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Pediatric Dentistry Supporting Your Practice

Silver Diamine Fluoride in Caries Management

Dr. Flavia Lamberghini, Pediatric dentist in Chicago, spoke with Dr, Suham Alexander about silver diamine fluoride and its use in caries management. 


Silver diamine fluoride (SDF), although not currently available in Canada, is a safe and effective topical agent which helps to arrest tooth decay in patients with high caries risk who are unable to tolerate conventional care from the very young to the elderly. It is currently being used in the United States and has been used in Japan for more than 80 years. SDF, a colourless solution with a pH of 10, is composed of silver, fluoride and ammonia.

Mechanism of Action

  • Dentin sensitivity is decreased as a squamous layer of dentin forms after application and partially plugs dentinal tubules
  • Silver and fluoride ions penetrate ~25 microns into enamel and ~50-200 microns into dentin
  • The silver ions form a layer of silver protein increasing resistance to acid dissolution and antimicrobial activity is exerted via inhibition of DNA replication and disruption of bacterial membranes
  • Fluoride ions promote remineralization

When the caries process has been arrested, the lesion is hardened and darker in appearance. The application of potassium iodide immediately after SDF application can minimize the dark staining. Eventually, the area may be covered with an esthetic restoration such as a glass ionomer, composite resin or crown. SDF is contraindicated in patients with a known allergy to silver. Relative contraindications include gingivitis or mucositis that disrupts the epithelium. Patients may complain of a transient metallic or bitter taste in their mouths. Additionally, there may be temporary staining of the skin which will resolve with natural exfoliation within 2 weeks, but long-term mucosal staining is observed when SDF is applied to intraoral wound, which is not recommended.

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  1. John Wilson February 27, 2017

    There is also an excellent article on SDF in the California Dental Assoc Journal last year

  2. Peter Kearney February 27, 2017

    Just back from Chicago and itlooks like Oral Sciences will be bringing the Elevate Oral Care Advantage Arrest SDF to Canada.
    SDI Riva Star is not in the US yet and Canada will be after that.

    1. John Wilson March 1, 2017

      Yes. it has been approved and they will be shipping it by the end of the month. Available to order at the PDC

  3. Reza Nouri March 5, 2017

    A word of CAUTION for our colleagues contemplating using SDF in their practices that this material STAINS EVERYTHING from caries lesions to mucosa, skin, clothing, working surfaces, and so on. Therefore, proper technique for placing this material in a manner to avoid its contact with anything other than carious tooth structure is critical. It is also imperative to get signed consent from patients with respect to the black staining that will present on the teeth as a result. BE CAREFUL about applying SDF to the teeth of an uncooperative and screaming child, with arms swinging around and pushing you away, making you splash SDF everywhere but onto the teeth.

  4. Steve Pardue March 20, 2017

    SDF is now available in Canada through Oral Science.

  5. Anonymous October 13, 2018

    Can sdf be applied to exposed pulp.tissue?

    1. Azita Zerehgar July 17, 2019

      SDF cannot be applied for the teeth having exposed pulp.

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