Skip to main content
Toggle Menu of ADA WebSites
ADA Websites
Partnerships and Commissions
Toggle Search Area
Toggle Menu
e-mail Print Share
Science in the News

New Guideline Addresses the Use of Silver Diamine Fluoride in Pediatric and Special-Needs Patients

October 13, 2017 The American Academy of Pediatric Dentistry (AAPD) has issued an evidence-based guideline1 that recommends use of 38% silver diamine fluoride (SDF) to treat active dental caries in primary teeth in pediatric and special-needs patients. Although silver diamine fluoride is cleared by the U.S. Food and Drug Administration for use in adults with tooth hypersensitivity, it has been used “off label” for treatment/arrest of caries in children and adults. The AAPD guideline is based on a 2016 systematic review and meta-analysis by Gao et al.2 that evaluated prospective, randomized, and controlled trials published through March 2016. The specific PICO (Population, Intervention, Control, and Outcome) question posed by the guideline panel was, “Does the application of SDF arrest cavitated caries lesions as effectively as other treatment modalities in primary teeth?”

The guideline specifically states that “Prevention of new caries lesion development and outcomes in permanent teeth, such as root caries lesion arrest, were not the focus of this guideline; however, because they are of interest and relevant to caries management within the scope of pediatric dentistry, they are mentioned and will be included in future iterations of the guideline as the supporting evidence base increases.”

Using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to assess the quality of the evidence and formulate recommendations, the SDF panel made a conditional recommendation based on low-quality evidence supporting the use of 38% SDF for the arrest of cavitated caries lesions in primary teeth as part of a comprehensive caries management program. Considering the low cost of the treatment and the disease burden of caries, panel members were “….confident that the benefits of SDF application in the target populations outweigh its possible undesirable effects.” The main disadvantage of SDF is its characteristic black staining of enamel and treated dentinal caries lesions and potential staining of skin, clothing, and surfaces that it comes into contact with.

The guideline panel urged researchers “to conduct well-designed randomized clinical trials comparing the outcomes of SDF to other treatments for the arrest of carious lesions in primary and permanent teeth.”


  1. Crystal YO, Marghalani AA, Ureles SD, et al. Use of Silver Diamine Fluoride for Dental Caries Management in Children and Adolescents, Including Those with Special Health Care Needs. American Academy of Pediatric Dentistry 2017.  Accessed October 12, 2017.
  2. Gao SS, Zhang S, Mei ML, Lo EC, Chu CH. Caries remineralisation and arresting effect in children by professionally applied fluoride treatment - a systematic review. BMC Oral Health 2016;16:12.

Prepared by: Center for Scientific Information, ADA Science Institute

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.

Content on is for informational purposes only, is neither intended to and does not establish a standard of care, and is not a substitute for professional judgment, advice, diagnosis, or treatment. ADA is not responsible for information on external websites linked to this website.