Little Pearls Dentistry For Children

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Silver Diamine Fluoride


Silver Diamine Fluoride is a product that is painted on areas of active caries (cavities) for the purpose of stopping, or arresting the caries. Products like it have been used in Japan for 80 years and in parts of Europe for decades. We are excited to offer this treatment for cavities and hope that it will lead to a significant reduction in the number of cavities requiring treatment.

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Silver nitrate has been successfully used by dentists since the 1800’s.

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We will begin by determining if your child is a good candidate for SDF treatment. SDF is usually a good option for very young children or children with special needs as it helps to stabilize the cavity until the child is older and can receive treatment without sedation.


After your child is approved for SFD treatment, we will dry the teeth with air, and then apply the silver diamine fluoride. It will be left in place for one to two minutes. It is as simple as that! No numbing or drilling needed.


SFD is not always a permanent solution. We will continue to monitor your child’s cavities. Depending on the rate of progression, we may recommend reapplication of the SDF. If the SDF has not sufficiently kept the cavities from progressing, it may be necessary for you child to have conventional treatment.


Minimally-invasive Treatment

Because the silver diamine fluoride will simply be painted onto the tooth or teeth being treated, this is a completely non-invasive treatment. Plus, it only takes a small amount of the silver diamine fluoride liquid to treat several teeth. In fact, SDF is so concentrated, one drop of SDF can treat up to 5 teeth.

Minimize Exposure To Filling Materials & Sedation

SDF is helpful for some children who may have a sensitivity to certain types of sedation. By postponing treatment until they are older, it may be possible for your child to avoid the need to be sedated during a dental filling procedure, or avoid the filling procedure altogether. SDF treatment does expose your child to a small amount of fluoride, but it is less than the amount of fluoride in preventive topical fluoride applications and contains about the amount of fluoride present in one liter of fluoridated water.

Create Positive Dental Experiences

Since the use of SDF may help your child avoid dental treatment, or at the least delay treatment, one of our goals in recommending it is to limit your child’s treatment needs when he or she is younger. Generally, children do better for treatment as they get older and develop emotional maturity and coping skills.

FDA Approved, Safe Treatment

The FDA has approved silver diamine fluoride as a safe and effective treatment method. While SDF contains silver and fluoride. The silver effectively kills the bacteria present in the cavities. Silver ions are small enough to penetrate the weak parts of the tooth and work to plug up the microscopic holes in the enamel or dentin surface. Since fluoride is a naturally occurring mineral, it is completely safe and actually helps to improve your child’s oral health. It does this by “remineralizing” and strengthening tooth enamel that has been affected by minor decay. Together silver and fluoride can work to safely keep your child’s tooth healthy.


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SDF can prevent cavity growth with a success rate of up to 80% when applied biannually.

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SDF contains two active ingredients, silver and fluoride. The silver actually kills the bacteria present in caries (cavities). In addition, the silver ions penetrate the weak part of the tooth and plug up the microscopic holes in the enamel or dentin surface. This residual silver continues to work at killing additional bacteria resulting in tooth structure that can be immune from further decay. The fluoride then helps to remineralize the weak areas of the tooth. One study showed that applying SDF once a year was more effective in stopping cavities than four applications of fluoride varnish four times a year.

Absolutely not! Since treatment with SDF is non-invasive there is not typically pain. If the liquid gets on the tongue or lips there can be a temporary tingling sensation. There is no need for local anesthesia (numbing) or removal of the decay (drilling). Food debris, if present, is cleaned out, the teeth are gently dried with air, and the SDF solution is applied with a small brush for one minute.

  • For the very young child who has caries (cavities): In the past the only options for treating very young children with cavities was to treat them under duress as well as possible, to treat them under sedation or general anesthesia, or to leave the cavities alone which usually results in worsening of their condition. SDF can now be used to stabilize the cavities until the child is older and can receive treatment without sedation or general anesthesia.
  • For the special needs child: Special needs children often have unmet dental needs. Parents are naturally nervous about how their child will “act” at the dentist so they avoid even taking their child to the dentist. Cavities in special needs kids can be stabilized with SDF, thus avoiding the need for sedation or general anesthesia.
  • For children with cavities in primary (baby) teeth: We weigh many factors when deciding whether cavities in baby teeth need treatment or not. Usually baby molars are lost around the ages of 10-12. For kids with moderate sized cavities, SDF can be used to stabilize the cavities until the teeth are lost. For younger kids with cavities in baby molars, SDF can be used to stabilize cavities and hopefully prevent the need for any treatment at all.
  • For children who display hypoplasia or hypomineralization: Sometimes children have a condition in their enamel called hypoplasia or hypomineralization in which the enamel does not properly calcify. Causes for this condition can be high fevers or illness when younger, antibiotics, prematurity, genetic, and unknown causes. These teeth can decay quickly and are frequently very sensitive. Teeth with hypomineralization can be very painful to have treated even when proper local anesthetic has been provided. SDF can be used to stop the progression of the decay and to even stabilize the weak enamel. By stabilizing the enamel it also provides relief from what can be a very painful condition.
  • For the adolescent with small cavities on the biting surfaces or between the teeth: Although SDF is not as effective for treating cavities between the teeth as it is for treating exposed parts of the teeth, it can stabilize the cavities. Along with changes to diet and hygiene, it is hoped that cavities on the permanent teeth will not progress and will not require treatment. Our goal is to prevent the need for large fillings on kids at such a young age since large fillings can many times lead to larger fillings, crowns, root canal treatment and even tooth loss as a person gets older if the factors that led to the cavities are not addressed and modified.
  • For the parent who wants to avoid treatment and minimize the child’s exposure to filling materials, sedation, general anesthesia and fluoride: Even though SDF does contain fluoride, it is minimal compared with professional topical fluoride and prescription strength fluoride and only contains the amount of fluoride present in one liter of fluoridate water. Additionally, there can be significant cost savings if treatment can be avoided.

SDF has been approved for use by the FDA. Silver nitrate has been successfully used by dentists since the 1800’s without reported incidence. The advent of local anesthesia possibly caused a shift away from the use of silver nitrate since teeth with cavities could be treated without pain. SDF has been used in Australia and parts of Europe for decades, and in Japan for over 80 years without any reported adverse effects. One drop of SDF is usually sufficient to treat up to five teeth. Within that one drop of SDF there is roughly the same amount of fluoride as a properly fluoridated liter of water. Another comparison is that the amount of fluoride is approximately 1/10th of the fluoride found in the topical fluoride varnish we use. The amount of silver is also well within safe limits. While we are not qualified to discuss silver used in other products, it is considered safe by the NIH for some indications. From the NIH website, “Topical silver (used on the skin) has some appropriate medical uses, such as in bandages and dressings to treat burns, skin wounds, or skin infections. It’s also in medicines to prevent conjunctivitis (an eye condition) in newborns.”

Possibly, but there is no guarantee. SDF has been shown to have about an 80% success rate when applied twice per year. 20% of cavities will continue to grow. SDF has been shown to be a little less effective for cavities between the teeth compared to cavities on other surfaces. Along with changes to dietary habits, hygiene, and the use of other “anti-cavity” products, we are hopeful our success rate will exceed 80%!

We are finding that many insurance companies are covering treatment with SDF. Hopefully companies that do not currently cover it will find that this is a more cost effective treatment than traditional dental treatment. To find out if your insurance company covers SDF you can provide them with code D1354 to see if it is a benefit.

There are some downsides. SDF does permanently turn the part of the tooth with decay black. Therefore, it is not indicated for front teeth except in very young children when we want to try to avoid the need for sedation or general anesthesia. It can also discolor weak or hypomineralized enamel. SDF does not always work and will likely need to be reapplied annually. SDF does not fill in any open cavities and may not prevent the need for treatment. Additionally, not all insurance plans cover the treatment. Although it is not a “silver bullet” that works all the time, we are excited that SDF does offer us a conservative method to treat cavities.

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SDF can provide relief from the pain of a toothache caused by tooth decay.

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