Silver Diamine Fluoride

Silver diamine fluoride (SDF) is a liquid substance used to help prevent tooth cavities (or caries) from forming, growing, or spreading to other teeth.

SDF is made of:

  • silver: helps kill bacteria
  • water: provides a liquid base for the mixture
  • fluoride: helps your teeth rebuild the materials they’re made of (called reminerilzation)
  • ammonia: helps the solution remain concentrated so that it’s maximally effective against cavity resonance

SDF was approved by the U.S. Food and Drug Administration (FDA)  in 2014 for use in the United States.

How is it used?

Our dentists at Barbara Bell DDS, PA use a liquid form of SDF containing at least 38 percent of the SDF solution. It’s applied topically, meaning that it’s applied directly to the surface of your teeth.

Dr. Katie Bell use the following steps:

  1. Cotton or gauze is placed near the affected teeth to prevent saliva from moistening the teeth.
  2. Moisture is removed from the surface of the teeth using a vacuum suction tool.
  3. SDF is applied to the area affected by a cavity.

Dr. Katie Bell may also use the following to mask the areas affected by cavities:

  • glass ionomer
  • opaquer
  • crowns

SDF is most commonly used on areas affected by cavities. It can be just as helpful when used as a preventive measure by being applied to healthy tooth surfaces.

Our dentists don’t need to treat cavities with fillings or tooth surface modification before using SDF.

Traditionally, many dentists have used a fluoride varnish to help stop cavity development. SDF has proven to be much more successful at reducing cavity growth than varnish. SDF also requires fewer treatments over time.

There’s no set number of applications required for SDF to work. Our dentists apply SDF once every 6-12 months. Varnishes often need to be applied four or more times per year.

  • SDF has widely been shown to be effective to help stop cavity development after a cavity has formed. Dentists call this process caries resonance.
  • SDF helps kill the bacteria that break down tooth surfaces while also keeping them from spreading to other teeth.
  • SDF is often suggested as a more comfortable alternative to drilling cavities. This can be helpful for children or adults who have anxiety about the dentist or may not be able to fully engage in dental procedures, such as those with special healthcare needs.
  • SDF can be helpful as a cavity treatment if you’re overly sensitive to the instruments and substances used during cavity treatments.
  • SDF can help keep cavities to a minimum or prevent them entirely if you feel that it’s difficult to make time for regular dental check-ups or feel uncomfortable about cavity procedures. It’s quick, requires no special equipment, and generally can be done once per year.

Are there any side effects?

Few harmful or negative side effects have been found with use of SDF. SDF is widely considered by dentists to be safe, even on young children.

You shouldn’t use SDF if you have a silver allergy, oral ulcerations or canker sores, advanced gum disease, or major tooth decay that’s exposed the soft tissue of your tooth beneath the enamel. These conditions can have painful reactions with the acid or ammonia in SDF.

A common side effect of SDF noted is black staining around the area where SDF is applied. SDF can also stain surfaces that it comes into contact with when being applied, such as clothing or nearby tissues in the mouth.

How much does it cost?

This average cost of a treatment is about $50.

SDF may be covered by certain dental insurance plans and be eligible for flexible spending accounts (FSAs) available from some healthcare providers because it’s a class II medical device.


SDF is a safe, painless alternative to traditional cavity drilling procedures.

Dr. Katie Bell may not recommend SDF in every case of cavities. It’s also not yet as widely available as similar treatments, such as fluoride varnish.

But SDF has been proven to be highly successful in stopping the development and spread of cavities. Even more effective forms that leave fewer black stains continue to be tested.