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To Drill or Not to Drill

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Dental caries affects about one out of four children aged 2-5 years in the United States. Fixing those cavities for such young aged children is the most difficult part of my job, since these children are often too young to even know to cooperate and it becomes very difficult to do the treatments.  In some cases, we even have to resort to putting these children to sleep under General Anesthesia for dental treatments. 

Is there any other choice?

I am very excited about this new product called Silver Diamine Fluoride (SDF), which recently got approved for use in the United States, in arresting dental caries!   This means that instead of going through a difficult process of doing dental restorations on a young child, you can apply SDF on the teeth with cavities to “arrest” the progression of dental decay.  It basically gives us an option to “buy time” until child becomes old enough to have the tooth fixed.   This is very exciting!!

How does it work? Any drawbacks? 

SDF is a clear liquid.  Once the tooth is dry, all it takes is to rub on this clear liquid on the cavity for about 1 minute.  No drilling!  Now, understand that this does not work on all types of cavities.  It has less effect on larger cavities and “in between” cavities that are hard to access.  Also, it needs to be applied at least 2 times per year to have best result.  The drawback is that once this is applied to a cavity, it turns the part of the tooth that has a cavity black.  So, it is not a good option for front teeth.  Also, it does not taste all that great, so young kids may still be fussy or cry during application.  But it only takes a few minutes to do and if we can possibly delay “drilling" until they are old enough to cooperate, or to even prevent drilling period, I see this as a revolutionary product! 

Who’s the best candidate for SDF application?   

  • Young children with small to moderate sized cavities in the back teeth. 
  • Anyone else with tiny (incipient) “in-between teeth” cavities on permanent molars.

How do you know if it’s working?

By feel! When the dentist feels the cavity and it’s black and hard, the decay is arrested! On surfaces that can’t be seen, we look at the x-rays. If the cavity has not grown in 6 months, and 12 months consecutively on the x-ray, SDF is working! 

It’s important to understand that this does not eliminate cavities. It simply has the ability to “STOP” it from growing. SO, if you ever move on to another dentist, it is important to let the new dentist know that you’ve had SDF treatments. 


Currently, insurance companies do not cover for SDF applications. However, SDF is very affordable and is a fraction of the cost of a filling or a crown! Please ask our staff for pricing. 

* All information subject to change. Images may contain models. Individual results are not guaranteed and may vary.