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Treatment of decayed teeth using Silver Diamine Fluoride (SDF)

What is Silver Diamine Fluoride (SDF)?

Silver diamine fluoride (SDF) is an antimicrobial liquid that is painted onto decayed baby teeth to treat the decay. It is composed of two primary components: silver and fluoride.

Silver acts as an anti-microbial that can inhibit the decay causing bacteria and possibly halt the progress of the decay.

Fluoride is the active ingredient and it strengthens enamel which can prevent additional decay from occurring.

SDF works by allowing the soft decayed part of the tooth to harden. It can help to keep the decayed teeth stable until the tooth falls out, if it is a baby tooth or your child is able to manage to have a filling.


  • This treatment carries very little risk and generally has no side effects
  • Application is quick, pain-free and does not involve the use of a drill
  • It can stop tooth decay and help to prevent it reoccurring in the same area


Before and after silver diamine fluoride treatment.

  • SDF does make the decayed part of the tooth surface that it is applied to permanently black in colour. Healthy enamel remains stain free and is not changed by SDF
  • It can stain lips and gums if it touches them but this will wear away after a few weeks, we will do what we can to prevent this from happening

Other things to be aware of

  • SDF is not a filling so if there is a large hole in a tooth this will remain and may require a filling to stop food trapping in there.
  • Further application may be necessary.
  • If the nerve of the tooth has been affected, SDF cannot be used
  • SDF is not licensed for this use in the UK and therefore it is being used as an off label cariostatic (decay preventing) agent. It is used in many other countries including the US, Australia, Brazil, China, Hong Kong and Japan which supports the use of SDF as a cariostatic agent.

From a safety point of view SDF has great appeal. It allows treated teeth to stay in place for longer thus keeping space for the adult teeth to erupt into the correct position.

Treated teeth usually no longer cause the pain or sensitivity that you would normally associate with a hole in a tooth.

When do we recommend the use of Silver diamine fluoride?

  1. Children who have difficulty sitting still for treatment for a period of time and/or are too young to understand exactly what is happening: SDF can keep the baby teeth from decaying further until they fall out.
  2. Children with multiple cavities that may not all be treated in one visit
: When a child has a significant number of cavities, the filling process can be quite lengthy. Since SDF treatment can cover up to about 8 teeth at once, it’s an effective solution for children with several affected teeth
  3. Special needs patients: 
Children of all ages with special needs may not have the ability to restrict their own movement enough to receive numbing, and may not be able to understand the process enough to remain calm. SDF can treat their cavities in just a few minutes, without causing unnecessary distress
  4. Older children: 
Baby teeth don’t fall out all at once, and children up to age 12 or 13 may be dealing with tooth decay in baby teeth as their permanent teeth come in. SDF can keep decaying baby teeth from impacting surrounding permanent teeth as they emerge and develop and can help to avoid pain and discomfort for the child.

Alternative treatment

Depending on the location and how advanced the decay is, other options for treatment are to apply fluoride varnish, do a filling or crown or of course do nothing and monitor the tooth at each visit.

SDF does not guarantee the decay will not progress and reapplication or perhaps other treatments such as placing a filling may still be necessary.

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