Silver diamine fluoride is the treatment parents most often want to know more about after we mention it. It is a liquid, not a drill. It arrests decay rather than removing it. And it turns the treated tooth black. Those three facts together require an explanation before anyone agrees to it, and giving that explanation is most of what the conversation is actually about.
What it is
Silver diamine fluoride (SDF) is a concentrated solution of silver and fluoride in ammonia. Silver is antimicrobial and arrests the activity of decay bacteria. Fluoride hardens the softened dentine that decay has created. Together they stop the disease process in active decay, and the tooth becomes hard and resistant to further progression. This has been the standard approach to managing early childhood caries in parts of Asia for decades, and Australian dental schools have increasingly incorporated it into paediatric dentistry training over the past ten years.
We use it a lot here, mostly on children. Dr Linda Huang incorporates it heavily in her paediatric work.
What it does not do
Silver diamine fluoride does not remove the decay. It does not fill the cavity. It does not restore the shape or the function of the tooth if that has been lost. What it does is stop the disease process, convert the softened material into a hard, dark layer, and prevent the decay from deepening until either a definitive restoration can be placed, or the tooth exfoliates naturally as a baby tooth.
This is the important distinction. SDF is not a substitute for a filling in every situation. It is a substitute for a filling right now, for a child who is not ready or not cooperative enough for a filling appointment, or for a tooth where the decay is early enough that arresting it is the appropriate management.
Why it turns the tooth black
The silver in the solution oxidises when it contacts the organic material in the decayed area, producing silver phosphate and silver carbonate, which are black. The sound surrounding tooth structure does not discolour.
This is the part parents need to see before they consent, not hear described. We show photographs at the appointment, because “dark” and “black” read differently in a photo than as a word. The area that blackens is the arrested lesion: the decay that is no longer progressing. It is stable and permanent. It does not wash off.
On a back baby molar that is not visible when the child smiles, this is almost always acceptable. On an upper front baby tooth, it is more significant, and the conversation is more specific: we show the photograph, we talk through what it will look like when the child smiles, and the parent makes the decision with that information in front of them, not on the basis of a description.
When we use it
The clinical situations where silver diamine fluoride is the right choice rather than drilling:
The child is too young for a filling. A two-year-old with early decay on the upper front teeth often cannot sit through the combination of local anaesthetic and drilling, even with nitrous. SDF buys time: the tooth is stabilised, and either the child grows enough to tolerate a restoration in six months, or the tooth naturally exfoliates before a restoration was ever needed.
The decay is early. A white spot lesion or a small cavitation on a surface that has not yet spread into the dentine significantly can be arrested with SDF and monitored. We review it at three months, check it is hardened and not progressing, and reassess whether a restoration is needed.
The tooth is close to exfoliating. A baby molar with eighteen months of life left in it and a small carious lesion is often better arrested than drilled. A filling in that tooth serves its purpose for eighteen months and then the tooth comes out. SDF achieves the same arrest for less disruption.
The child has had a difficult appointment elsewhere. A number of children arrive at Whitehorse Dental after an attempted treatment at another practice that did not go well. The first priority with these children is not treatment, it is re-establishing trust with the dental environment. SDF allows us to address active disease in one appointment where the child has a positive experience, while we work on cooperation over subsequent visits toward a more complete treatment plan.
Multiple teeth with active decay. In children with rampant early childhood caries, trying to restore every tooth in sequence across many appointments has significant attrition costs for the child and the family. SDF can be applied to all active lesions in a single appointment, stabilising the disease process across the whole mouth while a sequenced restoration plan proceeds.
What the appointment looks like
No anaesthetic is needed. The tooth is dried, the solution is painted on with a small brush or a micro-applicator, and it is left in contact with the decay for one to two minutes. The whole process for each tooth is about ninety seconds. There is no pressure, no vibration, no noise beyond the normal dentist conversation.
We do have the child avoid eating or drinking for an hour afterwards, and we ask them to avoid rinsing.
One thing worth saying plainly: silver diamine fluoride is not a painless alternative to dentistry that makes the dental visit effortless. It resolves the immediate treatment question, but a child still needs to sit in the chair, be examined, and have a liquid applied. For very young or very anxious children, even that requires building up to. The work of getting children comfortable in the dental environment is a process, not a single appointment solution.
CDBS and silver diamine fluoride
Silver diamine fluoride is covered by the Child Dental Benefits Schedule as a preventive treatment. CDBS covers children aged 0 to 17 for at least one day in the calendar year, where the family receives a qualifying payment such as Family Tax Benefit Part A. The benefit cap is $1,158 over two consecutive calendar years, or $1,132 if the child’s window opened in 2025.
We bulk bill under CDBS, which means there is no co-payment on a bulk-billed CDBS service. A practice cannot bulk bill a CDBS service and then charge a gap on top of it.
The follow-up
A tooth treated with silver diamine fluoride needs monitoring. At the next recall, usually three months later, we check that the area is hard (arrested decay has a hard surface; active decay is soft) and that the lesion is not progressing. Most arrested lesions remain stable. Where a tooth shows signs of reactivation, we can reapply, or move to a definitive restoration if the child is now cooperative enough for that.
The blackened area does not reverse. When the tooth exfoliates, it exfoliates with the dark area in it. That is what exfoliation looks like for these teeth, and it is clinically normal.
Where to from here
If your child has decay you know about or suspect, or if they have had a difficult experience at the dentist and you are not sure where to start, a first appointment at 129A Canterbury Road, Blackburn, is the right next step. Saturday mornings run 9am to 1pm, parking is on site, and we can run the whole appointment in Mandarin, Cantonese, Teochew or Shanghainese where that helps the grandparent or carer who does the school run understand the plan.
Call (03) 8838 8820 or text 0435 025 318.
The children’s dentistry service page and the no-drill dentistry page cover the full picture of how we approach paediatric care. For CDBS eligibility and what it covers, our CDBS guide has the detail.
Related reading: happy gas for kids by age covers nitrous oxide and when we use it alongside or instead of SDF. When your child needs a filling is for the stage where a definitive restoration is needed. My child’s first dental visit is where most families should start.