Study finds silver diamine fluoride can stop cavities without drilling in young children

A cheap treatment at the dentist’s office that only takes seconds may offer a viable alternative to drilling out cavities—even in babies. New research published in JAMA Pediatrics found that the topical substance known as silver diamine fluoride can stop cavities when painted onto the surface of a tooth. The no-drill option for tooth decay is a potent, inexpensive option for treating cavities, particularly in children and babies. The study examined silver diamine fluoride’s efficacy in treating cavities in more than 800 children younger than 6. The substance stopped tooth decay in over half of the young participants’ baby teeth when applied every six months. Unlike the traditional way of treating cavities, silver diamine fluoride can simply be painted onto a tooth without drilling out the affected area.  Countries around the world have used silver diamine fluoride, also known as SDF, for many years. It was approved in the U.S. in 2014 to treat tooth sensitivity and has not been formally approved as a treatment for cavities, though dentists already use it unofficially. The treatment could be a huge benefit for reducing tooth decay, which impacts almost half of children in the U.S. and can lead to pain, infection, and school disruption for visits to the dentist’s office. “If we want more children and families to benefit from this treatment, we need rigorous evidence showing both that it works and that it’s safe,” said University of Michigan School of Dentistry professor Margherita Fontana, the study’s lead researcher. “From a public health perspective, if we want broader implementation across the United States, including in medical settings, we need carefully collected data in U.S. populations, and we now have that.” A gateway to FDA approval  Conducted by the University of Michigan in partnership with the New York University College of Dentistry and the University of Iowa, the study could open the door for Food and Drug Administration approval of SDF as a cavity treatment in the U.S., where large clinical trials are required for new applications of medical treatments. “Our results support FDA approval of SDF for managing arrest of tooth decay in young children,” Amr Moursi, an NYU professor of pediatric dentistry who worked on the study, said of the results. Moursi called the idea of removing SDF’s off-label status an “important innovation” in dentistry. A no-drill cavity treatment could particularly be a revelation in babies and young children, people with disabilities, older adults, and people with intense dental anxiety. For children dealing with decay in their baby teeth, regular SDF applications could stop dental problems from growing until a tooth falls out naturally. In adults, the painted substance could manage cavities long-term or buy patients time while they plan around a more expensive but more permanent solution.  “For almost anyone, this can arrest the decay and stop the infection and the pain it causes,” Fontana said. “This could benefit many people.”

A liquid brushed onto cavities in seconds may spare many young children from pain, infection, and surgery. A major U.S. trial found that silver diamine fluoride stopped decay in more than half of treated baby teeth. The treatment requires no drilling, shots, or sedation, although it does permanently darken the decayed area.