SILVER DIAMINE FLUORIDE (SDF)
Silver diamine fluoride: a simple preventive treatment with major potential
Silver diamine fluoride has been used in Japan for more than 70 years and has been applied millions of times, with a strong safety record. It has also been licensed in the USA for over 10 years and is available on prescription in the UK.
When applied regularly, usually twice a year, silver diamine fluoride has the potential to significantly reduce tooth decay in children and may help prevent many cases from progressing to the point where treatment under general anaesthetic is needed.
In care homes, it could also play an important role in reducing tooth decay among frail older adults and may have benefits for gum health. Early research suggests it may help improve periodontal health, and further research is needed to explore whether better oral health in care homes could also reduce the risk of serious infections such as pneumonia.
For dentists, the video below explains how silver diamine fluoride can be used when treating a child.
The final five minutes show how a dental nurse, working within appropriate training, prescription, consent, and professional guidance, could support the treatment of a care home resident.
Silver diamine fluoride has been used in Japan for more than 70 years and has been applied millions of times, with a strong safety record. It has also been licensed in the USA for over 10 years and is available on prescription in the UK.
When applied regularly, usually twice a year, silver diamine fluoride has the potential to significantly reduce tooth decay in children and may help prevent many cases from progressing to the point where treatment under general anaesthetic is needed.
In care homes, it could also play an important role in reducing tooth decay among frail older adults and may have benefits for gum health. Early research suggests it may help improve periodontal health, and further research is needed to explore whether better oral health in care homes could also reduce the risk of serious infections such as pneumonia.
For dentists, the video below explains how silver diamine fluoride can be used when treating a child.
The final five minutes show how a dental nurse, working within appropriate training, prescription, consent, and professional guidance, could support the treatment of a care home resident.
It has just been added to the 2025 WHO Model List of Essentail medicines. We need to promote it as a form of paliative care for children to avoid childhood dental extrations, adults to "but time" before treatment time and finance are available, and the frail to secure a comforatable and dignified end of life. https://en.wikipedia.org/wiki/WHO_Model_List_of_Essential_Medicines
The following is a YouTube teeth4life video shorts list aimed at the public to explain how it works.
Silver Diamine Fluoride (SDF)has a long and interesting history in dentistry, evolving from traditional practices to modern preventive care:
1. Origins and Early Use (1960s - Japan)
- The development of SDF dates back to the 1960s in Japan, where it was introduced as a treatment for dental caries (cavities). It combines silver, a known antimicrobial agent, with fluoride, which strengthens tooth enamel and prevents demineralization.
- SDF was primarily used to arrest (halt) caries in children and adults, particularly for those who were unable to tolerate conventional restorative treatments, such as elderly patients or individuals with special healthcare needs.
2. Mechanism of Action
- SDF works by both inhibiting bacterial activity (silver component) and remineralizing the tooth structure (fluoride component). The silver ions act to kill cariogenic bacteria, while the fluoride promotes the formation of fluorapatite, which is more resistant to acid attack than hydroxyapatite, the natural form of enamel.
3. Global Adoption (2000s)
- While it was primarily used in Japan for several decades, SDF slowly gained attention in other countries for its effectiveness in caries management, especially in public health settings or for populations with limited access to dental care.
- The clinical success of SDF in Japan and other countries led to increased research and trials in countries such as the United States and other parts of the world.
4. FDA Clearance (2014 - USA)
- In 2014, the U.S. Food and Drug Administration (FDA) cleared SDF for use as a "desensitizing agent." Although it wasn't initially approved specifically for caries arrest, dentists recognized its potential for treating carious lesions, especially in pediatric and geriatric populations.
- By 2016, SDF began gaining widespread attention in the U.S. as researchers published data showing its efficacy in arresting caries without the need for invasive drilling or restorations, especially in cases where traditional dental care was inaccessible or undesired.
5. Increased Popularity (2016 - Present)
- Since its introduction in the U.S., SDF has become an increasingly popular non-invasive option for managing dental caries, especially in public health dentistry, pediatric dentistry, and for use in populations with special healthcare needs.
- It is now recognized as a valuable tool in minimally invasive dentistry, emphasizing caries prevention and management over invasive, restorative procedures.
- Its ability to arrest caries has made it an attractive option in managing cavities in both primary and permanent teeth, as well as a preventive measure in community dental health programs.
6. Modern Applications
- SDF is widely used to treat early childhood caries, manage root caries in the elderly, and prevent caries progression in areas where traditional dental care is difficult.
- Despite its success, the main drawback of SDF is that it stains decayed tooth areas black, which can be a cosmetic concern. However, in cases where esthetics are less of a priority, its benefits far outweigh this side effect.
In summary, SDF has evolved from a niche treatment in Japan to a globally recognized tool in modern dentistry, revolutionizing how we approach caries prevention and management in underserved populations.
