A Major U.S. Trial Finds a Liquid Can Stop Children's Cavities Without Any Drilling

A large U.S. trial has found that silver diamine fluoride can arrest tooth decay in more than half of affected baby teeth when applied every six months. The Phase III study, published in JAMA Pediatrics, included 830 children under the age of six with severe early childhood caries.

Dentists have used silver diamine fluoride off-label in the United States since 2014, when it received clearance as a device to treat tooth sensitivity, but it has lacked the large population clinical trials needed for FDA approval as a treatment for cavities.

Dentists apply the liquid directly to a cavity using a small sponge-tipped applicator — a process that takes only a few seconds per tooth and requires no removal of decayed tooth material, unlike traditional cavity treatment, which typically involves drilling out damaged tissue before placing a filling.

At six months, 54% of lesions treated with silver diamine fluoride had arrested, compared with 22.5% in the placebo group. At eight months, arrest rates were 50.2% for the treatment and 17.4% for placebo.

The treatment requires no drilling, shots, or sedation, although it does permanently darken the decayed area.

Every year, untreated tooth decay sends thousands of young U.S. children to emergency departments for dental problems doctors cannot treat, and many eventually undergo surgery under general anesthesia.

The lead investigator, Professor Margherita Fontana at the University of Michigan School of Dentistry, said the treatment was effective and safe, including in children as young as one.

The trial enrolled children recruited through dental offices, pediatric medical practices, and Head Start and Early Head Start programs in Michigan, New York, and Iowa.

The authors said the findings provide evidence that could support a future FDA application for silver diamine fluoride as a treatment for dental caries in children.

Because the product is already widely available and low in cost, researchers and clinicians see potential for it to reach underserved communities where access to traditional restorative dentistry remains limited.