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Silver Diamine Fluoride

Silver Diamine Fluoride Treatment to Stop Tooth Decay

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We are one of the first and few dental offices in Arizona to offer this revolutionary treatment option for the management of tooth decay.  Silver Diamine Fluoride is an antimicrobial liquid that is able to treat cavities in a non-invasive, fast, affordable, and painless manner.

Some patients who have active tooth decay may be eligible for an alternative treatment that uses Silver Diamine Fluoride.  FDA cleared in August of 2014, SDF became commercially available to dental professionals in April of 2015 as Advantage Arrest by Elevate Oral Care.  Compared to a traditional filling that requires shots of local anesthetic and drilling of tooth structure, this treatment is non-invasive and more comfortable for the patient.  It is a liquid that is simply brushed on to the cavity that can stop current decay and also prevent new decay in the future.

silver-diamine-fluoride-dentist-and-patientsilver-diamine-fluoride-applicationSilver Diamine Fluoride

Photo Credits: Caitlin O’hara

What’s more interesting, is the fact that the use of silver to treat cavities is nothing new.  Reports of its use date back to the 1800s.  It has been widely used to treat decay in Japan for over 50 years.  G.V. Black, revered as the ‘Father of Modern Dentistry,’ regularly used silver nitrate to treat cavities in children.  It wasn’t until the 1950’s that this method seemingly vanished from popular use in the US, which coincides with the development of better anesthesia options to make dentistry “painless” and the addition of fluoride toothpastes and tap water with the promise of eradicating tooth decay.  In fact, the use of Silver Diamine Fluoride is not part of the majority of the current dental school curriculum.  Unfortunately, tooth decay remains the number one most common disease of childhood, five times more common than asthma.  Readily available snacks, frequent consumption of sugary and acidic beverages, bottled water without fluoride, infrequent or delayed trips to the dentist have all contributed to nearly one-third of Arizona’s children having a cavity by age three.  More than half have experienced a cavity by kindergarten.  This problem is not unique to our state and has prompted forward-thinking dentists to rethink our approach to managing tooth decay.  Oregon’s Medicaid system and the University of California, San Francisco School of Dentistry have been instrumental in bringing SDF back to the table for dentists to offer their patients.  This technique is very exciting for young, fearful or pre-cooperative children, special needs patients, and medically compromised individuals who may otherwise require sedation for traditional dental restorations such as fillings or crowns.  It is also a great option for nursing homebound elderly patients, those that lack access to care, and those individuals without dental insurance or the funds to afford traditional dental restorations.

Pros: SDF has very low toxicity, it is quick, painless, non-invasive, affordable, and can stop tooth decay and help prevent recurrent decay.


Cons: SDF permanently stains cavities black. SDF does not restore tooth form or function, so large holes that trap food may still eventually require a SMART filling (see below) or traditional restorations. SDF requires repeat application for maximum efficacy.
SDF can not be used in the presence of infection or decay into the nerve.


To read more evidence based articles on the mechanisms and benefits of SDF, please click on the following links;

MMC Library
UCSF Protocol for Caries Arrest Using Silver Diamine Fluoride: Rationale, Indications, and Consent
Efficacy of Silver
Silver Diamine Fluoride: A Caries ”Silver-Fluoride Bullet”
Effectiveness of silver diamine fluoride and sodium fluoride varnish in arresting dentin caries in Chinese pre-school children



SDF Application Tutorial with Advantage Arrest Silver Diamine Fluoride 38%


#SDF #silverdiaminefluoride

Non-Aerosol SDF Application Tutorial #SDF #silverdiaminefluoride

Dr. Jeanette MacLean of Affiliated Children’s Dental Specialists in Glendale, Arizona demonstrates the SMART Filling technique using Advantage Arrest silver diamine fluoride (SDF) and Fuji glass ionomer cement (GIC). This is a quick, painless alternative to ‘drill and fill’ for the parents of young, apprehensive children with cavities who wish to avoid or delay drills, shots, sedation or general anesthesia for their treatment.

Watch pediatric dentist Dr. Jeanette MacLean demonstrate the minimally invasive SMART Hall Crown Technique using Advantage Arrest silver diamine fluoride (SDF), Fuji Cem2 glass ionomer cement, and NuSmile stainless steel crowns. This revolutionary dental treatment is quick, painless, simple, and effective, with high levels of evidence. Most importantly, it can help young or fearful patients, (such as children and special needs patients) avoid shots, drills, sedation and/or general anesthesia (GA) for dental work to treat their cavities. This treatment is standard of care in the UK, with its origins in Scotland more than a decade ago. The Hall technique is not well known or widely practiced in the US, though we hope that is changing as awareness and adoption of minimally invasive treatment options increase.

Mom Shares Her Experience with Her Son Receiving Silver Diamine Fluoride

Listen to a patent’s mom share her thoughts and feelings about her son receiving Silver Diamine Fluoride (SDF) and Hall Crown treatment by Dr. Jeanette MacLean, interviewed by Dr. Steve Duffin. 3 Year old Christian first had SDF treatment in Washington at 1 year old. The family moved to Arizona when he was 2 years old. Mom brought him to two pediatric dentists in Arizona who were both unfamiliar with SDF and told her he had to have general anesthesia (GA) to treat his teeth. She found Dr. Jeanette MacLean from Affiliated Children’s Dental Specialists online as a SDF provider. Dr. MacLean told her they would not need GA to treat his teeth. They did another SDF treatment, and then 6 months later placed crowns using the Hall Technique (no shots, no drills, no anesthesia) in mere minutes for 5 teeth with mom in the room. Patients, parents and dentists; For more information visit

Resources for Dental Professionals

Visit our YouTube channel
Affiliated Children’s Dental Specialists on YouTube

Articles by Dr. Jeanette MacLean:

Online Continuing Education

Dentists interested in learning SDF and SMART;

Minimally Invasive Treatment of Proximal Lesions
A Crest Webinar

NY Times

Should Kids Be Sedated for Dental Work?

“Dr. MacLean was interviewed a second time by the New York Times regarding the safety of dental sedation for children, “Pediatric dentists also learn how to manage kids by talking to them. “Anyone can work on a patient who is knocked out,” said Dr. Jeanette MacLean, a pediatric dentist in Glendale, Ariz., adding, “Behavior management is a dying art form.”…..Dr. MacLean said. “If not, get a second opinion.” to read the full article click here.

See Dr. Jeanette MacLean LIVE!

Visit the Upcoming Continuing Education Page.

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