On The Go Dental Group

Silver Diamine Fluoride (SDF)

What is Silver Diamine Fluoride?

  • Silver Diamine Fluoride (SDF) is a clear, odorless, non-toxic liquid that has multiple uses in dentistry. It is used to treat tooth hypersensitivity, help stop cavity enlargement after a cavity has formed, and effectively help prevent further decay.
  • SDF penetrates cavities and kills harmful bacteria that break down tooth surfaces and helps to keep them from spreading to other teeth. It hardens weakened tooth structure and makes it more acid- and wear- resistant.
  • SDF can help keep cavities to a minimum, or prevent them entirely if used as part of a regular preventive dental program with emphasis on good oral hygiene and healthy diet.

Advantages of Silver Diamine Fluoride:

  • Painless and easy application with a small brush.
  • Effective in preventing and arresting the development of cavities.
  • Remineralizers the tooth surface, making the tooth stronger.
  • Relieves tooth sensitivity.
  • If a cavity develops at a restoration margin, SDF can help prevent the cavity from growing, which may postpone or eliminate the need to replace it.
  • SDF can postpone the need for traditional dental treatment (fillings, crowns) and delay/possibly eliminate the need for sedation/general anesthesia for patients who are unable to accept treatment in the dental chair.

Who could benefit from the treatment?

  • Adults who have anxiety about dental treatment or are overly sensitive to the instruments and substances used during conventional cavity treatments.
  • Patients who are not able to fully engage or stay still during dental procedures, such as those with special healthcare needs or medically frail patients. Oftentimes, SDF treatment may help these patients avoid the added cost and risk of hospital dentistry.
  • Older adults who are prone to experience ongoing tooth decay due to various health conditions, chemotherapy, and/or taking multiple medications which cause dry mouth.
  • Patients who are too medically compromised to safely receive dental treatment and present with tooth caries which may be extensive, but is not associated with pain and/or infection. This can be important especially where tooth extractions are contra-indicated for medical or behavioral reasons.
  • Patients with extensive dental disease, the cost of which may be beyond their financial means. Rather than letting the condition get progressively worse, SDF can help halt the disease progress with regular monitoring by a dentist during recall visits, or can help bridge the gap until an individual has the financial means for restorative care.

What are the drawbacks?

  • SDF permanently stains tooth cavities black. This can be a concern for a patient if the area is visible during smiling or talking. However, the dark spots can be covered with tooth-colored material if patient so desires. SDF does not stain healthy tooth structure, only the areas of decay.
  • SDF can temporarily stain skin or gums that come in contact with it during application. This temporary staining can last from 3 days to 3 weeks.
  • It can stain clothes permanently (we take precautions not to).
  • It works best to keep the cavities arrested if it is re-applied periodically in combination with regular dental exams and cleanings.
  • A tooth restoration may still be recommended if SDF treatment is done after a cavity has damaged the tooth to the extent where it is much weaker or experiences food impaction. We are able to provide conventional restorations as well as atraumatic restorative treatment, where local anesthesia and drilling may not be necessary, depending on patient’s needs and wishes.

Is it safe?

  • There are no known side-effects other than cavity staining.
  • It has been used in other countries for more than 80 years without a single adverse event reported.
  • It has been approved for use in the United States by the FDA in 2014.
  • SDF should not be used in people with allergies to silver.
  • If you have ulcerations in your mouth, you should wait until they heal before applying SDF.

Facts to consider:

  • SDF is an antimicrobial liquid placed on cavities to help stop tooth decay. It is also used to treat tooth sensitivity.
  • SDF application every six (6) to twelve (12) months is recommended.
  • Treatment may not eliminate the need for dental fillings or other treatment to repair function or esthetics.
  • The decayed areas will stain black permanently. Healthy tooth structure will not stain. The stain can be masked with a dental restoration.
  • Tooth-colored fillings and crowns may discolor if SDF is applied to them. Color changes on the surface can usually be polished off. The edge between a tooth and a filling may keep the stain.
  • If accidentally applied to skin or gums, a brown or white stain may appear that is not harmful. It will disappear in one to 3 weeks.
  • You may notice a metallic taste. It will go away rapidly.
  • If tooth decay is not arrested, it will progress. In that case the tooth will require further treatment, such as repeat SDF, a filling or a crown, tooth canal treatment, or extraction.
  • Alternatives to SDF: no treatment, fluoride varnish, fillings, crowns, extractions, referral for advanced treatment modalities.
  • Advise your dentist if you have a history of chemical allergies such as silver, fluoride, or ammonia.

Quick, easy, painless Can relieve tooth sensitivity Can help stop tooth decay Prevents biofilm (plaque) adhesion Arrests 80% of cavities when applied twice yearly

Permanently stains cavities black Some cavities may still require restoration Not an option for very deep cavities SDF is a treatment for cavities, not a cure 20% of cavities continue to grow.


Every reasonable effort will be made to ensure the success of your SDF treatment. There is a risk that the procedure will not stop the decay and no guarantee of success is granted or implied.

Proper diet and oral hygiene are very important for long term success.