Dental cavities: new brush-on treatment SDF usually cures them with no drilling or injection

SDF is a new brush-on cavity treatment that kills decay-causing bacteria and can cure most cavities with no drilling - and no injection, since no anesthetic is needed. Cost is minimal, much less than the usual drill-and-fill cavity treatment. SDF is FDA-approved for some uses, and was first available to U.S. dentists in 2015 (but has been used in some countries for decades, for all ages).

The biggest public-health advantage is that each dentist (or dental assistant) can now treat many more patients than before, at greatly reduced cost -- reducing the burden of untreated tooth decay in those who could not pay for dentistry until now.

Often two applications are used, in separate visits weeks or months apart.

SDF can also also help prevent new cavities - and can show dentists where early decay is developing, even before it is visible otherwise.

The main disadvantage is that SDF stains cavities dark brown or black, so patients will not want to use it in locations that show. It also stains previous fillings. It does not stain healthy teeth. It does stain skin, in case of accidental exposure - and the stain will not wash off, but goes away by itself, usually within 2 weeks.

SDF does not cure all cavities; some still need to be drilled. But in these cases SDF every six months or so can usually postpone the need for treatment. This works well for children with cavities in their baby teeth, since those teeth will soon fall out anyway. And it can delay treatment until the patient is better able to afford it - or in case other medical conditions prevent immediate treatment.

In the U.S. the main use is for children, who otherwise might need general anesthesia for necessary dentistry. But dentists are allowed to use SDF off-label to treat cavities in adults. In Japan, Argentina, and some other countries, SDF has been used for decades for treating cavities at all ages. (In Japan, more than 2,000,000 multi-use containers have been sold, with no reports of adverse effects.)

'SDF' is an abbreviation for the chemical name, silver diamine fluoride. It is a generic, but the only commercial product approved in the U.S. has the brand name Advantage Arrest.

Tooth preparation and some cautions are necessary. This prescription treatment is NOT something to try at home.

For More Information

The first article below, from The New York Times, provides a general introduction for the public. The others are written for dentists, who are often unfamiliar with SDF because it is new in the U.S.


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