Reviewed by a licensed dentistTreatment: Silver diamine fluoride (SDF)Code: D1354Question: Alternatives
Are there alternatives to SDF?
The short answer
Yes. The main one is a filling. Others include fluoride varnish for early cavities, watching a cavity that looks inactive, or for baby teeth, a crown or removing the tooth. SDF and a filling can also work together.
More detail
Your options
- A filling. Removes the decay and rebuilds the tooth, with no black stain. Usually needs numbing, and young children may need sedation for several fillings.
- SDF first, filling later. SDF stops the cavity now, and a tooth-colored filling can go over it later. This also covers most of the dark color. See Will the tooth need a filling later?
- Fluoride varnish. Painted on, with no stain. Works best on early cavities that haven't broken through the surface yet.
- Sealing an early cavity. For an early cavity in the grooves of a back tooth that hasn't broken through the surface yet, a sealant (a thin coating) can help stop it. The ADA's guideline supports this.
- Watching it. For a cavity that looks inactive, with better brushing, fluoride, and diet.
- For baby teeth with large cavities: a crown, nerve treatment, or removing the tooth, depending on how close it is to falling out.
Why dentists can reasonably differ
Some dentists stop cavities first and fill later, especially in children. Others fill right away. The ADA's guideline supports options that don't involve drilling for many cavities, and the right choice depends on the person, the tooth, and how active the decay is.
Questions to ask
- Would a filling be reasonable instead? What would it involve?
- Could we use SDF now and fill it later?
- Is fluoride varnish enough for any of these?
- For a baby tooth: how long until it falls out on its own?
- Before we schedule, can I get my cost in writing? (A predetermination if I'm using insurance, or a good faith estimate if I'm paying myself.)
When a second opinion makes sense
Reasonable if you'd prefer fillings and aren't sure why they weren't offered, or if many fillings are recommended for a young child.