Scientists Find Simple Way to Stop Cavities Without Drilling

Researchers at the University of Michigan have found that a simple, inexpensive liquid called silver diamine fluoride (SDF) can stop tooth decay in many young children without the need for drilling, injections, or general anesthesia. Results from a large Phase III U.S. clinical trial showed that applying 38% silver diamine fluoride to cavities every six months successfully halted decay in more than half of affected baby teeth, offering a less invasive alternative to traditional cavity treatment. The findings, published in JAMA Pediatrics, could pave the way for broader use of the treatment in the United States and support future approval by the U.S. Food and Drug Administration (FDA) specifically for treating tooth decay.

The treatment involves brushing the liquid directly onto the decayed portion of a tooth using a small applicator, a procedure that takes only a few seconds per tooth. Unlike conventional fillings, SDF does not require removing damaged tooth material, making it particularly beneficial for young children, patients with dental anxiety, older adults, and individuals with disabilities who may struggle with standard dental procedures. However, the treatment permanently darkens the decayed area of the tooth, which remains its primary cosmetic drawback.

Large U.S. Trial Demonstrates Effectiveness

The study is the largest U.S. clinical trial evaluating silver diamine fluoride for childhood cavities.

Researchers enrolled:

• 830 children under the age of six.
• Participants from Michigan, New York, and Iowa.
• Children recruited through dental clinics, pediatric practices, and Head Start programs.

The trial found that applying 38% silver diamine fluoride every six months successfully arrested tooth decay in more than half of affected baby teeth, significantly reducing the need for conventional drilling and fillings.

Study Snapshot

Item	Details
Institution	University of Michigan
Journal	JAMA Pediatrics
Participants	830 children under age 6
Treatment	38% Silver Diamine Fluoride (SDF)
Application Frequency	Every six months
Primary Outcome	Stopped decay in more than half of treated baby teeth

How Silver Diamine Fluoride Works

Silver diamine fluoride combines two important functions:

• Silver acts as an antimicrobial agent, killing bacteria responsible for tooth decay.
• Fluoride strengthens tooth structure and helps prevent further decay.

Instead of removing decayed tissue with a dental drill, dentists simply paint the liquid onto the cavity, allowing it to halt bacterial activity and stabilize the affected tooth. The treatment requires:

• No drilling.
• No injections.
• No sedation.
• Only a few seconds per tooth.

Benefits for Children and Vulnerable Patients

Researchers believe SDF could significantly improve access to dental care for patients who cannot easily undergo conventional treatment.

Potential beneficiaries include:

• Very young children.
• Patients with severe dental anxiety.
• Older adults.
• Individuals with developmental or physical disabilities.
• People with limited access to dental care.

Untreated cavities remain one of the most common chronic childhood diseases and can lead to severe pain, infections, eating difficulties, missed school days, and, in some cases, surgery under general anesthesia. By stopping decay early, SDF may reduce these complications and lower healthcare costs.

Advantages and Limitation

Advantages	Limitation
No drilling required	Permanently darkens decayed portion of the tooth
No anesthesia or injections	Cosmetic appearance may concern some patients
Fast application	Does not restore lost tooth structure like a filling
Low-cost treatment	Some cavities may still require future restorative care

Long History, New U.S. Evidence

Silver diamine fluoride has been used successfully for decades in several countries.

In the United States:

• It has been available since 2014 to reduce tooth sensitivity.
• Dentists have used it off-label to treat cavities.
• Large U.S. clinical evidence supporting cavity treatment had previously been limited.

The new Phase III trial provides the clinical data needed for the manufacturer to seek FDA approval specifically for treating dental caries (cavities), potentially expanding insurance coverage and wider adoption across pediatric and primary healthcare settings.

Potential Impact on Dental Care

Researchers say broader adoption could transform how early childhood cavities are managed.

Possible benefits include:

• Earlier treatment before cavities become painful.
• Reduced need for operating-room dental procedures.
• Improved access through pediatric medical practices.
• Lower healthcare costs.
• Better preventive dental care for underserved communities.

Experts also note that pediatricians often see children years before their first dental visit, meaning SDF could become an important tool for managing cavities until children receive comprehensive dental care.

Looking Ahead

The University of Michigan study provides strong clinical evidence that silver diamine fluoride offers a safe, fast, and affordable way to stop tooth decay in many young children without the need for drilling or anesthesia. By demonstrating effectiveness in a large U.S. Phase III trial, the research strengthens the case for FDA approval of SDF as a dedicated treatment for dental cavities, potentially expanding access through dentists, pediatricians, and community healthcare providers.

Looking ahead, wider regulatory approval and insurance coverage could make silver diamine fluoride a standard first-line treatment for early childhood cavities, particularly for patients who cannot tolerate conventional dental procedures. While the treatment does not replace fillings in every case and permanently darkens decayed tooth surfaces, its simplicity, low cost, and ability to halt disease progression could significantly improve oral health outcomes and reduce the burden of untreated tooth decay among children and other vulnerable populations.

Frequently Asked Questions

What is silver diamine fluoride and how does it stop cavities?

Silver diamine fluoride (SDF) is a liquid that combines silver, which kills decay-causing bacteria, with fluoride, which strengthens tooth structure; dentists paint it directly onto a cavity instead of drilling out decayed tissue.

How effective was SDF in the clinical trial?

In a Phase III U.S. trial of 830 children under six, applying 38% silver diamine fluoride every six months successfully halted decay in more than half of affected baby teeth.

Does silver diamine fluoride have any drawbacks?

Its main drawback is cosmetic – the treatment permanently darkens the decayed area of the tooth – but it requires no drilling, injections or sedation and takes only a few seconds per tooth.