Caries Management

All stages of dental caries require treatment.

  • Fluoride varnish may arrest small cavitated lesions and prevent development of new lesions
  • Comprehensive dietary and oral hygiene counseling
  • 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 stabilization. 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 out-weigh its possible undesirable effects.
  • As SDF use continues to gain traction in the dental community, it important that primary care providers be able to recognize signs of treated disease.


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.

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.