New Study: Silver Diamine Fluoride Can Stop Cavity Progression in Young Children Without Drilling.

Image source: Efficacy of Silver Diamine Fluoride on Young Children With Severe Early Childhood Caries

DentalGoodNews｜July 27, 2026, a phase 3 randomized controlled trial (n=830) published in JAMA Pediatrics showed that a single application of 38% silver diamine fluoride (SDF) at baseline and 6 months significantly improved the arrest rate of active caries lesions in primary teeth of young children. At the 6-month follow-up, the lesion arrest rate in the SDF group was 54.0%, compared with 22.5% in the placebo group.

The study was led by Dr. Margherita Fontana of the University of Michigan School of Dentistry, in collaboration with a multicenter team including New York University (NYU). Participants were recruited from dental clinics, healthcare institutions, and Head Start early education programs across Michigan, New York, and Iowa, enrolling 830 children under 6 years of age with severe early childhood caries (S-ECC). At the 8-month secondary endpoint follow-up, the lesion arrest rate in the SDF group remained at 50.2%, compared with 17.4% in the control group.

The researchers noted that SDF, as a low-cost liquid agent applied via micro-sponge applicator, enables non-invasive control of caries lesions, achieving lesion arrest without the need for drilling. The cost per application ranges from approximately $20 to $75, making it particularly suitable for young children who have difficulty cooperating with conventional dental treatment. Based on these findings, the researchers believe that although SDF causes permanent black staining of the treated lesions, presenting an aesthetic limitation, its non-invasive nature and high efficacy make it an important alternative for oral health management in young children. Additionally, Dr. Fontana stated that this treatment approach is even applicable to 1-year-old children, with favorable safety and clinical utility.

Currently, SDF is only approved by the U.S. Food and Drug Administration (FDA) for the treatment of dentin hypersensitivity in the United States, and its clinical use for caries lesion arrest remains off-label. Dr. Amr Moursi, a professor at New York University, stated that the study findings support further efforts to obtain FDA approval for SDF in the management of caries lesion arrest in children, moving it beyond off-label status and helping to expand clinical application and insurance coverage.

The study was funded by the National Institute of Dental and Craniofacial Research (NIDCR), part of the National Institutes of Health (NIH).