Silver diamine fluoride in practice: indications, the 38% protocol, staining consent and pairing with fluoride varnish

In short

Silver diamine fluoride at 38% arrests active carious lesions without drilling or anaesthesia, which makes it the first option for young or uncooperative children, for patients with many lesions, and for root caries in older adults. The arrested lesion turns permanently black, so written consent is required before the first drop. Common protocols re-apply every six months; fluoride varnish covers the rest of the mouth.

• Silver diamine fluoride is about 24 to 27% silver, 5 to 6% fluoride and 7.5 to 11% ammonia by weight in the products; the silver is antibacterial and the fluoride remineralises.