Silver Solutions – The New/Old Solution for Dental Caries 5

In August 2014, the FDA reclassified Silver Diamine Fluoride (SDF) as a fluoride, but does that mean dental auxiliaries such as dental hygienists who are authorized to administer fluoride can utilize this product in Texas? The state of Oregon’s Board of Dentistry followed the FDA’s announcement with a resolution to allow dental auxiliaries to apply SDF.

SDF and Silver Nitrate are liquid silver solutions that have both shown great success in treating decay. SDF works by reducing the demineralization process and inhibiting the growth of bacteria and “cariogenic biofilms”. An adverse reaction to some silver solutions is tooth discoloration where the solution blackens the tooth’s dentin and enamel.

In a press release dated May 6, 2015, Advantage Silver Dental Arrest and Elevate Oral Care launched Advantage Arrest silver diamine fluoride (SDF), which:

  • “Provides immediate relief from dentinal hypersensitivity.
  • Kills pathogenic organisms.
  • Hardens softened dentin, making it more acid- and abrasion-resistant.
  • Will not stain sound dentin or enamel.”

Silver’s antimicrobial properties have been known for centuries and dentists have used silver to arrest dental decay for over one hundred years. The use of silver in dentistry greatly declined in the 1950‘s and was replaced with surgical means of treating tooth decay. In recent years, silver solutions have made a comeback in use on both adults and children.

Research shows that Silver Nitrate and Silver Diamine Fluoride (SDF) are both safe and effective in treating dental caries, even showing SDF is more effective than fluoride varnish in treating dental caries. Fluoride varnish helps to prevent dental cavities and silver solutions may be the answer to stop active decay. Compared to costly surgical treatments brushing on SDF to arrest decay is comparatively easier, less painful and less expensive.SDF application

R. Mike Shirtcliff, DMD, the CEO of Advantage Dental of Oregon, a Medicaid dental insurer, sees SDF as an investment to help those on Medicaid. “Dr. Shirtcliff estimated it would cost $1 billion to provide needed dental care to Oregon’s Medicaid population with the available technology for restorations. [ However,] SDF has great potential as a treatment option, [. . .] you can finally get the disease under control [and] it has the potential to last longer and not re-decay.”

One Oregon family dentist, Dr. Randy Morgan, discusses on his website using silver nitrate on children’s cavities instead of filling them or pulling teeth. “The technique is simple: We use a small brush to paint on the silver nitrate, then immediately seal the area with a fluoride varnish. Once applied, the silver nitrate disinfects and hardens the cavity, which stops the decay process. [. . .] This treatment is fast and easy, and all present cavities can be treated in a matter of minutes. Here’s the best part: no shots and no tears.”

Share with us what you think of Silver Solutions. Could they prove to be the future of caries treatment and reduce the burden of tooth decay for our vulnerable populations? Is the issue of tooth discoloration a marked downside, or do new silver solutions such as Elevate Oral Care’s Advantage Arrest silver diamine fluoride, alleviate that concern? Are silver solutions the future of dental caries treatment or part of the past?


FDA’s reclassification of SDF as a fluoride could mean new treatment options
Dr. Bicuspid, December 26, 2014\

Silver compounds used in dentistry for caries management: a review
PubMed, July 2012

How does silver diamine fluoride stop dental caries?
Dr. Bicuspid, March 19, 2013

Advantage Silver, Elevate Oral Care launch Advantage Arrest SDF
Dr. Bicuspid, May 6, 2015

Silver diamine fluoride: a caries “silver-fluoride bullet”
PubMed, February 2009

Black diamonds: The case for silver nitrate and silver fluoride
Dr. Bicuspid, February 18, 2015

Cavity Treatment with Silver Nitrate
Newberg Family Dental, August 13, 2012

Black diamonds: The case for silver nitrate and silver fluoride — Part 2
Dr. Bicuspid, February 25, 2015

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5 thoughts on “Silver Solutions – The New/Old Solution for Dental Caries

  • Michelle Landrum, RDH, MEd

    One thing to keep in mind is that this is a VERY high dose and it turns the tooth black where it arrests the active caries. We need to carefully consider the safety, efficacy, risks/benefits, and social/cultural implications.

  • Dallas Orthodontists

    Hi TxOHC,

    I thought Silver Nitrate is a chemical that can cause danger to the human health? I’m really missing something here this silver nitrate solution that’s being used for dental solution is different from the silver nitrate that I was thinking.


  • TxOHC Post author

    Per the Dental-Public-Health Listserv, January 30, 2016

    Q – Where are people acquiring silver diamine fluoride in the US? Have you figured out how many teeth you can treat from one bottle? Is the bottle 1 oz in size?

    A – We order Advantage Arrest 38% SDF directly from the manufacturer, Elevate Oral Care, It runs about $120 for an 8 ml bottle, which treats a couple hundred teeth. Use just 1 drop for most patients, which will treat multiple lesions. Consider getting their applicators, also.

    Scott L. Tomar, DMD, MPH, DrPH
    Professor & Interim Chair
    University of Florida College of Dentistry Dept. of Community Dentistry & Behavioral Science
    1329 SW 16th Street, Suite 5180
    PO Box 103628
    Gainesville, FL 32610-3628
    Tel: 352.273.5968/ Fax: 352.273.5985

  • TxOHC Post author

    Per the Dental-Public-Health Listserv

    Q: Is anyone aware of a state Medicaid or private insurer who is paying for Silver Diamine Fluoride? Thanks!
    Jane Gillette, DDS

    A: As for a state where Medicaid is paying for silver diamine fluoride treatment, Oregon will be soon. Our Oregon Health Authority Health Evidence Review Commission recently approved it to be placed on our prioritized list in a covered position. We’re creating rules around this now–the basics are that it will be covered twice per tooth per year, and it does not preclude coding for fluoride varnish at the same appointment. We’re not yet sure what the dollar amount of reimbursement will be.
    Bruce W. Austin, DMD
    Statewide Dental Director, Oregon Health Authority

  • TxOHC

    Per the Dental-Public-Health Listserv, July 1, 2016

    If dark arrested decay in primary teeth is a cosmetic problem just cover it up with a GIC product like Beautifil Opaquer by Shofu and then cover that with a flowable resin. No shots, no drills.

    For permanent teeth we first arrest with SDF then restore in the conventional manner. 0ften, no LA is necessary.

    That is what we do. What are other people doing?

    Dr. Steve Duffin
    Shoreview Dental, LLC