Decay Away - Silver Diamine Fluoride (SDF)
A simple, minimally invasive approach to managing tooth decay, particularly useful when conventional treatment is difficult, delayed or undesirable.
Watch the short overview
A short introduction to how Silver Diamine Fluoride can help arrest tooth decay.
Simple, quick and minimally invasive
Silver Diamine Fluoride is a topical treatment used to arrest dental caries. It can be particularly helpful for children, older adults and people who find conventional dental treatment difficult.
Helps arrest decay
SDF can harden active carious dentine and slow or stop progression of suitable lesions.
Quick application
A very small amount of liquid is applied directly to the affected tooth surface.
Minimally invasive
It can reduce the immediate need for drilling or more complex restorative treatment in suitable cases.
Useful for vulnerable patients
It may be especially valuable when mobility, frailty, anxiety or access makes conventional treatment more difficult.
SDF varnish - gentle palliative care for teeth
Silver Diamine Fluoride has been used internationally for many years as a simple way of managing tooth decay without immediately removing tooth tissue.
Treatment is quick and does not normally require drilling or local anaesthetic. Appropriately trained members of the dental team may apply SDF within an appropriate clinical care pathway and in accordance with local professional requirements.
One important trade-off is that arrested carious tooth tissue usually becomes dark brown or black. This colour change should be discussed as part of informed consent.
The principle is simple: dry the tooth, apply a tiny amount to the appropriate lesion, then review and monitor.
What about gum health in older adults?
The current page also highlights emerging research into the effect of 38% SDF on gingival inflammation and plaque accumulation in older adults. A 2024 study reported improvements in both outcomes among people living in retirement homes.
This is still an emerging area. The evidence base for arresting dental caries is much larger than the evidence specifically examining gum health, so the two should not be presented as equally established.
2024 gum-health paper
Read the study currently linked from this page on the use of 38% SDF and gingival inflammation in older adults.
Read the research paperADA SDF evidence
The American Dental Association provides an evidence overview, clinical guidance and resources on Silver Diamine Fluoride.
View ADA guidanceView the clinical before-and-after image
Care homes, frailty and palliative oral care
SDF may be particularly useful for people living in care homes who have root caries, reduced mobility, cognitive impairment or difficulty tolerating conventional dental treatment.
The wider oral-health question is also important. Poor oral hygiene and oral bacterial burden are associated with respiratory complications in vulnerable older people. There is interest in whether improving oral health with simple preventive measures could contribute to reducing that risk, but a direct reduction in pneumonia from SDF itself has not yet been established.
This is therefore an area where prevention, careful monitoring and further research can develop together.
How much evidence is enough?
Questions are often raised about the strength of evidence needed before adopting new approaches. SDF has a substantial evidence base for arresting dental caries, while some of the wider potential benefits discussed on this page remain less well established.
The most useful approach is to separate what is already well supported from what is still emerging, then allow patients, carers and professionals to make informed decisions with appropriate consent and clinical oversight.
ADA application video
The American Dental Association published an evidence-based video showing how SDF is applied to arrest suitable carious lesions.
Watch the ADA videoADA clinical guideline
Review the ADA evidence-based clinical guideline on non-restorative treatments for carious lesions.
Read the clinical guidelineHelp make SDF easier to access
If you are looking for this service, or you provide preventive dental care and want people to find you, use the Dental Health Service directory. You can also support wider access through the petition.
More SDF and prevention resources
More videos and practical information are available through the wider Teeth4life and Care4Teeth resources.
Prevent where possible. Intervene when necessary.
SDF is one example of minimally invasive dentistry: using the simplest appropriate treatment to control disease, preserve tooth tissue and buy time for a longer-term plan when one is needed.
