Silver Diamine Fluoride in Pediatric Dentistry: A Narrative Review of Evidence, Clinical Applications, And Limitations
Abstract
Objective(s): To synthesize current evidence on the mechanism of action, clinical indications, application protocols, effectiveness, safety profile, and adverse effects of silver diamine fluoride (SDF) in pediatric dentistry. Data Sources: Published literature was sourced from peer-reviewed journals, systematic reviews, randomized controlled trials, and institutional guidelines from organizations including the American Dental Association (ADA), the Scottish Dental Clinical Effectiveness Programme (SDCEP), and regulatory bodies. Study Selection: Studies examining SDF composition, mechanism of action, regulatory status, clinical effectiveness, application protocols, safety, and parental acceptance in pediatric populations were included, with emphasis on systematic reviews and randomized controlled trials published within the past decade. Summary: Early childhood caries remains a significant global health burden, and conventional restorative treatment is often difficult to deliver in young, uncooperative, medically compromised, or anxious pediatric patients. SDF has re-emerged as a minimally invasive, inexpensive, and easy-to-apply therapeutic agent capable of arresting and preventing dental caries in primary and young permanent teeth. Findings from systematic reviews and randomized controlled trials indicate that SDF, applied biannually, achieves high caries-arrest rates and offers a practical alternative or adjunct to conventional restorative care, particularly in resource-limited and behavior-management-challenged settings. Black staining of arrested lesions remains the principal adverse effect. Conclusion: SDF is a well-supported, minimally invasive option for caries arrest and prevention in children. With appropriate patient selection and informed consent, SDF can be integrated into pediatric dental practice as part of a comprehensive minimally invasive approach. Further long-term and comparative studies are warranted to refine treatment protocols and patient selection criteria. Keywords: silver diamine fluoride; pediatric dentistry; dental caries; early childhood caries