Liquid treatment can stop tooth decay in children without drilling, major trial finds

Scientists have confirmed that a relatively inexpensive liquid applied directly to decayed teeth can stop cavities from progressing without drilling, injections or anaesthesia. This could change dental care for young children and other patients who struggle with conventional treatment.

The treatment, known as silver diamine fluoride (SDF), takes only seconds to apply. It could help prevent cavities from developing into painful infections that sometimes require complex dental procedures or surgery.

Researchers led by the University of Michigan reported the findings from a Phase III clinical trial involving 830 children younger than six years. The study was published in JAMA Paediatrics.

The findings could be particularly important for families who face financial, logistical or behavioural barriers to conventional dental treatment. However, they do not mean that every cavity can be treated without drilling, or that fillings and other dental procedures will become unnecessary.

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Unlike conventional fillings, which generally require dentists to remove decayed tooth material and restore the damaged area, SDF works by slowing or stopping the progression of existing decay.

A dentist applies a small amount of the solution directly to the affected tooth using a tiny applicator. The procedure does not ordinarily require drilling, injections or sedation.

The treatment combines the antibacterial properties of silver with the protective effects of fluoride. Silver helps control bacteria associated with tooth decay, while fluoride supports the mineral structure of teeth and helps them resist further damage.

In the trial, researchers used a 38 per cent SDF solution. They found that treatment given at six-month intervals arrested decay in more than half of the affected baby teeth.

Arresting decay means stopping the damaged area from deteriorating further. It does not mean that the lost tooth structure has been restored or that every dental problem has been eliminated.

Margherita Fontana, a professor at the University of Michigan School of Dentistry and the study's lead investigator, described the treatment as effective and safe, including for very young children.

Tooth decay remains a major childhood health problem. Cavities that go untreated can cause persistent pain, infections, difficulty eating and sleeping, missed school days and repeated medical visits.

For young children, conventional dental procedures can be especially challenging. Some struggle to remain still during treatment, while others experience considerable fear and anxiety. In severe cases, children may require dental surgery under general anaesthesia.

The liquid treatment could provide an alternative in suitable cases by allowing dentists to intervene early, before decay progresses into a more serious condition.

Researchers also point to its potential value where children have limited access to dental services. Paediatric medical practitioners could help identify children with cavities and facilitate timely treatment or referral to dental professionals. This could strengthen cooperation between medical and dental services, particularly for children who see a paediatrician before visiting a dentist.

The potential benefits extend beyond childhood. Older adults, people with physical or developmental disabilities, patients with severe dental anxiety and individuals who cannot easily access conventional dental care may also benefit from SDF where clinically appropriate.

SDF is not a universal cure for tooth decay. Its suitability depends on the extent of the damage, the condition of the affected tooth and whether complications have developed.

It does not rebuild damaged teeth. SDF can help stop a cavity from progressing, but it does not fill the hole or restore lost tooth structure. Where substantial damage has weakened the tooth, a filling, crown or another restorative procedure may still be necessary.

Deep decay may require more extensive treatment. If decay reaches the pulp, the inner tissue containing nerves and blood vessels, the patient may need additional treatment. Depending on the diagnosis, options can include pulp treatment, a root canal procedure or extraction. SDF alone should not be relied upon to resolve these complications.

Established infections need urgent attention. A dental abscess, facial swelling, fever or signs that an infection is spreading require prompt professional assessment, and SDF is not a substitute for treating them. Difficulty breathing or swallowing alongside facial or mouth swelling requires emergency medical care.

The treatment also does not guarantee permanent control. Some cavities may continue to progress despite application, and repeat treatment or additional procedures may be required. Dentists need to examine the affected teeth regularly to determine whether the decay has stopped.

Stopping decay and repairing a tooth are two different things. A cavity may become inactive after treatment, yet the tooth may still have a hole that affects its strength, appearance or function. The decision to use SDF should therefore be made with a qualified dental professional after examining the tooth and discussing the available alternatives.

Another significant limitation is the cosmetic effect. SDF permanently darkens the decayed portion of a treated tooth, turning it black. The discolouration can be particularly noticeable on front teeth, which may make the treatment less attractive to patients and parents concerned about appearance.

Although the discolouration is primarily cosmetic, families should be informed about it before treatment. The decision may depend on the position of the affected tooth, the severity of the decay and the patient's priorities.

For some patients, avoiding drilling, pain, and more invasive procedures may outweigh the cosmetic disadvantage. Others may prefer a restorative option that better preserves the tooth's appearance. Healthy tooth structure is not typically darkened in the same way as the decayed area treated with SDF.

SDF is not a new invention. Dentists in several countries have used it for decades to manage tooth decay.

In the United States, the Food and Drug Administration (FDA) approved SDF as a medical device for treating tooth sensitivity in 2014. Its use to arrest cavities has been off-label, meaning it has been used for a purpose beyond its original authorised indication.

The latest trial was designed to provide stronger evidence of the solution's safety and effectiveness in treating tooth decay among young children in the United States.

Participants were recruited through dental clinics, paediatric medical practices and Head Start and Early Head Start programmes in Michigan, New York and Iowa. These programmes provide early childhood education and related services to eligible families.

The research brought together investigators from the University of Michigan, New York University, the University of Iowa and Indiana University. The US National Institute of Dental and Craniofacial Research provided more than $12 million in funding. The investigation began in 2018 and continued despite disruptions caused by the COVID-19 pandemic.

The results could support an application seeking FDA approval specifically for the treatment of dental caries, the medical term for tooth decay. Researchers believe such approval could encourage wider adoption by healthcare providers, improve insurance coverage and support more consistent product quality.

Amr Moursi, a professor of paediatric dentistry at New York University College of Dentistry and a co-principal investigator, said removing the treatment from off-label status could encourage wider use by healthcare providers and more consistent product quality.

Why follow-up care remains essential

If access expands, SDF could offer a practical way to manage certain cavities while patients await more comprehensive treatment, or when conventional procedures are difficult to undertake.

In some children, repeated applications may help keep decay under control until a baby tooth naturally falls out. In adults, the treatment may serve as a management option or a temporary measure when restorative treatment is not immediately practical.

The treatment should form part of a broader dental care plan rather than replace regular examinations and preventive measures. Dentists may recommend repeat applications, often at intervals such as six months, depending on the patient's condition and the response of the affected tooth.

Patients should also maintain good oral hygiene, use fluoride toothpaste appropriately, limit frequent consumption of sugary foods and drinks, and attend recommended dental reviews.

The findings should not be interpreted as evidence that every cavity can be treated permanently without fillings or other procedures. The appropriate treatment depends on the depth of decay, the presence of pain or infection, the amount of remaining tooth structure and whether the tooth can be preserved.