Silver diamine fluoride as a minimally invasive and aerosol free approach in pediatric dentistry: An extensive case series

Case Report

Contemp Pediatr Dent 2021:2(2):113-125

Silver diamine fluoride as a minimally invasive and aerosol free approach in pediatric dentistry: An extensive case series

OrcidAbhishek Soni1, OrcidSanchit Paul2 , OrcidPriyanka Sachdeva3


1. Chief Pediatric Dentist, Vanilla Smiles, Soni Capital 1237 Apte Rd.,Shivajinagar Pune, Maharashtra, India

2. Chief Pediatric Dentist, Tooth Tales, House No. D-2, Sec-P-3,Greater Noida, U.P., India ( Correspondence:

3. Assistant Professor, Department of Pediatric and Preventive Dentistry, School of Dental Sciences, Sharda University, Knowledge Park 3,Greater Noida, U.P., India


This study reports usage of SDF as extensive case series in various form of SMART, in proximal deep caries as indirect pulp therapy medicament, sealants and in MIH in various clinical situations in pediatric dentistry.

With correct diagnosis and appropriate treatment planning, SDF can be an indispensable tool for both minimally invasive pediatric dentistry (MIPD) and aerosol free dentistry (AFD) especially in pandemic times.

SDF parental handout form, clinical protocol along with decision making tree and usage of teflon tape could be immensely helpful for practitioners for administering SDF in both primary and permanent dentition routinely.


The current pandemic of COVID-19 warrants a repeal from conventional dentistry to an aerosol free, minimally invasive yet maximally effective clinical approach. Silver diamine fluoride (SDF) is an established modality for caries arrest in children fulfilling all the above. This extensive 25 case series highlights various clinical situations in which SDF was successfully used in children between 1-12 years of age with asymptomatic carious lesions of ICDAS score 2 or more in primary and permanent teeth. Primary outcome measure was caries arrest in the form of the hard and shiny lesion with no/minimal sensitivity. The secondary outcome measure was the zombie effect which was the residual staining on other tooth surfaces and indications of substantivity. SDF can be effectively and efficaciously used across different behaviour patterns and age groups of children in a various clinical scenario for both primary and permanent teeth routinely experienced in a paediatric dental office especially during these pandemic times with minimal aerosol generation.

Keywords: Case Reports; COVID-19; Dental Caries; Dental Enamel Hypoplasia; Fluorides; Silver Diamine Fluoride

Copyright © 2021 Contemporary Pediatric Dentistry


1. Peng X, Xu X, Li Y, Cheng L, Zhou X, Ren B. Transmission routes of 2019-nCoV and controls in dental practice. Int J Oral Sci 2020;12:1-6

2. Mallineni SK, Innes NP, Raggio DP, Araujo MP, Robertson MD, Jayaraman J. Coronavirus disease (COVID-19): Characteristics in children and considerations for dentists providing their care. Int J Paediatr Dent 2020;30:245‐250

3. Slayton RL, Urquhart O, Araujo MWB, Fontana M, Guzmán-Armstrong S, Nascimento MM et al. Evidence-based clinical practice guideline on nonrestorative treatments for carious lesions: A report from the American Dental Association. J Am Dent Assoc. 2018;149:837-849

4. Crystal YO, Niederman R. Evidence-Based Dentistry Update on Silver Diamine Fluoride. Dent Clin North Am 2019; 63:45‐68

5. Jiang M, Wong MCM, Chu CH, Dai L, Lo ECM. A 24-month randomized controlled trial on the success rates of restoring untreated and SDF-treated dentine caries lesions in primary teeth with the ART approach. J Dent 2020;100:103435

6. Oliveira BH, Rajendra A, Veitz-Keenan A, Niederman R. The Effect of Silver Diamine Fluoride in Preventing Caries in the Primary Dentition: A Systematic Review and Meta-Analysis. Caries Res 2019;53:24-32

7. Seifo N, Cassie H, Radford JR, Innes NPT. Silver diamine fluoride for managing carious lesions: an umbrella review. BMC Oral Health. 2019;12;145-152

8. Chibinski AC, Wambier LM, Feltrin J, Loguercio AD, Wambier DS, Reis A.

Silver Diamine Fluoride Has Efficacy in Controlling Caries Progression in Primary Teeth: A Systematic Review and Meta-Analysis. Caries Res 2017;51:527-541

9. Contreras V, Toro MJ, Elías-Boneta AR, Encarnación-Burgos A. Effectiveness of silver diamine fluoride in caries prevention and arrest: a systematic literature review. Gen Dent 2017;65:22-29

10. Agha RA, Borrelli MR, Farwana R, Koshy K, Fowler AJ, Orgill DP; PROCESS Group. The PROCESS 2018 statement: Updating Consensus Preferred Reporting Of CasE Series in Surgery (PROCESS) guidelines. Int J Surg 2018;60:279-282

11. Pitts, N. “ICDAS” – an international system for caries detection and assessment being developed to facilitate caries epidemiology, research and appropriate clinical management. Community Dent Health 2004;21:193-198

12. Pitts NB, Ekstrand KR. International Caries Detection and Assessment System (ICDAS) and its International Caries Classification and Management System (ICCMS)-methods for staging of the caries process and enabling dentists to manage caries. Community Dent Oral Epidemiol 2013,41:41-52.

13. Horst JA, Ellenikiotis H, Milgrom PL. UCSF Protocol for Caries Arrest Using Silver Diamine Fluoride: Rationale, Indications and Consent. J Calif Dent Assoc 2016;44:16-28

14.Seifo N, Robertson M, MacLean J, et al. The use of silver diamine fluoride (SDF) in dental practice. Br Dent J 2020; 228:75‐81

15. Horst JA. Silver Fluoride as a treatment for dental caries. Adv Dent Res 2018;29:135‐140

16. Zhi QH, Lo EC, Lin HC. Randomized clinical trial on effectiveness of silver diamine fluoride and glass ionomer in arresting dentine caries in preschool children. J Dent 2012;40:962-967

17. Fung MHT, Duangthip D, Wong MCM, Lo ECM, Chu CH. Arresting dentine caries with different concentration and periodicity of silver diamine fluoride. JDR Clin Trans Res 2016;1:143-152

18. Wakshlak RB-K, Pedahzur R, Avnir D. Antibacterial activity of silver-killed bacteria: the “zombies” effect. Sci Rep 2015;5:e9555

19. Jiang M, Mei ML, Wong MCM, Chu CH, Lo ECM. Effect of silver diamine fluoride solution application on the bond strength of dentine to adhesives and to glass ionomer cements: a systematic review. BMC Oral Health 2020;20:40-50

20. Schwendicke F, Meyer-Lueckel H, Stolpe M, Dörfer CE, Paris S. Costs and effectiveness of treatment alternatives for proximal caries lesions. PLoS One 2014;9:e86992 

21. Braga, M., Floriano, I., Ferreira, F.R., Silveira, J.M., Reyes, A., Tedesco et al. Are the approximal caries lesions in primary teeth a challenge to deal with? A critical appraisal of recent evidences in this field. In:Virdi MC; Emerging trends in Oral Health Sci Dent;2015:83–116

22. Hammersmith KJ, DePalo JR, Casamassimo PS, MacLean JK, Peng J. Silver diamine fluoride and fluoride varnish may halt interproximal caries progression in the primary dentition. J Clin Pediatr Dent 2020;44:79-83

23. Mei ML, Zhao IS, Ito L, Lo EC, Chu CH. Prevention of secondary caries by silver diamine fluoride. Int Dent J 2016; 66:71‐77

24. Felemban, O., Dabroom, W., Al-Sharif, M., Alghamdi, B., Bantan, F.S., Farie, G.A. et al. The effect of silver diamine fluoride in preventing secondary caries in primary teeth: in-vitro study. EC Dental Science 2018;17:1564-1569

25. MacLean J. Minimally invasive treatment for molar incisor hypomineralisation. Dec Dent 2018;4:18-23

26. Horst JA, Ellenikiotis H, Milgrom PL. UCSF Protocol for Caries Arrest Using Silver Diamine Fluoride: Rationale, Indications and Consent. J Calif Dent Assoc 2016;44:16-28

27. Bagher SM, Sabbagh HJ, AlJohani SM, Alharbi G, Aldajani M, Elkhodary H. Parental acceptance of the utilization of silver diamine fluoride on their child’s primary and permanent teeth. Patient Prefer Adherence. 2019;13:829-835

28. Rossi G, Squassi A, Mandalunis P, Kaplan A. Effect of silver diamine fluoride (SDF) on the dentin-pulp complex: ex vivo histological analysis on human primary teeth and rat molars. Acta Odontol Latinoam. 2017;30:5-12

Full Text





Article Info


27 April 2021


07 June Apl 2021

Online First:

21 June 2021