Silver Diamine Fluoride Halts Tooth Decay, NIH Study Finds

A recent study funded by the National Institutes of Health (NIH) has shown that a topical liquid known as silver diamine fluoride (SDF) has demonstrated the ability to effectively halt tooth decay in young children. Preliminary results revealed that 54% of cavities stopped progressing after SDF treatment, compared to only 21% in the placebo group, per a press release from NIH. The study was published in Pediatric Dentistry.

SDF, already approved by the United States Food and Drug Administration (FDA) for treating dental sensitivity, is used off-label to combat tooth decay, commonly referred to as cavities or dental caries. The liquid can be applied to cavities and has been utilized for decades for the management of tooth decay, proving both its efficacy and longevity. Studies indicate that the silver component in SDF eradicates cavity-causing microbes, while the fluoride aids in rebuilding and strengthening the affected tooth.

Lead investigator Margherita Fontana, DDS, PhD, of the University of Michigan, emphasized the significance of this discovery, stating in the press release, "Current treatments for severe early childhood caries rely on restoration and tooth extraction, which can involve general anesthesia. These interventions are expensive, cavities often return, and anesthesia can have long-term effects on a developing brain. We didn’t really have any other options until recently—SDF is a game changer."

The study, funded by the National Institute of Dental and Craniofacial Research (NIDCR), included children aged 1 to 5 with severe tooth decay. An interim analysis of 599 children revealed that 54% of cavities treated with SDF had halted progression 6 months after a single treatment, compared to 21% in the placebo group. The trial was stopped early, as the planned interim analysis met its primary endpoint, demonstrating the effectiveness of SDF in stopping the progression of cavities.

Dena Fischer, DDS, MSD, MS, director of NIDCR’s Center for Clinical Research, highlighted the potential impact of FDA approval for treating dental cavities with SDF. Fischer said in the press release, "SDF marketing authorization from FDA for treating dental cavities could lead to SDF becoming more widely available; more acceptable among providers, patients, and parents; and more likely to be covered by insurance."

While SDF appears promising, researchers are now analyzing final data on over 800 children to assess its effects on tooth pain, quality of life, and potential side effects. As SDF can darken the color of cavities, researchers are also evaluating patient and parent satisfaction and acceptability. Not all cavities responded to the treatment, and further studies will be conducted to determine the reasons behind this variability.

NIDCR Director Rena D’Souza, DDS, PhD, MS, stressed the public health impact of oral health problems, noting, "This study provides evidence that SDF could be a powerful tool against cavities and help improve the health and well-being of children."

Tooth decay is the most common chronic disease of childhood, affecting nearly 46% of children in the United States, with a disproportionate impact on Hispanic and non-Hispanic Black children and those from lower-income households. Cavities can lead to chronic pain, impaired development, and long-term oral and overall health problems, if left untreatred. In severe cases, tooth infections can have life-threatening consequences.

The research was supported by NIDCR grant UH3-DE027372. Additional information about the trial can be found on clinicaltrials.gov under the identifier NCT 03649659.