July 30, 2026
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Silver diamine fluoride halted cavities in more than half of children participating in a new study and could provide an alternative to fillings, researchers say.
An inexpensive liquid treatment should get approval in the United States as a non-invasive, painless way to treat tooth decay, particularly in children, the researchers behind a new study say.
The treatment, called silver diamine fluoride, has been used for decades outside of the United States to combat cavities without the need for fillings. But in the United States, the Food and Drug Administration only has it approved it to treat tooth sensitivity, which occurs when the outer layer of tooth enamel wears down, exposing a softer, under layer.
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Taking into account a growing body of research indicating the effectiveness of silver diamine fluoride for tooth decay, the American Academy of Pediatric Dentistry in 2017 recommended the off-label use of silver diamine fluoride to treat cavities in children and adolescents, including those with special health needs. Health providers sometimes prescribe FDA-approved medications for other uses they deem safe, known as off-label use.
The FDA has been unable to approve silver diamine fluoride for cavities because it has lacked data from large clinical trials showing its effectiveness and safety among the U.S. population. But a new clinical trial conducted in the United States bolsters the argument for the FDA to approve silver diamine fluoride for tooth decay, the researchers say.
The study found silver diamine fluoride effectively stopped tooth decay in more than half of children's baby teeth treated every six months with the liquid. The study enrolled 830 children under 6 through dental offices, pediatric clinics and Head Start programs in Michigan, New York and Iowa.
"This is a very effective and safe treatment — even in children as young as one," Margherita Fontana, professor of dentistry at the University of Michigan School of Dentistry and the study's lead researcher, said in a news release.
The treatment is applied to a cavity with a sponge-tipped applicator. It stops tooth decay within a few seconds, eliminating the need for shots, drilling and sedation.
Tooth decay is the most common chronic health problem in young people. More than 1 in 10 children ages 2 to 5, and 1 in 5 children ages 6 to 8, have at least one untreated cavity, according to 2024 data from the Centers for Disease Control and Prevention.
Untreated cavities can lead to pain, tooth loss and infections. In rare cases, those infections can be life-threatening, the Mayo Clinic says.
Anxiety about visiting the dentist and costs bar some children – and adults – from getting dental care, making silver diamine fluoride a viable and needed alternative, researchers said. The main downside of using silver diamine fluoride is that is permanently stains the site of decay on teeth.
But applying the solution once every six months to the site of decay on baby teeth may be sufficient until the teeth fall out. Silver diamine fluoride is also viable as a treatment for adults to halt decay until they receive more thorough treatment, according to the study.
"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," Amr Moursi, professor of pediatric dentistry at NYU College of Dentistry and a co-principal investigator on the study, said in the news release.
