Parent Guide: Silver Diamine Fluoride for Kids: SDF vs. Fillings

Updated November 2026.

Silver diamine fluoride (SDF) is a liquid a dentist brushes onto a cavity to help stop decay without drilling or numbing. It works well for many baby-tooth cavities, especially in toddlers and young children, but it permanently stains the decayed area black and doesn’t rebuild the tooth. A filling restores the tooth’s shape and color, and some children need both.

If your child’s dentist has mentioned SDF, you probably have questions: Does it hurt? Will my child’s teeth turn black? Is it safe for a 2-year-old? Is it as good as a filling? This guide explains what silver diamine fluoride for kids is, how it compares to fillings, what the side effects are, and which children it tends to help most, using guidance from the American Academy of Pediatric Dentistry (AAPD), the American Dental Association (ADA), the American Academy of Pediatrics (AAP) and Head Start.

What is silver diamine fluoride?

Silver diamine fluoride is a clear liquid made of silver, fluoride and ammonia. The silver helps kill the bacteria that cause tooth decay, and the fluoride helps harden the weakened tooth. When it’s painted onto a cavity, the decay can stop growing and become hard and dark.

According to the ADA’s overview of silver diamine fluoride, SDF is cleared by the U.S. Food and Drug Administration (FDA) for treating tooth sensitivity. Using it to stop cavities is an off-label use, which is common in medicine and dentistry when research supports it. The ADA’s summary says evidence shows that 38% SDF “can be an effective, noninvasive treatment option to arrest dentinal caries,” and the AAPD’s policy on silver diamine fluoride states that it is more effective for stopping cavities in dentin than fluoride varnish.

How well does SDF stop cavities?

SDF doesn’t work on every cavity, but it works on many. The AAPD chairside guide on SDF reports that one application stops decay in an estimated 47 to 90 percent of cavities, depending on the cavity’s size and where the tooth is. Front teeth respond more often than back teeth. More applications raise the odds: the AAPD notes that reapplying twice a year stops more decay than a single treatment when the cavity isn’t filled.

The AAP also points out that SDF may not stop every cavity, so treated teeth need monitoring and follow-up. That’s why your dentist will want to see your child again after treatment.

SDF vs. fillings: how do they compare?

SDF and fillings do different jobs. SDF aims to stop decay. A pediatric dental filling removes the decay and rebuilds the tooth.

The two can also work together. The AAPD chairside guide says cavities can be filled after SDF treatment, and SDF can be used before a filling is placed. Some dentists use SDF to stop decay in a toddler, then place a tooth-colored filling when the child is older and more comfortable.

Who is SDF best for?

The AAPD chairside guide lists children who may benefit from SDF, including those:

• at high risk of cavities who already have active cavities
• with behavior or medical challenges that make traditional treatment hard
• with several cavities that can’t all be treated in one visit
• with cavities that are hard to reach or treat
• who have trouble getting to dental care

SDF is used on cavities that haven’t reached the nerve. It isn’t the right choice for a tooth with signs of nerve inflammation, spontaneous pain or infection. The AAP and Head Start both say children with a silver allergy should not receive SDF, and Head Start adds children with sores or ulcers in the mouth.

Is SDF safe for toddlers?

For many families, the biggest question is whether silver diamine fluoride is safe for toddlers. Dental and medical groups consider SDF a reasonable option for young children when it’s used correctly:

• The ADA reports that the AAPD knows of no systemic or serious side effects from SDF when it’s used according to the manufacturer’s directions.
• The ADA notes that the amount of SDF used to treat a cavity contains less fluoride than a fluoride varnish treatment.
• The American Academy of Pediatrics describes SDF for children who can’t tolerate traditional treatment, such as young children, and supports its use by pediatricians for patients through age 5.
• The AAPD chairside guide says no more than one drop of SDF should be used for the whole appointment.

For a toddler who can’t sit through a filling, SDF can stop decay while avoiding a longer, harder visit. Ask your child’s dentist whether SDF makes sense for your child’s teeth and health.

Does silver diamine fluoride stain teeth?

Yes, and this is the most important thing to know before choosing SDF. The decayed part of the tooth usually turns black and stays black. The AAPD describes successfully treated cavities as “black and hard.” A few points can help parents decide:

• Only the decay darkens. The ADA notes that healthy, mature enamel isn’t stained.
• Adult teeth aren’t affected. Head Start explains that the permanent tooth that later replaces a treated baby tooth won’t be stained.
• The stain can be covered. A tooth-colored filling or a crown can be placed over the treated area later.
• Back teeth matter less. Many parents find staining on back baby teeth easier to accept than on front teeth.

The AAPD notes that before-and-after photos can help parents understand what to expect when deciding.

Silver diamine fluoride side effects

What happens during an SDF treatment?

The AAPD chairside guide describes a quick visit:

1. The dentist clears food and debris from the cavity. Drilling out the decay isn’t needed.
2. The tooth is kept dry with cotton rolls and gentle air.
3. A tiny brush applies SDF to the cavity only, ideally for about a minute.
4. Extra liquid is wiped away, and the tooth is kept dry for a few minutes.
5. Fluoride varnish may be placed on the other teeth.

Expect a follow-up visit about two to four weeks later to check that the treated cavities look dark and hard. If not, the dentist may reapply SDF.

Why SDF is part of the conversation for Hawaiʻi keiki

Cavities are a big concern for children in Hawaiʻi. The Hawaiʻi State Department of Health’s Hawaiʻi Smiles report found that 71% of third graders had experienced tooth decay, compared with a national average of 52%. Most island tap water also has no added fluoride: in the CDC’s 2022 water fluoridation statistics, only 8.5% of Hawaiʻi residents on community water systems received fluoridated water, the lowest share in the country.

That means many Oʻahu families meet cavities in children early, sometimes before a child is old enough to sit for a filling. Treatments that stop decay without drilling, like SDF, sit alongside prevention such as professional fluoride treatment for kids and catching white spots on teeth while they’re still reversible.

Questions to ask your child’s dentist about SDF

• Which teeth would you treat, and will the staining show when my child smiles?
• Has the decay reached the nerve, or is SDF an option?
• How many visits or reapplications might be needed?
• Would you recommend a filling now, later, or not at all?
• What can we change at home to stop new cavities?

Frequently asked questions about silver diamine fluoride

What is silver diamine fluoride?

Silver diamine fluoride (SDF) is a clear liquid that a dentist brushes onto a cavity to help stop it from growing. The silver helps fight bacteria and the fluoride helps harden the tooth. It doesn’t need drilling or numbing, but the decayed area turns permanently black. The FDA has cleared SDF for tooth sensitivity; using it to stop cavities is an off-label use.

Is SDF better than a filling?

Neither is better for every child. SDF can stop many cavities quickly and without drilling, which helps very young children or kids who can’t sit for a filling, but it stains decay black and may need reapplying. A filling rebuilds the tooth’s shape and color in one visit. Some children get SDF first and a filling later.

Does silver diamine fluoride stain teeth?

Yes. SDF turns the decayed part of the tooth black, and that stain is permanent. The ADA notes that healthy, mature enamel isn’t stained, and Head Start explains that the adult tooth that later replaces a treated baby tooth won’t be stained. A tooth-colored filling or crown can cover the stain later if needed.

What are the side effects of silver diamine fluoride?

The main side effect is permanent black staining of treated decay. Other possible effects include a metallic taste for a short time, mild gum irritation where the liquid touches, and temporary brown or white marks on the lips or skin that can last up to about three weeks. SDF also permanently stains clothing.

Is SDF safe for toddlers?

Dental groups consider SDF an option for young children when used correctly. The AAPD lists children with behavior or medical challenges among those who may benefit, the AAP describes SDF use for children through age 5 in medical settings, and the amount of fluoride used is less than in a fluoride varnish treatment, according to the ADA. Children with a silver allergy should not receive SDF.

How long does it take for SDF to turn black?

Treated decay usually darkens over the following days as the silver reacts with the tooth. AAPD guidance describes successfully arrested lesions as dark and hard, and recommends a follow-up visit two to four weeks after the first treatment to check whether the decay has stopped.

How often does SDF need to be reapplied?

It depends on the child and the cavity. The AAPD notes that several applications may be needed, and that twice-yearly reapplication arrests more decay than a single application when lesions aren’t restored. Head Start recommends reapplying every 6 to 12 months. Your dentist will set a schedule at follow-up visits.

How to use this parent guide

Use this article to prepare questions and recognize details worth sharing at a dental visit. General education cannot diagnose a child or replace an individual examination. If your child has pain, swelling, bleeding, an injury, fever, difficulty eating, or another urgent concern, call the dental office for guidance. Bring current health information, medications, relevant dental records, and notes about when symptoms began.

Talk with a pediatric dentist in Kahala

Every child’s teeth are different, and the right choice between SDF and a filling depends on the cavity, your child’s age and comfort, and what matters most to your ʻohana. Families have trusted Uchida Pediatric Dentistry for more than 30 years. Call (808) 739-0878 to book a visit in Suite 3070 at Kahala Mall, 4211 Waialae Ave, Honolulu, HI 96816, with free parking at Kahala Mall.