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Dr. Tania (Henriquez) McIntosh
Dentist in Langley, British Columbia

Silver Diamine Fluoride (SDF) and Silver Modified Atraumatic Restorative Technique (SMART)

January 21, 2019
Posted By: Dr. Tania Edelma Henriquez Miranda

In dentistry ongoing scientific research keeps looking for the least traumatic way to deliver proper dental care to the ones that needs it the most. Thankfully after so many years of ongoing research in August 2014 FDA approved the use of Silver Diamine Fluoride for use in the dental office.


Dr. Jeanette MacLean has been an advocate and excellent educator on this subject and we have so much to thank her for spreading the good news to the dental profession, and I take pride myself for counting her in my friends' list. She is so much fun, we went to fly over canada and the christmas market in Vancouver.


Silver Diamine Fluoride (SDF) is  a form of liquid silver that turns active cavities black and hardens tooth structure that was soften by decay. ONLY will turn black where there is cavities, healthy tooth structure will NOT undergo discolouration. (I have personally tried the product myself and the liquid has a little metallic taste and when there is no decay on the tooth, no staining was developed)


The use of silver for the treatment of cavities is NOT new, but with the new development of atraumatic techniques developed through the years it has fallen out of favor to the point that is not even taught at most dental schools anymore, as it does NOT remove permanently the disease (decay) only ARRESTS it (stops its advancement and growth).

The SMART (Silver Modified Atraumatic Restorative Technique) approach has been developed to reduce the utilization of sedation and/or General Anesthetic for kids. This treatment is NOT for every child but for the ones with few cavities that can be treated with SDF for a period of time. Once cavities have been arrested, teeth can be restored with Glass Ionomer Cement to avoid food trap in the "CAVITATED AREAS" and to ‘cover’ the stained areas, once the patient is old enough to cooperate for the procedure.

In other words it buys time to gain babies' trust in order to restored those teeth atraumatically and cover the black staining, or buys time to allow exfoliation without the need to restoration. All these decisions are made based on so many factors, and the advantages and disadvantages will be discussed with every patient

Who can benefit from these treatments:


  • Small children that are unable to cooperate for proper restorative procedures due age
  • Small children that otherwise will need the use of general anesthesia and/or deep sedation to proceed with restorations
  • Small children with cavities NOT involving/close to the tooth’s nerve
  • Elderly adults with oral hygiene impediments in the early stages of root decay

Pros: SDF has very low toxicity, it is quick, painless, non-invasive, affordable, and can stop tooth decay and help prevent recurrent decay*.


Cons: SDF permanently stains cavities black. SDF does not restore tooth form or function, so large holes that trap food may still eventually require a SMART filling (see below) or traditional restorations. SDF requires repeat application for maximum efficacy.

SDF can not be used in the presence of infection or decay into the nerve*.


For more information please visit my friend's website as mentioned below, most of the info in this post is based on the knowledge Jeannette shares on her website.