New guidelines may encourage use of low-cost, painless dental treatment

A treatment that offers a painless, minimally-invasive alternative to drilling and filling teeth has gotten a boost from a prominent children’s dental organization.

The American Academy of Pediatric Dentistry (AAPD) has issued new guidelines for the use of silver diamine fluoride (SDF) for treating tooth decay in children and adolescents.

The product, which is painted onto decayed lesions, contains fluoride, which helps remineralize the damaged tooth, and silver, which kills the bacteria that drive decay. SDF has been used for decades in Japan, but has only recently attracted the attention of U.S. health care providers.

In 2014, SDF was cleared by the U.S. Food and Drug Administration to be marketed as a treatment for dental sensitivity in adults. Now, some U.S. dentists have begun using the material as an off-label restorative material.

A workgroup formed by the AAPD relied upon a systematic review of published research in developing the guidelines, published in October. Taking into account the low cost of the treatment and the high prevalence of tooth decay among American children, the panel offered a “conditional recommendation” for the use of SDF in arresting cavitated lesions in primary teeth.

“As the research grows, I suspect the recommendation will move to a strong recommendation and become more of a standard of care in some situations,” James Nickman, a practicing pediatric dentist and president of the AAPD explained in an interview with Anna Nguyen who serves as kids health assistant editor for, an online publication of the Philadelphia Inquirer and the Philadephia Daily News.

“Simply stated, SDF works really well when it’s used in the right cases and the benefits of using SDF outweigh the negatives associated with the treatment,” Nickman said.

One downside of the material is the fact that SDF blackens the decayed area of the tooth to which it is applied. Another is that treatments are not yet always covered by insurance. Then too, deeper decay or advanced infection can require more extensive care.

While continuing research is needed, no significant adverse effects have been reported in published studies on SDF, Nickman noted.

The material represents an important tool for stopping tooth decay in children – particularly those who are very young, fearful or who have special needs – without the added expense and health risks associated with sedation or general anesthesia, he said.

“SDF is a very cost-effective way to halt the disease process before it creates an emergency,” said Nickman. “We want to make sure that children have a good experience at the dentist, and if they have cavities, this is a painless way to treat them, and make sure they are willing to come back.”

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