Silver diamine fluoride stops decay in over half of baby teeth

Silver diamine fluoride stopped decay in more than half of affected baby teeth when applied every six months, according to University of Michigan material published Oct. 25 on an 830-child Phase III trial.

The Oct. 25 University material said silver diamine fluoride could matter for childhood dental care because tooth decay affects more than 40% of American children and is associated with pain, infections and surgery when untreated.

The peer-reviewed study, published in JAMA Pediatrics, enrolled children younger than 6 through dental clinics, pediatric medical practices, and Head Start and Early Head Start programs in Michigan, New York and Iowa.

"This is a very effective and safe treatment -- even in children as young as 1," said Margherita Fontana, professor of dentistry at the University of Michigan School of Dentistry and the study's lead investigator.

The trial tested Advantage Arrest 38% silver diamine fluoride, supplied by Elevate Oral Care. The liquid is painted onto a cavity with a small applicator, and the source material said the process does not require drilling, injections or sedation.

Arresting tooth decay means the damaged area stops worsening. The treatment does not rebuild tooth structure or work like a filling; the University material said silver acts against bacteria linked to decay, while fluoride strengthens tooth mineral.

Silver diamine fluoride is not new. The material said dentists have used it in several countries for decades.

The Food and Drug Administration approved silver diamine fluoride in 2014 as a medical device for tooth sensitivity. Dentists in the United States have used it off-label to stop cavities, meaning for a purpose beyond the existing authorization.

"Our results support FDA approval of SDF for managing arrest of tooth decay in young children. Removing SDF from off-label status would be an important innovation which could lead to increased utilization by providers, enhanced payments by insurers and more consistent product quality," said Amr Moursi, a professor of pediatric dentistry at New York University College of Dentistry and a co-principal investigator.

The study cannot show that silver diamine fluoride is suitable for every cavity or that children will never need later dental work. The main reported tradeoff is cosmetic: the treated decayed area permanently turns dark, which may be more visible on front teeth.

The evidence applies most directly to young children with affected baby teeth in the trial settings. The source material said older adults, people with developmental or physical disabilities, patients with severe dental anxiety and people with limited access to conventional dental care could also benefit, but those groups were not the trial population described.

The National Institute of Dental and Craniofacial Research, part of the National Institutes of Health, provided more than $12 million in funding. The University material said the findings could be used by the manufacturer in an FDA application for approval of silver diamine fluoride as a drug for arresting dental caries, the medical term for tooth decay.

Source: University of Michigan press material via ScienceDaily, Oct. 25, 2026; JAMA Pediatrics, 2026.

Atlas360 reports health research and does not provide medical advice.