Scientists Find a Way to Stop Childhood Cavities Without Drilling

For young children with cavities, a routine trip to the dentist can sometimes lead to a frightening experience involving drills, injections and, in severe cases, surgery under general anesthesia. Now, a major U.S. clinical trial suggests that a simple liquid applied directly to decayed teeth could help many children avoid those procedures.

The treatment, known as silver diamine fluoride (SDF), stopped tooth decay in more than half of the affected baby teeth examined in a study involving 830 children. The results could help pave the way for wider use of a treatment that takes seconds to apply, although it comes with a permanent cosmetic drawback.

A Major Clinical Trial Finds an Alternative to Traditional Fillings

Researchers at the University of Michigan School of Dentistry led a Phase III clinical trial investigating whether silver diamine fluoride could safely stop tooth decay in young children. Published in JAMA Pediatrics, the study included 830 children younger than six years old recruited through dental offices, pediatric medical practices, and Head Start and Early Head Start programs in Michigan, New York and Iowa.

The researchers examined the effectiveness of 38% SDF applied to affected baby teeth every six months. Unlike conventional cavity treatment, which typically involves removing decayed tooth material before placing a filling, SDF is painted directly onto the damaged area.

The findings showed that the treatment arrested decay in more than half of the affected baby teeth. This provides substantial clinical evidence for a noninvasive approach that could be particularly useful for children who struggle to tolerate conventional dental procedures.

Margherita Fontana, professor of dentistry at the University of Michigan School of Dentistry and the study’s lead investigator, described the results as evidence of the treatment’s safety and effectiveness in very young patients.

“This is a very effective and safe treatment, even in children as young as 1,” Fontana said.

The study also addresses an important gap in the evidence supporting SDF. Although dentists have used the treatment in many countries for decades, researchers needed large U.S. clinical trials to establish its safety and effectiveness as a cavity treatment for the American population.

The new findings provide data that the manufacturer can use to submit a drug application to the U.S. Food and Drug Administration (FDA). That process could eventually make the treatment more widely available for managing childhood tooth decay.

How Silver Diamine Fluoride Stops Tooth Decay

Silver diamine fluoride is a liquid that dental professionals apply directly to a cavity using a small sponge-tipped applicator. The procedure takes only a few seconds per tooth and does not require drilling, injections or sedation.

Traditional treatment usually involves removing the decayed portion of a tooth and filling the resulting space. Young children can find that process difficult, particularly when they are frightened by dental equipment or cannot remain comfortable during a procedure.

SDF offers another way to manage decay. Rather than removing the damaged tooth material, the liquid is used to arrest the progression of the cavity. This can help control the problem without immediately requiring a conventional filling.

Why the Application Is Different From a Filling

A filling restores a tooth after a dentist removes the decayed material. SDF works differently because the treatment aims to stop the decay from progressing without removing that material as part of the application.

This distinction makes the liquid particularly relevant for young children who may struggle with longer procedures. It may also be useful when conventional restorative treatment cannot be arranged immediately.

However, arresting decay does not mean that the damaged portion of the tooth has been rebuilt. A dental professional still needs to assess the cavity and determine whether further treatment is appropriate.

Why Researchers Tested Repeated Applications

In the clinical trial, researchers evaluated SDF applied at six-month intervals. The results support its potential to control decay when used repeatedly, rather than relying on a single application in every case.

For some children, continued treatment may help preserve a baby tooth until it naturally falls out. That possibility could reduce the need for more involved procedures while the tooth remains functional.

The trial focused on young children, but researchers also identified potential applications for older adults and other patients who have difficulty accessing or tolerating conventional dental treatment.

Untreated Childhood Cavities Can Lead to Serious Problems

Tooth decay is often regarded as a routine childhood complaint, but the consequences can become serious when cavities remain untreated. The supplied study reports describe dental caries as the most common chronic disease affecting children in the United States, with more than 40% of children experiencing cavities.

As decay progresses, children may develop severe tooth pain and infections. These problems can interfere with eating and sleeping, lead to missed school days and require repeated medical appointments.

Some children with untreated dental problems end up in emergency departments. Hospital doctors can address certain immediate complications, but they may not be able to repair the underlying dental damage. Children can therefore continue to experience problems until they receive appropriate dental care.

In more severe cases, treatment may require surgery under general anesthesia. This can be especially challenging for young patients and their families.

The researchers believe SDF could help address some of these difficulties by providing a way to arrest decay before it progresses. Because the application is quick and does not require drilling or sedation, it may be suitable for children who would otherwise struggle to receive conventional treatment.

The approach could also have implications for access to care. Children sometimes visit pediatricians years before establishing a regular relationship with a dentist. If SDF becomes more widely accepted for use in appropriate medical settings, healthcare providers may have another way to help families address tooth decay earlier.

Five Groups Who Could Benefit From the Treatment

Although the Phase III trial focused on children younger than six, the potential uses of SDF extend beyond early childhood. Researchers have identified several groups who may benefit from a treatment that does not require drilling or injections.

• Very young children: Toddlers may struggle to remain comfortable during conventional dental procedures. A quick application could offer another option for managing suitable cavities.
• People with severe dental anxiety: Patients who find drills and injections difficult to tolerate may prefer to discuss a noninvasive approach with their dentist.
• People with developmental or physical disabilities: Some patients face additional challenges when receiving conventional dental care, making simpler treatment options valuable.
• Older adults: SDF may help manage tooth decay when restorative procedures are difficult to access or tolerate.
• People with limited access to dental services: The treatment may provide an option for controlling decay while patients arrange further care or wait for restorative treatment.

Fontana highlighted the potential value of SDF for people who cannot easily tolerate or access standard dental procedures. Its simple application could make it useful in circumstances where conventional treatment presents practical difficulties.

For children, the ability to manage decay without drilling could be particularly significant. Early intervention may help prevent some cavities from progressing to the point where more complicated treatment becomes necessary.

However, the treatment is not automatically suitable for every patient or every cavity. Dental professionals must evaluate the condition of the tooth and decide whether SDF offers an appropriate option.

The Permanent Black Stain Is a Major Drawback

Despite its potential benefits, silver diamine fluoride has a cosmetic disadvantage that families need to consider carefully. The treatment permanently darkens the decayed portion of the tooth.

The silver causes the treated area to turn black, making the change visible when the affected tooth can be seen. For parents deciding how to treat a cavity in a child’s front teeth, the appearance may be a significant concern.

The discoloration is permanent on the treated decayed area, so families should understand what to expect before agreeing to the procedure. The location of the cavity, the child’s needs and the available alternatives may all influence the decision.

For some families, avoiding drilling or sedation may outweigh the cosmetic drawback. Others may prefer to discuss conventional restorative options, particularly when the cavity affects a prominent tooth.

The treatment also has limitations beyond its appearance. Although SDF can arrest decay, it does not reconstruct the damaged portion of a tooth in the same way a filling does. Some patients may still require additional dental procedures.

Parents should therefore discuss the likely outcome with a dental professional before choosing the treatment. Understanding both its benefits and limitations can help families make an informed decision about their child’s care.

FDA Approval Could Help More Patients Access SDF

Silver diamine fluoride has a long history of use in many countries. In the United States, dentists have used it off-label since 2014, when it was cleared as a medical device for reducing tooth sensitivity.

Using the liquid to treat cavities involves a separate regulatory question. Researchers needed high-quality clinical evidence demonstrating that the treatment was safe and effective for that purpose in U.S. patients.

The new Phase III trial supplies evidence that could support the manufacturer’s application to the FDA for approval as a drug for managing tooth decay. The supplied reports do not establish that this approval has already been granted.

Fontana explained why rigorous evidence was necessary before wider adoption of the treatment.

“If we want more children and families to benefit from this treatment, we need rigorous evidence showing both that it works and that it’s safe,” Fontana said.

The study began in 2018 and continued despite disruptions caused by the COVID-19 pandemic. Researchers from the University of Michigan worked with colleagues at New York University, the University of Iowa and Indiana University, alongside the National Institute of Dental and Craniofacial Research.

The institute provided more than $12 million in support for the research. The product tested was Advantage Arrest 38% SDF, supplied by Elevate Oral Care.

Amr Moursi, professor of pediatric dentistry at New York University College of Dentistry and a co-principal investigator, said the findings could support broader use of the treatment.

“Our results support FDA approval of SDF for managing tooth decay in young children,” Moursi said.

He explained that removing SDF from off-label status could encourage more providers to use it, improve insurance reimbursement and support more consistent product quality.

Those changes could make the treatment easier for families and healthcare providers to access. Wider acceptance could also help more children receive care before cavities become painful, infected or require surgery.

What the Findings Mean for Parents and Children

The trial offers evidence that silver diamine fluoride can stop decay in many affected baby teeth without the drilling and injections associated with conventional treatment. For families dealing with childhood cavities, it provides another option worth discussing with a dental professional.

Parents should ask whether SDF is appropriate for their child’s specific cavity, what the permanent discoloration will look like and whether follow-up applications or additional procedures may be needed. Routine dental examinations and preventive care remain important because the treatment does not eliminate the need for ongoing attention to oral health.

The study also points toward possible benefits for patients who face barriers to conventional dentistry, including people with disabilities, severe dental anxiety or limited access to dental services. Further adoption will depend partly on the regulatory process and how healthcare providers incorporate the treatment into practice.

For a young child who might otherwise face a difficult dental procedure, a liquid applied in seconds could make cavity management considerably simpler. The permanent darkening remains a trade-off, but the evidence gives families and dentists another approach to consider before tooth decay becomes a more serious problem.