Using Silver Diamine Fluoride (SDF)

In this article, you will learn more about silver diamine fluoride.

What is Silver Diamine Fluoride?

SDF, or silver diamine fluoride (or silver diamine fluoride if you want to get technical), was new to some of us when articles recommending its use started to appear in the last few years. But it’s a material that has a long history and was due for re-appreciation.

Silver diamine fluoride (SDF) is a colourless ammonia solution of silver and fluoride ions that are used for preventing and arresting caries. The fluoride promotes remineralisation, and the silver has an antibacterial effect. After the application of SDF, a highly remineralized surface zone rich in calcium and phosphate is formed, which has a further protective effect.

Evidence supporting the efficacy of SDF as a method for caries management is well established (Gao et al., 2016). A meta-analysis was carried out on eight studies looking at the arrest of caries in primary teeth. The overall proportion of arrested dental caries after SDF treatment was 81%. SDF is usually delivered at a strength of 38%, and it can be placed annually or bi-annually. Bi-annual application may provide more benefits than annual (Fung et al., 2016).

Why is Silver Diamine Fluoride Important?

SDF is an effective method for managing decay in young, anxious difficult to treat children. There are no real side effects (except for a black discolouration). There is some evidence to show that SDF is more effective than fluoride varnish for the arrest of caries. A systematic review (Trieu et al., 2018) identified four papers reporting two different RCTs, after meta-analysis, they concluded that SDF was significantly more likely to arrest caries than NaF at 18 and 30 months. Duangthip et al (2018) compared annual application of 30% SDF (three in total) with three applications of 5% fluoride at weekly intervals in the first year. At 30 months, 48% of cavitated lesions in the SDF group were arrested, compared to only 34% in the fluoride varnish group (p<0.001).

How do I use it, and where can I find out more?

Lots of resources exist to support the use of SDF, probably the most commonly cited one is the UCSF Protocol. The British Society of Paediatric Dentistry also has a protocol for its use on their website along with a consent form, video for children and an information sheet.

References used in this article

Duangthip D., Wong M.C.M., Chu C.H., Lo E.C.M. Caries arrest by topical fluorides in preschool children: 30-month results Journal of Dentistry 70 (2018) 74–79. https://doi.org/10.1016/j.jdent.2017.12.013

Fung, M. H. T. et al. (2016) ‘Arresting Dentine Caries with Different Concentration and Periodicity of Silver Diamine Fluoride’, JDR Clinical & Translational Research, 1(2), pp. 143–152. https://doi.org/10.1177/2380084416649150

Gao, S. S. et al. (2016) ‘Clinical Trials of Silver Diamine Fluoride in Arresting Caries among Children: A Systematic Review’, JDR Clinical & Translational Research, 1(3), pp. 201–210. https://doi.org/10.1177/2380084416661474

Trieu, A., Mohamed, A. & Lynch, E. Silver diamine fluoride versus sodium fluoride for arresting dentine caries in children: a systematic review and meta-analysis. Sci Rep 9, 2115 (2019). https://doi.org/10.1038/s41598-019-38569-9