Guidance on the Application of Silver Diamine Fluoride (SDF) in the Pediatric Medical Setting 

The American Academy of Pediatrics (AAP) is excited to introduce guidance on the use silver diamine fluoride, an effective tool now available to physicians seeking to stop the progression of untreated tooth decay in patients through age 5. 


Overview

Pediatricians are often the first health professionals to identify tooth decay in young children, making the medical home the de facto source for oral health care. This is especially true for the many families who have no access to professional dental care.  

Since the AAP Section on Oral Health (SOOH) began introducing oral health resources in 2000, pediatricians have been able to provide preventive care by performing oral health risk assessments and applying  fluoride varnish. Now medical professionals can actually treat decay with this caries-arresting liquid medication that is easily and quickly applied to affected teeth, buying precious time until referral to professional dental care can be achieved. 

Before You Begin

Developing the AAP SDF Guidance

The rationale, guiding knowledge, and assumptions of the AAP work group in the development of this guidance. Download and use this brief in your practice.

FAQ for Health Professionals

Frequently asked questions about using SDF in the medical setting.

Advantages and Disadvantages

Advantages and disadvantages to inform a choice of SDF.

SDF at A Glance

A 4-page introduction to silver diamine fluoride application.

Partnering with Families 

Coordinating Care

Ensure families and patients have the information they need and can be successfully referred to dental care.

Discussing Indications and Obtaining Informed Consent

Effectively explain informed consent and gather all the required information in your consent form.

Silver Diamine Fluoride to Stop Tooth Decay

Caregivers can learn more about SDF on HealthyChildren.org.

FAQ for Families

Print and share these frequently asked questions with families so they can learn more about SDF treatment.
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Preparing Your Practice

Enabling Referral to a Dental Home

Learn about the components of a dental referral and browse sample referral forms to use in practice.

Supplies, Equipment, Storage and Handling

View a list of common supplies used in SDF application and how to properly clean and store all equipment.

Coding and Billing

View the coding information for oral services and preventive medicine.

Sample Workflows

Refer to these sample workflows to effectively integrate SDF into your practice step-by-step.

Applying SDF 

Preparing the Child

Some children will have special considerations that involve a measured approach to assessment and treatment. Learn calming techniques and distractions to use before SDF application.

Indications and Contraindications

Indications, contraindications and important assumptions to consider before applying SDF.

Detailed Steps for Applying SDF

Detailed step-by-step instructions for applying SDF from start to finish.

Aftercare Instructions

Aftercare instructions and resources for health professionals and families.

Disease Progression, Reapplication, Confirming Arrest

Steps to screen and identify disease progression following SDF treatment and considerations for SDF reapplication.

Oral Health Education for Health Professionals

A variety of educational resources for physicians, including AAP courses and reference guides.

Learn More

Acknowledgements

This guidance was developed by the American Academy of Pediatrics (AAP) Silver Diamine Fluoride (SDF) Work Group with generous funding from the CareQuest Institute for Oral Health. The Work Group was made up of pediatric medical and dental professionals, researchers, and representation from the AAP FamilY Partnerships Network. We would like to express our gratitude for the collegial way in which this group engaged in detailed and thoughtful discussions to adapt SDF clinical guidance from the dental to the pediatric medical setting, keeping a constant focus on the wellbeing of children and families. Thank you. 

Work Group Members

Blakely Amati MD 
University of South Carolina School of Medicine 

Rebecca Bernstein MD
Medical College of Wisconsin 

Patricia Braun MD, MPH
University of Colorado School of Medicine 

Eileen Crespo MD
Delta Dental of Minnesota 

Stephen Holve MD 
Tuba City Regional Health Care Corporation 

Emily Horney RDH
North Carolina Division of Public Health 

Divya Khera DDS
New York University College of Dentistry 

Quentin Knutson DDS
Apple Tree Dental 

Alexis Snyder
Patient & Stakeholder Engagement Specialist 

Lauren Spilles RDH
Access to Baby and Child Dentistry 

Norman Tinanoff DDS, MS
University of Maryland 

American Academy of Pediatrics 

Hollis Russinof MUPP 
Project Manager, Guidance on Silver Diamine Fluoride Application in the Pediatric Medical Setting 

Lauren Barone MPH 
Director, Primary Care & Workforce 

Kera Beskin MPH, MBA
Former Manager, Maternal & Child Health Initiatives 

Jeff Karp DDS 
Chair, Section on Oral Health Executive Committee