDA classified SDF as a fluoride and cleared its use as a Class II medical device for the same indication. A number of products are currently available in other countries, but at this time, Advantage Arrest™ (Elevate Oral Care, L.L.C.) is the only commercially available SDF product for dental treatment in the U.S.3
Although FDA-cleared for use in the management of hypersensitivity, SDF received coverage in the Times
for its use in treating cavities in children, although this might be more accurately described as caries control and management. Likely a result of its fluoride content, when applied to a carious lesion, SDF has also been shown to lower caries risk of the adjacent tooth surface.4
While the Times
article focused on the use of SDF in young children, it has also been shown to be effective in management of root caries in the elderly.5, 6
It likely has additional applicability as an interim approach for managing problematic caries in individuals currently unable to tolerate more involved dental treatment.
SDF is not a complete solution to caries risk. Single application has been reported to be insufficient for sustained benefit.7
Its downsides include a reportedly unpleasant metallic taste, potential to irritate gingival and mucosal surfaces, and the characteristic black staining of the tooth surfaces to which it is applied.3
A search of ClinicalTrials.gov for silver diamine fluoride returned 14 studies; 7 of which have been completed, 5 that are recruiting, and 2 that have not yet begun recruiting.8
This suggests that more scientific insight and news will likely be forthcoming about this product.
- Saint Louis C. A Cavity-Fighting Liquid Lets Kids Avoid Dentists' Drills. New York Times 2016. http://www.nytimes.com/2016/07/12/health/silver-diamine-fluoride-dentist-cavities.html. Accessed July 11, 2016.
- Mei ML, Chu CH, Lo EC, Samaranayake LP. Fluoride and silver concentrations of silver diammine fluoride solutions for dental use. Int J Paediatr Dent 2013;23(4):279-85.
- Mei ML, Lo EC, Chu CH. Clinical Use of Silver Diamine Fluoride in Dental Treatment. Compend Contin Educ Dent 2016;37(2):93-8; quiz100.
- Llodra JC, Rodriguez A, Ferrer B, et al. Efficacy of silver diamine fluoride for caries reduction in primary teeth and first permanent molars of schoolchildren: 36-month clinical trial. J Dent Res 2005;84(8):721-4.
- Li R, Lo EC, Liu BY, Wong MC, Chu CH. Randomized clinical trial on arresting dental root caries through silver diammine fluoride applications in community-dwelling elders. J Dent 2016.
- Zhang W, McGrath C, Lo EC, Li JY. Silver diamine fluoride and education to prevent and arrest root caries among community-dwelling elders. Caries Res 2013;47(4):284-90.
- Horst JA, Ellenikiotis H, Milgrom PL. UCSF Protocol for Caries Arrest Using Silver Diamine Fluoride: Rationale, Indications and Consent. J Calif Dent Assoc 2016;44(1):16-28.
- U.S. National Institutes of Health. ClinicalTrials.gov search for silver diamine fluoride. https://clinicaltrials.gov/ct2/results?term=silver+diamine+fluoride&Search=Search. Accessed July 11, 2016.
About Science in the News
Science in the News is a service by the American Dental Association (ADA) to its members to present current information about science topics in the news. The ADA is a professional association of dentists committed to the public's oral health, ethics, science and professional advancement; leading a unified profession through initiatives in advocacy, education, research and the development of standards. As a science-based organization, the ADA's evaluation of the scientific evidence may change as more information becomes available. Your thoughts would be greatly appreciated.