Silver diamine fluoride: where it fits in a general practice
It arrests decay, it is inexpensive and it stains. Getting the consent conversation right matters more than the technique.
Silver diamine fluoride has moved from a niche product to a standard item in the drawer of most Canadian general practices. The 38 percent solution arrests active caries in a high proportion of lesions with a single application, without local anaesthetic, drilling or a long appointment. That combination makes it valuable for exactly the patients who tolerate conventional treatment least well.
Who it is for
- Young children with early lesions, where a filling would need sedation or a hospital appointment.
- Older adults with root caries, especially in long-term care or with limited mobility.
- Patients with medical conditions that make longer procedures risky.
- Anyone with a large number of lesions where treatment needs to be staged over months.
What it does not do
It does not restore the tooth. The lesion stops progressing, but the cavity stays, and in load-bearing areas or where food traps, a restoration is still needed later. It is also not a one-time treatment. Most protocols call for reapplication at intervals, commonly every six to twelve months, with an examination at each visit to confirm the lesion is still arrested.
The staining conversation
Treated decay turns black and stays black. This is the single reason patients and parents decline the treatment, and the single reason they complain afterwards if they were not told clearly. The consent discussion should include the words "permanent" and "black", ideally with a photograph. Sound enamel does not stain, but any skin, clothing or countertop it touches will.
Written consent that records the staining discussion is standard practice. On anterior teeth in an adult, most clinicians offer a conventional restoration first and reserve silver diamine fluoride for cases where the patient chooses it with full understanding.
Technique in one paragraph
Isolate, dry the lesion, protect the soft tissue with petroleum jelly, apply a small amount with a microbrush, let it sit for the time the manufacturer specifies, then blot. Avoid rinsing immediately. A fluoride varnish over the top is common. The whole thing takes a few minutes, which is the point.