A trip to the dentist for a cavity often brings thoughts of drills, fillings, or even anesthesia for young children.
New research suggests there may be a much simpler way to slow tooth decay before it reaches that stage. A large U.S. clinical trial has found that a low-cost liquid called silver diamine fluoride (SDF) can stop many cavities from getting worse without drilling or removing any part of the tooth.
The findings could change how dentists and medical providers manage tooth decay, especially for children who struggle with traditional dental treatment.
Large U.S. Trial Adds Strong Evidence
Dentists have used silver diamine fluoride, or SDF, in many countries for decades. In the United States, they have used it off-label since 2014 after it received approval as a medical device to reduce tooth sensitivity. Even so, researchers still needed large U.S. clinical trials to confirm that it safely treats cavities.
The University of Michigan led a Phase III clinical trial that provided that evidence. The study appeared in JAMA Pediatrics. Researchers followed 830 children younger than 6 years old. They recruited participants from dental clinics, pediatric practices, Head Start, and Early Head Start programs in Michigan, New York, and Iowa.
Researchers started the trial in 2018. They continued the work despite delays caused by the COVID-19 pandemic. The NIH's National Institute of Dental and Craniofacial Research provided more than $12 million to support the project.
How Silver Diamine Fluoride Works
Freepik | Traditional cavity treatment drills away decay to prepare the natural tooth for a lasting filling.
Traditional cavity treatment removes damaged tooth material before placing a filling. SDF works differently. Dentists simply paint the liquid onto the decayed area with a sponge-tipped applicator. The process takes only a few seconds for each tooth. It requires no drilling, injections, or sedation.
Researchers found that 38% SDF stopped tooth decay in more than half of the treated baby teeth when dentists applied it every six months.
Margherita Fontana, professor of dentistry at the University of Michigan School of Dentistry and the study's lead investigator, described the treatment's safety.
"This is a very effective and safe treatment -- even in children as young as 1," Fontana said.
Why Early Cavity Treatment Matters
Tooth decay remains the most common chronic disease among children in the United States. More than 40% of children experience cavities, and untreated decay can lead to serious problems beyond tooth pain.
Children with untreated cavities may develop infections, have difficulty eating or sleeping, miss school, and require repeated medical visits. Every year, thousands of young children are taken to emergency departments because of untreated dental problems. Since emergency physicians generally cannot repair cavities, many children continue to experience pain until they receive proper dental care. Some eventually require surgery under general anesthesia.
Using SDF early may help prevent many of these complications before they become severe.
A Practical Choice for Many Patients
Researchers believe SDF could help many groups. It may work well for very young children who cannot sit through traditional dental treatment. Older adults, people with developmental or physical disabilities, and patients with severe dental anxiety may also benefit. It may also help people who have limited access to dental care.
The treatment has one drawback. It permanently turns the decayed part of the tooth dark. Healthy tooth structure does not change color.
Fontana explained why the new evidence matters.
"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. 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."
She also explained why medical providers need reliable research.
"In medicine, clinicians want high-quality evidence before changing practice. It is important to have data they can refer to because young children often see pediatricians years before they ever visit a dentist; broader acceptance could allow many more cavities to be treated while a referral to a dental home is successful, and before they become painful, infected, or require surgery."
Findings Could Support FDA Approval
Gemini AI | SDF is a painless, liquid treatment painted onto decayed teeth in seconds without drills, needles, or sedation.
Researchers from New York University, the University of Iowa, Indiana University, and the NIH's National Institute of Dental and Craniofacial Research joined the study. Elevate Oral Care supplied Advantage Arrest 38% SDF for the clinical trial.
The researchers said the study provides the evidence needed for the manufacturer to submit a dental caries drug application to the U.S. Food and Drug Administration.
Amr Moursi, professor of pediatric dentistry at New York University College of Dentistry and co-principal investigator, explained why FDA approval could expand access.
"Our results support FDA approval of SDF for managing arrest of tooth decay in young children. Removing SDF from off-label status would be an important innovation which could lead to increased utilization by providers, enhanced payments by insurers and more consistent product quality," Moursi said.
Silver diamine fluoride could become an important option for many patients. Children may receive repeat applications until their baby teeth fall out naturally. Adults may use the treatment to slow decay until they can receive restorative dental care.
Fontana summarized the treatment's potential.
"For almost anyone, this can arrest the decay and stop the infection and the pain it causes. This could benefit many people."
The study gives strong clinical support for a fast and affordable treatment that may prevent pain, reduce complications, and make cavity care easier for children and adults alike.
