AAPD Releases SDF Guideline for Pediatric Patients

Dentistry Today


The American Academy of Pediatric Dentistry (AAPD) has issued the first evidence-based guideline on the use of silver diamine fluoride (SDF) to treat cavities in pediatric patients, based on a review of research from 1969 to 2016. The guideline recommends SDF to treat active caries in pediatric and special needs patients, likely leading to broader adoption of the treatment, according to the AAPD.

SDF is a minimally invasive, low-cost treatment that dentists paint on teeth to painlessly treat cavities. The Food and Drug Administration approved it for treating tooth sensitivity in adults in 2014. Dentists have been using it off label to treat cavities since then, but adoption has not been as widespread. Now, the AAPD says, dentists have increased clarity around its uses and benefits due to this guidance.

“Aside from fluoridated water, silver diamine fluoride may be the single greatest innovation in pediatric dental health in the last century,” said James Nickman, DDS, AAPD president and practicing pediatric dentist. “Given its minimal cost and easy, painless application, it could help close the gap in healthcare disparities.”

The systematic review found no significant adverse effects. The most notable downside of SDF is that it turns cavities black. Comparatively, treating cavities in young children, particularly those with special needs, often involves sedation or general anesthesia, both of which have additional health risks. Additionally, the cost of treating cavities in young children often is disproportionately high.  

“Silver diamine fluoride gives us another simple and safe option to treat cavities in children who can’t cope with getting traditional fillings,” said Yasmi Crystal, DMD, clinical associate professor of pediatric dentistry at the New York University College of Dentistry. “Prevention is our number one priority, but if a child does have a cavity, we need to treat it before the child develops pain and infection. However, we also want to make sure they have a good experience at the dentist, so this is a good way to do both.”

The AAPD recommends visits to the dentist every 6 months for regular cleanings and checkups for every child over the age of one year. This is no different for children who have cavities treated with SDF, which doesn’t work all the time and needs monitoring and re-application twice a year for sustained effect. As the child gets older, the dentist can share other more aesthetic and lasting options for keeping a tooth treated with SDF healthy.

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