Silver diamine fluoride does a lot of work in this practice. We use a lot of it, mostly on children, and it has kept plenty of three- and four-year-olds out of a filling appointment they were not ready for.
It is not a substitute for a filling. It is a way of buying time, and there is a point where the time runs out. Knowing where that point is saves a family from finding out the hard way, at 11pm, with a swollen face.
What silver diamine fluoride actually does
It is a liquid, brushed onto the decayed spot. It arrests the decay by killing the bacteria and hardening the softened tooth surface. No drill, no needle, about a minute of a child’s cooperation.
The trade-off is not hidden and we raise it before we use it: the arrested area turns black. On a back baby molar nobody sees it. On an upper front tooth they do, and we will show you what it looks like and let you decide. Some parents take the black spot over a filling in a two-year-old. Some would rather have the filling. Both are reasonable.
It also is not permanent in the sense parents sometimes hope. It stops the decay that is there. It does not rebuild the tooth, it does not fill the hole, and it does not stop new decay elsewhere. A tooth treated with silver diamine fluoride gets checked every visit, and often re-treated.
Where it stops working
Four situations, and in each of them a filling is the more reliable answer.
The cavity has a hole you can catch a fingernail in. Once there is real cavitation, food is packing into it every meal. Silver diamine fluoride can arrest the surface but it cannot seal a space that is collecting debris. That tooth needs to be cleaned out and filled or capped.
It is between two teeth. Interproximal decay is the common case in baby molars, and the liquid cannot reliably reach the contact area. This is usually the decay that x-rays find and parents cannot see, and it is the most common reason a child who looks fine needs a filling.
The child has symptoms. Sensitivity to cold that lingers, pain when biting, pain at night, or a tooth the child chews around. Arresting the surface does nothing for a nerve that is already inflamed. Night pain in particular is a different conversation, not a filling conversation.
It has already been treated and it is progressing anyway. We re-check every treated tooth. If a spot is spreading despite treatment, we stop repeating something that is not working.
What a filling in a child’s tooth involves here
The mechanics are less dramatic than parents imagine, and the appointment is mostly about sequencing.
Topical numbing gel goes on first and sits for a proper couple of minutes, not fifteen seconds. Then the local anaesthetic goes in slowly. Delivered slowly, the injection is the part most children find easiest to forget, and delivered quickly it is the part they remember for a decade.
We use rubber dam. On a child this does two useful things at once. It gives us the dry field the bonding actually needs, and it keeps water, spray and instruments away from the back of the child’s throat, which is what most children are actually frightened of. Children who cannot tolerate the suction often manage rubber dam better than they manage the alternative.
Then air abrasion, where it suits the cavity, to prepare the surface and increase bond strength, followed by a white composite filling placed and cured in increments. On a baby molar with decay across several surfaces, a preformed crown is often the better answer than a large filling, because a heavily filled baby molar tends to fracture and come back.
The ceiling TV is on the whole time with a show your child has chosen, or their own music if they would rather. That is not decoration. A child watching a fixed point above them keeps their head still without anybody holding it.
Getting a nervous child through it
Happy gas is nitrous oxide with oxygen, breathed through a small nose mask. The child stays awake, can talk and can put a hand up. It does not numb anything, so the local anaesthetic is still needed. What it changes is how the child feels about the injection.
It works well from around five. It is unreliable at three, largely because anxious young children breathe through their mouth and vent most of it, and it does nothing at all through a blocked nose, so a cold means we reschedule.
Dr Linda Huang does most of our restorative work on young and anxious children. A number of the children she sees have already had a difficult appointment somewhere else, and are treated in the chair here rather than referred onward for a general anaesthetic. If your child has already failed an attempt at a filling somewhere else, say so when you book, because it changes how we plan the appointment.
We do not offer general anaesthetic. Happy gas and, for some children, an oral premedication taken beforehand, cover the large majority of children who need restorative treatment. Where a child genuinely cannot be treated awake, we say so at the assessment and refer for hospital care rather than let you pay for two failed attempts.
Why we would rather fill it than pull it
Parents often ask why we do not simply take out a tooth that is going to fall out anyway.
Because it is usually not going to fall out for years. A lower baby molar is often still there at eleven or twelve. Losing it at five leaves a gap that the teeth behind it drift forward into, and the adult tooth underneath then has nowhere to come through. That is a problem we cannot solve here, because we do not do orthodontics of any kind. We would be referring you out for something a filling at five would have avoided.
What it costs
We bulk bill under the Child Dental Benefits Schedule, and CDBS covers fillings.
- Eligibility is age 0 to 17 for at least one day of the calendar year, where the family receives an eligible payment such as Family Tax Benefit Part A.
- The cap is $1,158 over two consecutive calendar years, or $1,132 if your child’s window opened in 2025. On a child needing several fillings, knowing which figure applies changes how we stage the treatment across the two years.
- A bulk-billed CDBS service cannot carry a co-payment.
- CDBS covers exams, x-rays, cleans, fissure sealing, fillings, root canals, extractions and partial dentures, and it covers inhalation sedation under item 88943, benefit $77.60. It does not cover general anaesthetic or orthodontics.
If you are not eligible, Smile Squad covers every Victorian government school student with no card or Medicare requirement, and public dental covers children 0 to 12, free with a concession card and otherwise $40 flat per child capped at $160 per family. Privately, we run HICAPS on site so you see the rebate before you leave, and we are an HCF preferred provider under More For Teeth. You get the cost in writing before anything starts.
If you have been told your child needs fillings
Bring the x-rays or ask the previous practice to send them, so we are not repeating radiographs on a child who does not need them again.
We are at 129A Canterbury Road, Blackburn, with on-site parking and Saturday mornings 9:00 to 1:00. Consultations are available in Mandarin, Cantonese, Teochew and Shanghainese as well as English. Call (03) 8838 8820 or text 0435 025 318.
More on no-drill dentistry for kids, on happy gas and on children’s dentistry. See also happy gas for kids by age and crowns on children’s teeth.