Researchers Find Silver Diamine Fluoride Can Rebuild Tooth Structure, But Call for More Clinical Trials

Silver diamine fluoride (SDF) — a clear liquid applied directly to teeth — has long been used as a noninvasive way to halt the progression of cavities, particularly in children. Now, a systematic review published as the cover story of the July 2026 Journal of the American Dental Association takes a closer look at whether SDF can do something more: actually help rebuild the tooth material that decay has already damaged.

The review, led by researchers at the São Leopoldo Mandic Institute and Research Center in Brazil, analyzed 29 studies covering both laboratory experiments and a small number of clinical trials. The researchers found that 38% SDF showed consistent ability to remineralize — or restore mineral content to — both the outer enamel layer and the deeper dentin layer of primary teeth and young permanent teeth. When compared against other remineralizing agents such as fluoride gel and certain calcium-based compounds, SDF performed favorably across most measures.

However, the authors were careful to note the limits of what current evidence can support. The large majority of studies were conducted in laboratory settings rather than in patients, and the few clinical trials included carried a notable risk of bias. The researchers concluded that additional high-quality, real-world trials are needed before dentists can routinely apply SDF for remineralization as standard care.

For patients, this research is a reminder that SDF is already an accepted, dentist-monitored option for arresting active cavities — the American Dental Association has supported that use since 2020. Whether it will eventually earn a broader role in rebuilding tooth structure depends on the next generation of clinical studies. In the meantime, anyone curious about whether SDF might be appropriate for themselves or their children is encouraged to speak with their dentist.