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Freeze the Sugarbugs! Is SDF a treatment option for your child?

Oct 25, 2018

We wrote about SDF – which stands for silver diamine fluoride – back in 2016 (see post here)… but due to its popularity, we thought we would touch on the subject again!

SDF is a clear, colorless antimicrobial liquid substance that’s gaining popularity in the world of pediatric dentistry (and beyond).  The topical application of SDF on teeth is a newer treatment option that allows for a quick, easy, painless, non-invasive way to combat cavities.  In the past, traditional dentistry has relied on the ‘drill and fill’ technique alone, but SDF offers a more conservative approach: stopping a cavity in its track and killing off the causative bacteria involved.

Truth be told, SDF has been around for decades in countries like Japan, Australia, and China.  The USA finally jumped on board in 2014 with an FDA approval for market.  Extensive research has been done on SDF’s mechanism of action, treatment potential, and both short-term and long-term effects.  Here at Fountain Pediatric Dentistry, we are excited to have SDF available as yet another treatment option for your child.

So how does it work? SDF’s cavity-fighting action is found in its two main ingredients: silver and fluoride.  The silver acts as an antimicrobial agent, while the fluoride promotes remineralization (healing) of the cavity itself.  During your child’s visit, SDF is applied to the dried tooth surface using a small gentle brush.  After allowing the SDF to sit and soak onto the area of the cavity for approximately one minute, the excess is removed and a fluoride varnish is used to seal in the action.  We then advise avoidance of food and drink for 30 minutes post-treatment.

Here are the primary indications for SDF in our pediatric population:

  • For the young, pre-cooperative kiddos. It may be very difficult for young children with cavities to sit for traditional treatment! In the past, sedation was the main alternative here, but now SDF can be used to ‘freeze’ or stabilize cavity lesions until these children are older and mature enough to handle traditional treatment in the chair.
  • For the special needs patients. For years, options for many special needs patients have been limited to either no treatment at all or treatment under sedation/general anesthesia.  SDF is a game changer for this group of kiddos! SDF can stabilize cavities either temporarily or permanently, depending on the type, severity, and location of lesions.  SDF can potentially allow for a complete avoidance of sedation for your special needs child.
  • For children with developmental weak spots on their teeth. Some kiddos will present with weak or ‘hypoplastic’ enamel and/or dentin on certain teeth.  These weak spots are more vulnerable to cavities, breakdown, and sensitivity.  SDF can be applied to freeze or arrest these conditions until more definitive treatment can fully protect the tooth surface.

We love SDF as a treatment option, but it’s important to remember that it’s not for everyone.  One of the main drawbacks to SDF is the post-treatment grey-black discoloration left on the tooth surface.  SDF is most often applied to posterior teeth for this reason.  We are careful to select patients who will benefit from SDF without entirely damaging the esthetics of the smile.  SDF is often thought as a temporary solution; as the child matures and is able to handle traditional treatment in the chair, a white filling may replace or be placed over the tooth to remove or mask the SDF discoloration.

We are always exploring new and innovative ways to keep your child’s oral health at its best.

Talk to us about SDF at your next visit!


AAPD Guidelines on the Use of SDF for Dental Caries Management in Children and Adolescents, Including Those with Special Health Care Needs. 2017.

UCSF Protocol for Caries Arrest Using Silver Diamine Fluoride: Rationale, Indications and Consent (CDA Journal, Vol 44, No 1). 2016.

© 2014 Dr. Jennifer Fountain, DDS.
All rights reserved.