Caries Management
All stages of dental caries require treatment.
- Fluoride varnish may arrest small cavitated lesions and prevent development of new lesions.
- For a comprehensive overview of Fluoride varnish indications, risks & benefits, application, and billing, visit the Risk Assessment and Fluoride Varnish module.
- Comprehensive dietary and oral hygiene counseling.
- Silver Diamine Fluoride can be applied to mild or moderate cavities to slow progression to severe disease.
- Urgent dental referral for comprehensive treatment.
- Small cavities may be stabilized using fluoride releasing restorative materials.
- Severe cavities require extractions, fillings, and/or root canals.
Rocio Quinonez, DMD
Silver Diamine Fluoride (SDF) is a newer modality for cavity treatment and stabilization in primary care.
- SDF is a colorless liquid containing silver particles and fluoride.
- How does it work? SDF has antibacterial properties acts as a physical barrier, and the fluoride strengthens enamel.
- SDF arrests caries ~ 70% of the time. It is easily applied in an outpatient dental setting without use of anesthesia. The process to apply SDF is 1-2 drops of SDF with a microbrush, wait 30-60 seconds, follow up in 1-2 weeks to assess hardness. If enamel is not sufficiently hard, reapply SDF.
- Application every 6 months is better than when it is applied annually (38% vs 12%) due to increased silver and fluoride exposure.
- Disadvantage: SDF stains the treated area of the tooth black, but does not stain intact enamel. SDF may temporarily stain unprotected soft tissues.
- Silver allergy is the only known contraindication. No toxicity or adverse events associated with SDF have been reported.
- The American Academy of Pediatric Dentistry published a recommendation in 2018 that the benefits of SDF application in the target populations outweigh the possible undesirable effects.
- As SDF use continues to gain traction in the dental and medical communities, it important that primary care providers be able to recognize signs of treated disease.
Use of silver diamine fluoride (SDF) is an additional tool that primary care providers can use to provide dental treatment for children who are unable to access a dental home.
For a comprehensive overview of SDF indications, risks & benefits, SDF application, and billing, visit the SFL Silver Diamine Fluoride module.
References
American Academy of Pediatric Dentistry. Caries-risk assessment and management for infants, children, and adolescents. The Reference Manual of Pediatric Dentistry. Chicago, IL: American Academy of Pediatric Dentistry; 2025:325-31.
Crystal YO, Marghalani AA, Ureles SD, et al. Use of silver diamine fluoride for dental caries management in children and adolescents, including those with special health care needs. Pediatr Dent 2017; 39(5): E135-E145.
Crystal YO, Niederman R. Evidence-Based Dentistry Update on Silver Diamine Fluoride. Dent Clin North Am. 2019; 63(1): 45-68.
Fung MHT, Duangthip D, Wong MCM, Lo ECM, Chu CH. Randomized Clinical Trial of 12% and 38% Silver Diamine Fluoride Treatment. J Dent Res. Feb 2018;97(2):171-178.