Beyond Caries Arrest: Can Silver Diamine Fluoride Actually Remineralize Teeth?

For years, silver diamine fluoride (SDF) has earned its place in minimally invasive dentistry by effectively arresting dental caries, particularly in children and high-risk patients. But an important question has remained unanswered—does SDF simply stop the disease from progressing, or can it actually help rebuild lost tooth structure?

A recent systematic review has taken a closer look at the available evidence to evaluate whether 38% silver diamine fluoride promotes remineralisation of carious enamel and dentin in primary and young permanent teeth.

Researchers searched three major scientific databases and identified 29 studies, including randomized clinical trials, in vitro investigations, in vivo studies and cohort studies that evaluated the remineralising effects of 38% SDF.

Overall, the findings were encouraging.

Both laboratory studies and a randomized crossover clinical trial demonstrated positive evidence of remineralisation following SDF application. Across these studies, SDF consistently promoted mineral deposition within demineralised enamel and dentin, supporting its role beyond simply arresting carious lesions.

However, the authors also highlighted an important limitation of the current evidence.

Although the available findings are promising, much of the evidence comes from laboratory studies, many of which were judged to have a high risk of bias. Only limited clinical evidence is currently available, making it difficult to draw firm conclusions about the extent of remineralisation achieved under real clinical conditions.

To assess the reliability of the evidence, the researchers evaluated study quality using established risk-of-bias assessment tools and applied the GRADE approach. While laboratory findings consistently favoured SDF, the authors concluded that additional well-designed clinical studies are needed before its remineralising potential can be confirmed with greater certainty.