Reviewed by a licensed dentistTreatment: Silver diamine fluoride (SDF)Code: D1354Question: Trade-offs
SDF: risks and benefits
The short answer
SDF is quick, usually painless, and stops many cavities, especially on front teeth and surfaces that are easy to reach and keep clean. It also costs far less than a filling. The big trade-off is a permanent black stain on the decayed spot. It also doesn't rebuild the tooth and usually needs repeat applications.
Side by side
Benefits
- No drilling and usually no numbing; takes a few minutes
- Stops many treated cavities: in studies of children, about 7 in 10 treated cavities had stopped two years later. Results vary: front teeth and easy-to-reach spots respond best, and results are better with repeat applications and good brushing
- Can treat many cavities in one visit
- Can ease sensitivity in the treated spot (sensitivity is what the FDA cleared it for)
- Can help young children avoid sedation or general anesthesia for fillings
- Costs far less than a filling
Risks and downsides
- The decayed area turns permanently black. Healthy enamel doesn't stain
- Can leave a temporary stain on skin or gums, and a permanent stain on clothing or counters
- A metallic taste, and sometimes brief gum irritation where it touches
- Doesn't rebuild the tooth; many teeth still get a filling later. See Will the tooth need a filling later?
- Usually needs repeat applications, often twice a year, to keep working
- Not for a silver allergy or sores in the mouth
Questions to ask
- How many cavities will you treat, and which teeth?
- How likely is SDF to work on this cavity, given where it is?
- Will any of the stain show when I (or my child) smile?
- How often will it need to be reapplied?
- What happens if it doesn't stop the cavity?
- 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're unsure whether the trade-offs (the stain, repeat visits) are worth it compared with fillings for your situation.