Silver Diamine Fluoride (SDF) FAQ for Health Professionals

What is silver diamine fluoride?

SDF is a liquid medicament containing silver and fluoride that is currently used “off label” to arrest cavitated carious lesions (cavities). 

Why is SDF being introduced into pediatric practice now?

In 2022, silver diamine fluoride was assigned a Category III current procedural terminology (CPT) code (0792T) which allows pediatricians to be paid for application of SDF. This designation is given to emerging technologies, services, procedures, and service paradigms for the purposes of data collection, evaluation of service delivery, and development of policy. Pediatricians are now able to bill for SDF application, although valuation and payment have not yet been established and will be determined as a result of this process. 

The July 2023 introduction of a Category III code (Code 0792T) for silver diamine fluoride led the AAP to form a work group to draft guidance on its application by medical professionals. 

When can SDF be used?

SDF can be used to arrest decay in most instances of cavities as long as the patient does not have an allergy to silver and the affected tooth does not show signs of something called pulpitis. 

Learn more about the indications and contraindications of SDF. 

What are the risks and benefits of SDF?

Risks: 

• SDF permanently blackens dental caries and can temporarily tattoo skin and clothes if accidentally exposed.
• SDF-treated teeth require monitoring and follow-up. Reapplication may be necessary.
• SDF applied to some cavities may not arrest the decay and could further exacerbate infection and pain.  

Benefits: 

• SDF is a minimally invasive treatment and can be applied in one visit as soon as active decay is evident.
• SDF application is painless, requires little preparation, is easily performed, and takes only a few minutes.
• SDF can be used when a child is unable to tolerate traditional restorative treatment, for example young children, children with severe disease, and those with special health care needs and/or intellectual disability.
• Although not a definitive treatment, SDF may be an alternative when the parents and caregivers desire minimal intervention.
• SDF can postpone restorative care that would require local or general anesthesia.
• SDF represents access to care. 

What kind of training is required and available?

SDF in the pediatric medical home is new, and training to identify SDF-eligible lesions and apply treatment is evolving. Training is currently being developed. Smiles for Life is creating a module on indications for the use SDF in medical settings. In publishing this document, the American Academy of Pediatrics is providing initial guidance on considerations for and use of SDF. One-on-one training from dental professionals, including registered dental hygienists and dental therapists, may be available by arrangement with your dental professional colleagues and is recommended. 

Other things to remember

• SDF does not replace the need for a regular dentist /dental home for regular care. If necessary, help families to establish a dental home by the child’s first birthday. 
• SDF may not be enough to stop tooth decay. Families need to schedule a follow-up appointment with you in 3 months following treatment to assure that SDF was successful and to discuss any new concerns. In some cases, additional SDF application may be necessary.
• Patients may eat and drink normally after SDF application.
• After SDF treatment, help families to follow up with a dental professional as soon as possible. 
• Work with families to identify oral health habits they feel able to accomplish at home.