Dentistry for Children

SDF: SMART restorations

Silver Diamine Fluoride (SDF) FAQ

SDF (or Silver Diamine Fluoride) is a blue-tinted liquid made up of fluoride and silver ions.  It kills the bacteria that cause cavities.  In scientific terms, SDF acts as an antimicrobial agent that stops cavities from growing by making the tooth harder and limiting the growth of bacteria that causes tooth decay. 

SDF is an antimicrobial liquid that is able to treat cavities in a non-invasive, fast, affordable, and painless manner. SDF stops cavities from growing. Because SDF keeps decay from getting worse, fixing the teeth can be put off until a child is older or has an easier time sitting through treatment.  Sometimes SDF is the only treatment needed if the cavities in the teeth are tiny. 

SDF is painted on a cavity with a small brush.  Treating a cavity takes about two minutes.  Best of all, the application does not hurt and requires no drilling or injection of an anesthetic.  The treatment has a metallic taste.  It can sometimes cause mild irritation to the gums that will heal by itself in a couple of days. For maximum effectiveness, multiple applications will be required. 

Very safe, according to the evidence-based clinical guidelines of the American Academy of Pediatric Dentistry (AAPD).  SDF has been used in Japan for over 40 years and in Australia and China for over 10 years.  Most important, it can postpone or even prevent the need for sedation or general anesthesia, especially for very young patients.

  • You are allergic to silver or metals
  • Cavities are so large that they involve the nerve of the tooth
  • There are open sores or ulcers in your child’s mouth  

Yes.  Based on clinical trials, SDF works to stop cavities from growing in 70 to 90 percent of treated teeth (or as many as nine out of 10 teeth).  Teeth treated with SDF need to be checked by a dentist at least every six months to make sure the tooth decay has been stopped. 

Only ACTIVE cavities treated with SDF turn black, the healthy part of the tooth does not.  This color change is permanent, lasting the life of the tooth.  If the cavities are on the back teeth, it is barely noticeable.  If the cavities are on the front teeth, it can be very noticeable.  If SDF touches the lips or skin, perhaps when a patient moves too much during treatment, it will leave a dark stain for a few days (temporary tattoo). 

As your child gets older and behavior and/or health improves, fillings or caps may be placed on the teeth to cover the discoloration. 

Cavities on children’s teeth can grow very fast and cause pain and infection.  The factors that started the cavities in the first place can cause decay in other teeth, and as cavities get larger, the nerve of the tooth can become infected and lead to serious infections in the body. 

Baby teeth hold space for the proper placing of the permanent teeth.  If a baby tooth is lost too early, it may mean a crooked smile in the child’s future. 

For the treatment to work its best:

  • Keep your child’s teeth clean by brushing with fluoride toothpaste after breakfast and before bed.
  • Cut down how often your child has foods and drinks with sugar in them, and
  • Visit your pediatric dentist every six months.

Essential things you should know about this treatment are:

  • If patients move too much, and the liquid touches their lips or skin, there could be a dark stain for a few days.
  • If fillings cannot be done, SDF may need to be re-applied every six months for the effects to continue.

SDF - Before & After

SDF before 2
SDF After 2
SDF before 1
SDF after 1

Silver Modified Atraumatic Resin Technique (SMART)

SMART is the application of SDF followed by the placement of a Glass Ionomer Composite (GIC) to help arrest the progression of a cavity without the need for local anesthesia (aka needles) and drilling.

Repairing a tooth with SMART

SMART for Pediatric Patients

The carious lesion is treated first with SDF and then restored with a glass ionomer. This serves to effectively arrest caries, without removal of additional tooth structure, and then restore tooth form with a glass ionomer. The added benefit here is that the glass ionomer will also mask the black stain caused by the SDF.