Avoiding the drill and injection with Silver Diamine Fluoride
- Dr Abs Casaus
- Mar 6
- 2 min read
Silver diamine fluoride (SDF) is increasingly being used in paediatric dentistry as a minimally invasive way to arrest dental caries. It can be particularly helpful for young children, anxious patients, or those who struggle to tolerate conventional restorative treatment.
Rather than removing decay with a drill, SDF works by stopping the progression of caries, allowing the tooth to remain symptom-free until more definitive treatment becomes possible—or sometimes avoiding further treatment altogether.
How does silver diamine fluoride work?
SDF combines two key components:
Silver – acts as an antimicrobial agent, helping to kill the bacteria responsible for tooth decay.
Fluoride – helps strengthen tooth structure and promotes remineralisation.
When applied to a carious lesion, SDF can halt the caries process and harden the softened dentine. The treated area typically becomes dark in colour, which indicates that the lesion has arrested.
When is SDF useful?
SDF can be a valuable option in several clinical situations, including:
Young children with early childhood caries
Children who are anxious or unable to tolerate conventional treatment
Medically complex patients where treatment under general anaesthetic should be avoided
Arresting caries in primary teeth close to exfoliation
Managing caries temporarily before definitive care
Because it is quick and non-invasive, SDF can often be applied without local anaesthetic or drilling, which can make dental visits much easier for some children.
What are the downsides?
The main disadvantage of SDF is black staining of the treated decay. This is expected and actually indicates that the caries has been arrested.
For this reason, SDF is often most suitable for:
posterior teeth
primary teeth
areas where aesthetics are less critical
Clear explanation and informed consent from parents and carers are essential before treatment.
What does the evidence say?
A growing body of research supports the effectiveness of SDF in arresting dental caries. Studies have shown high arrest rates, particularly when SDF is reapplied periodically (often every 6–12 months).
Clinical guidance and further information about SDF can be found on the British Society of Paediatric Dentistry website:
The guidance includes clinical indications, protocols, and resources for practitioners interested in incorporating SDF into practice.
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