Silver diamine fluoride (SDF) is steadily gaining recognition in dentistry for its potential to address oral health challenges in vulnerable populations. First introduced in Japan in the 1970s and cleared by the U.S. Food and Drug Administration as a desensitizing agent in 2014, SDF has since been adopted globally as a simple, non-invasive, and cost-effective treatment option for dental caries. The World Health Organization underscored its importance by including SDF in the Model List of Essential Medicines in 2021.
For decades, SDF has been primarily associated with pediatric dentistry, particularly for managing early childhood caries. However, a growing body of evidence suggests that its application may be equally significant in geriatric dentistry. Older adults, often burdened with cognitive decline, systemic illnesses, reduced dexterity, and financial barriers, are at increased risk for oral diseases such as root caries and dentine hypersensitivity. In these cases, conventional restorative procedures may be invasive, impractical, or unaffordable. SDF offers an attractive alternative: a low-cost treatment that can be applied quickly, without anesthesia or drilling, even outside a traditional dental setting.
Recent clinical studies highlight its effectiveness in managing root caries among older populations. Root caries, a prevalent problem affecting nearly half of the global elderly population, is notoriously difficult to manage due to exposed root surfaces and reduced oral self-care abilities. Randomized controlled trials have shown that SDF applications can both prevent and arrest root caries, with caries arrest rates reaching as high as 90% in some cases. In institutionalized older adults, SDF demonstrated measurable reductions in new carious lesions, indicating particular value in dependent or medically compromised individuals.
Beyond caries management, SDF has also shown potential benefits for plaque control and dentine hypersensitivity. One clinical trial observed a reduction in plaque accumulation and subsequent improvements in gingival health among older adults following SDF use. Another trial demonstrated its efficacy in alleviating dentine hypersensitivity, with results surpassing those of potassium nitrate. These findings suggest that SDF could play a broader role in geriatric oral healthcare than previously recognized, including as an adjunct in periodontal management and post-treatment sensitivity control.
Despite its promise, the drawbacks of SDF remain notable. The most visible limitation is the black staining of arrested caries lesions, which may be a cosmetic concern for patients. Older adults have also reported metallic taste and unpleasant odor following application, particularly when multiple sites were treated simultaneously. While new formulations such as SDF gels may help reduce these side effects, more research is required to assess their impact on clinical efficacy.
Importantly, while SDF is widely studied in children, evidence in older populations remains limited. Only a small number of clinical studies have specifically addressed its use in geriatric dentistry, and further research is essential to determine optimal application protocols, comparative effectiveness with other fluoride therapies, and long-term safety outcomes.
As global populations age, the burden of oral disease in older adults is set to increase significantly. SDF represents a unique opportunity to expand access to oral healthcare, particularly for frail or underserved communities where traditional restorative dentistry may not be feasible. For practicing dentists, this evolving evidence underscores the need to consider SDF not only in pediatric practice but also as part of comprehensive geriatric care. With its affordability, simplicity, and growing clinical validation, silver diamine fluoride may well become a cornerstone in addressing the unmet oral health needs of ageing populations worldwide.
Source: Elsevier Journal of Dentistry
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