Nobody anticipates having a cavity drilled and filled with a dentist. Now there’s an alternative: an antimicrobial liquid that could be brushed on cavities to stop tooth decay – painlessly.

The liquid is named silver diamine fluoride, or S.D.F. It’s been useful for decades in Japan, but it’s been available in the us, under the name Advantage Arrest, for merely 12 months.

The foodstuff and Drug Administration cleared silver diamine fluoride for use being a tooth desensitizer for adults 21 and older. But research shows it can halt the continuing development of cavities preventing them, and dentists are increasingly making use of it off-label for all those purposes.

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

Silver diamine fluoride is definitely used in hundreds of dental practices. Medicaid patients in Oregon increasingly becoming the treatment, and at least 18 dental schools have started teaching generation x of pediatric dentists using it.

Dr. Richard Niederman, the chairman with the epidemiology and health promotion department in the New York University College of Dentistry, said, “Being capable of paint it on in 30 seconds without having noise, no drilling, is best, faster, cheaper.”

“I would encourage parents to inquire about it,” he added. “It’s less trauma for that kid.”

The main downside is aesthetic: Silver diamine fluoride blackens the brownish decay over a tooth. That may not matter over a back molar or perhaps a baby tooth which will fall out, however some people are probably be deterred by the prospect of the dark i’m all over this an evident tooth.

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

A cavity that have being drilled cost $151. The liquid “was very reasonable,” Dr. Urschel said.

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

But the liquid may be especially helpful for children. Nearly a quarter of 2- to 5-year-olds have cavities, based on the Centers for disease control and Prevention.

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

“S.D.F. provides for us a chance to reduce the quantity of toddlers with cavities visiting 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 holiday to a operating room.

Dr. MacLean said, “People think that parents will reject it due to poor aesthetics.” But “if it implies preventing a young child from needing to be sedated or having their tooth drilled and filled, there are several parents that like S.D.F.,” she added.

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

Two front teeth, however, were drilled. The very next time, Ms. Bujeiro said, she’d opt for silver diamine fluoride. “I would put it to use in baby teeth even though it’s in-front,” she said. When it comes to discoloration? “You can’t see it too much.”

Silver diamine fluoride has an additional advantage over traditional treatment: It kills the bacteria that create decay. A second treatment applied six to 18 months following the first markedly arrests cavities, research has shown.

“S.D.F. cuts down on the incidence of new caries and continuing development of current caries by about Eighty percent,” said Dr. Niederman, who’s updating an evidence review of silver diamine fluoride published in ’09.

Fillings, by contrast, usually do not cure a dental infection.

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

That’s why some children have to have Brighton NY under anesthesia twice.

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