✅ Abstract
Silver Diamine Fluoride (SDF) has emerged as a non-invasive and cost-effective treatment for managing dental caries in children.
📌 Recommended Article :
Dental Article 🔽 Fluoride Varnish in Pediatric Dentistry: Benefits, Indications, Mechanism, and Application Protocol ... Fluoride varnish is a topical treatment used to prevent, slow down, or even reverse the early stages of dental caries in children. Due to its ease of application, safety, and efficacy, it has become an essential part of caries management in clinical pediatric practice.This review explores its mechanism of action, clinical indications, advantages, and limitations compared to other fluoride therapies used in pediatric dentistry.
Advertisement
✅ Introduction
Dental caries remains one of the most prevalent chronic diseases in children worldwide. Managing early lesions in young or uncooperative patients is often challenging. In recent years, Silver Diamine Fluoride (SDF) has gained significant attention for its ability to arrest carious lesions without the need for mechanical removal or anesthesia.
Approved by the U.S. Food and Drug Administration (FDA) in 2014 as a desensitizing agent, SDF is now widely used off-label for caries control, particularly in pediatric and special needs dentistry.
📌 Recommended Article :
Dental Article 🔽 Fluoride Varnish for Preventing and Treating White Spot Lesions: Clinical Evidence and Best Practices ... White spot lesions (WSLs) are the first visible signs of enamel demineralization, frequently seen in pediatric and orthodontic patients. These non-cavitated carious lesions are reversible in early stages through non-invasive methods.✅ Composition and Mechanism of Action
SDF is a colorless liquid containing approximately 38% silver (Ag), ammonia, and fluoride ions (F⁻). The silver component acts as an antimicrobial agent, while the fluoride promotes remineralization of demineralized enamel and dentin.
The mechanism of action involves:
▪️ Inhibition of bacterial growth by disrupting cell walls and enzyme systems.
▪️ Formation of silver phosphate and calcium fluoride, which enhance enamel resistance.
▪️ Blocking dentinal tubules, reducing sensitivity and preventing further bacterial invasion.
SDF not only arrests active lesions but also prevents secondary caries formation.
📌 Recommended Article :
Webinar 🔽 Webinar: Silver Diamine Fluoride – A Silver Renaissance in Dentistry - Dr. Anas Al Salami ... Its ability to arrest decay without drilling provides a minimally invasive alternative that supports both restorative goals and behavioral management.✅ Clinical Applications
SDF is indicated for:
▪️ Arresting active carious lesions in primary teeth.
▪️ Patients with behavioral or medical limitations who cannot tolerate conventional treatment.
▪️ Early childhood caries (ECC) management.
▪️ Geriatric patients or those with high caries risk.
The standard application uses 38% SDF solution, typically applied with a microbrush for 1–3 minutes and repeated every 6–12 months.
📌 Recommended Article :
Dental Article 🔽 Silver Diamine Fluoride in Pediatric Dentistry: Clinical Guide 2025 ... Its topical application allows the arrest of carious lesions without the need for invasive procedures, making it especially useful in children with high caries risk, behavioral challenges, or limited access to dental care.✅ Advantages
▪️ Non-invasive and painless: Ideal for anxious or very young children.
▪️ Arrests caries effectively with minimal discomfort.
▪️ Cost-effective and requires minimal equipment.
▪️ Antibacterial and remineralizing effects act synergistically.
▪️ Can be combined with glass ionomer cements (SMART technique) for aesthetic coverage.
📌 Recommended Article :
Video 🔽 How to Apply: Clinpro Sealant - Step by step ... Dental sealants are flowable resins that are placed in the pits and fissures of teeth (usually molars) to prevent cavities. The sealant is placed when the permanent molars erupt (approximately 6 years).✅ Limitations and Disadvantages
▪️ Black staining of arrested lesions due to silver oxidation is the most reported drawback.
▪️ Unpleasant metallic taste and potential temporary gingival irritation.
▪️ Limited esthetic acceptance in anterior teeth.
▪️ Not effective for deep carious lesions requiring pulp therapy.
▪️ Requires parental consent and clear communication about expected discoloration.
📊 Comparative Table: Silver Diamine Fluoride vs. Topical Fluoride Varnishes in Pediatric Dentistry
| Aspect | Advantages | Limitations |
|---|---|---|
| Silver Diamine Fluoride (SDF) | Arrests active caries, antibacterial, non-invasive, affordable | Causes black staining, metallic taste, limited aesthetic use |
| Topical Fluoride Varnish | Enhances remineralization, prevents early lesions, aesthetically acceptable | Requires repeated applications, does not arrest existing cavitated lesions |
| Fluoride Gel or Foam | Quick application, broad preventive use | Less effective for deep lesions, risk of ingestion in young children |
Several clinical trials confirm that SDF arrests more than 80% of active caries lesions in primary teeth after a single application (Chu et al., 2002; Fung et al., 2018). When combined with proper oral hygiene and fluoride toothpaste use, SDF can significantly reduce the progression of dental caries in children.
However, aesthetic concerns limit its use in visible areas. For this reason, topical fluorides or varnishes remain preferred for preventive purposes, while SDF is prioritized for caries arrest in posterior teeth or non-aesthetic zones.
✍️ Conclusion
Silver Diamine Fluoride is a revolutionary agent in pediatric dentistry, offering a simple, effective, and affordable solution for managing caries without invasive procedures. Although tooth staining remains a major limitation, its clinical efficacy and safety make it an essential tool, especially in community or preventive dental programs.
📌 Recommended Article :
PDF 🔽 Fluoride Varnish in the Prevention of Dental Caries in Children and Adolescents: A Systematic Review ...The application of fluoride varnish is an effective method against tooth decay that can appear in the primary or permanent dentition. It is also effective in treatments against tooth sensitivity.🔎 Recommendations
▪️ Use SDF as part of comprehensive caries management in children.
▪️ Combine with fluoride varnish for preventive reinforcement.
▪️ Educate parents about aesthetic outcomes and obtain informed consent.
▪️ Conduct regular follow-ups to monitor lesion arrest.
📚 References
✔ Chu, C. H., Lo, E. C. M., & Lin, H. C. (2002). Effectiveness of silver diamine fluoride and sodium fluoride varnish in arresting dentin caries in Chinese pre-school children. Journal of Dental Research, 81(11), 767–770. https://doi.org/10.1177/154405910208101108
✔ Fung, M. H. T., Duangthip, D., Wong, M. C. M., Lo, E. C. M., & Chu, C. H. (2018). Arresting dentine caries with different concentration and periodicity of silver diamine fluoride. Journal of Dentistry, 77, 52–58. https://doi.org/10.1016/j.jdent.2018.07.006
✔ Horst, J. A., Ellenikiotis, H., & Milgrom, P. L. (2016). UCSF protocol for caries arrest using silver diamine fluoride: Rationale, indications, and consent. Journal of the California Dental Association, 44(1), 16–28.
✔ Mei, M. L., Ito, L., Cao, Y., Lo, E. C. M., & Chu, C. H. (2013). Inhibitory effect of silver diamine fluoride on dentine demineralisation and collagen degradation. Journal of Dentistry, 41(9), 809–817. https://doi.org/10.1016/j.jdent.2013.06.009
📌 More Recommended Items
► Fluoride varnish application in children
► Use of Silver Diamine Fluoride (SDF) - General Guide on its application
► Fluoride Varnish for Adults: Benefits, Mechanism of Action, and Application Guidelines
