Nobody looks forward to having a cavity drilled and filled by the dentist. Now there’s an alternative solution: an antimicrobial liquid which can be brushed on cavities to avoid dental cairies – painlessly.

The liquid is named silver diamine fluoride, or S.D.F. It’s been used for decades in Japan, but it’s been for sale in the United States, underneath the manufacturer Advantage Arrest, for nearly annually.

The meals and Drug Administration cleared silver diamine fluoride for usage as a tooth desensitizer for adults 21 and older. But research shows it may halt the progression of cavities preventing them, and dentists are increasingly making use of it off-label for all those purposes.

“The upside, the fantastic one, is that you don’t should drill and you don’t need an injection,” said Dr. Margherita Fontana, a professor of cariology in the University of Michigan.

Silver diamine fluoride is employed in a huge selection of dental practices. Medicaid patients in Oregon are experiencing treatments, and at least 18 dental schools have begun teaching generation x of pediatric dentists how to use it.

Dr. Richard Niederman, the chairman in the epidemiology and health promotion department in the New York University College of Dentistry, said, “Being able to paint it on in Thirty seconds with no noise, no drilling, is way better, faster, cheaper.”

“I would encourage parents to request it,” he added. “It’s less trauma to the kid.”

The primary downside is aesthetic: Silver diamine fluoride blackens the brownish decay on the tooth. That will not matter on the back molar or perhaps a baby tooth which will fall out, however some patients are likely to be deterred by the prospect of your dark spot on an apparent tooth.

Until more insurers cover it, patients must also cover the cost. Still, it’s comparatively cheap. Dr. Michelle Urschel, an anesthesiologist, was very happy to pay $25 to have Dr. Jeanette MacLean, a pediatric dentist in Glendale, Ariz., paint over a cavity that her son Knox, 4, had recently developed.

A cavity which in fact had to get drilled cost $151. The liquid “was very economical,” Dr. Urschel said.

The noninvasive treatment might be perfect for the indigent, elderly care residents while others that have trouble finding care. And lots of anxious dental patients wish to dodge the drill.

Though the liquid might be especially useful for children. Nearly 25 % of 2- to 5-year-olds have cavities, in line with the Centers for Disease Control and Prevention.

Some preschoolers with severe cavities must be treated within a hospital under general anesthesia, although it may pose risks towards the developing brain.

“S.D.F. provides us the opportunity to reduce the number of toddlers with cavities coming to the O.R.,” said Dr. Arwa Owais, an associate professor of pediatric dentistry in the University of Iowa.

Dr. Laurence Hyacinthe, a pediatric dentist in Harlem, used silver diamine fluoride on eight uncooperative children whose parents planned to delay a trip to the operating room.

Dr. MacLean said, “People assume that parents will reject it due to poor aesthetics.” But “if it means preventing a youngster from having to be sedated or having their tooth drilled and filled, there are numerous parents they like S.D.F.,” she added.

Alejandra Bujeiro, 32, was delighted that her 3-year-old daughter, Natalia, didn’t require two cavities filled in the rear of her mouth. Instead Dr. Eyal Simchi, a pediatric dentist in Elmwood Park, N.J., brushed silver diamine fluoride about the decay.

Two front teeth, however, were drilled. The next occasion, Ms. Bujeiro said, she’d select silver diamine fluoride. “I would utilize it in baby teeth even if it’s in front,” she said. Alternatives discoloration? “You can’t see it a lot of.”

Silver diamine fluoride has an additional advantage over traditional treatment: It kills the bacteria that cause decay. An extra treatment applied six to 1 . 5 years following the first markedly arrests cavities, research has shown.

“S.D.F. cuts down on the incidence of recent caries and progression of current caries by about 80 %,” said Dr. Niederman, who is updating an evidence report on silver diamine fluoride published during 2009.

Fillings, by contrast, usually do not cure an oral infection.

“There’s nothing which goes on within an operating room that treats the underlying problem,” said Dr. Peter Milgrom, a professor of pediatric dentistry in the University of Washington who had been instrumental in receiving F.D.A. clearance for silver diamine fluoride and possesses a monetary stake in Advantage Arrest.

That’s why some children must have braces dental trauma under anesthesia twice.

Bacterial infections also cause acne, but a “dermatologist doesn’t please take a scalpel and stop your pimples,” said Dr. Jason Hirsch, a pediatric dentist in Royal Palm Beach, Fla. Yet “that’s how dentistry has approached cavities.” Dr. Hirsch includes a Facebook page called SDF Action, where dentists can discuss individual cases.
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