Nobody anticipates having a cavity drilled and filled by way of a dentist. Now there’s an alternate: an antimicrobial liquid that can be brushed on cavities to stop cavities – painlessly.

The liquid is called silver diamine fluoride, or S.D.F. It’s been useful for decades in Japan, but it’s been for sale in the us, beneath the brand Advantage Arrest, for merely 12 months.

The Food and Drug Administration cleared silver diamine fluoride to be used as a tooth desensitizer for adults 21 and older. But research shows it can halt the advancement of cavities preventing them, and dentists are increasingly making use of it off-label for those purposes.

“The upside, the truly great one, is you don’t must drill so you don’t need an injection,” said Dr. Margherita Fontana, a professor of cariology on the University of Michigan.

Silver diamine fluoride is utilized in countless dental practices. Medicaid patients in Oregon are experiencing the therapy, and a minimum of 18 dental schools have begun teaching generation x of pediatric dentists utilizing it.

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

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

The key negative thing is aesthetic: Silver diamine fluoride blackens the brownish decay on the tooth. That won’t matter on the back molar or possibly a baby tooth that may fall out, however, many patients are likely to be deterred through the prospect of an dark right an obvious tooth.

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

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

The noninvasive treatment might be well suited for the indigent, elderly care facility residents and others who may have trouble finding care. And a lot of anxious dental patients want to dodge the drill.

Though the liquid might be especially useful for children. Nearly 1 / 4 of 2- to 5-year-olds have cavities, according to the Centers for Disease Control and Prevention.

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

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

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

Dr. MacLean said, “People assume that parents will reject it as a result of poor aesthetics.” But “if it implies preventing a kid from the need to be sedated or having their tooth drilled and filled, there are many parents that like S.D.F.,” she added.

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

Two front teeth, however, were drilled. The next time, Ms. Bujeiro said, she’d choose silver diamine fluoride. “I would use it in baby teeth even when it’s in front,” she said. As for the discoloration? “You can’t view it excessive.”

Silver diamine fluoride has an additional advantage over traditional treatment: It kills the bacteria that cause decay. An extra treatment applied six to Eighteen months as soon as the first markedly arrests cavities, research has shown.

“S.D.F. reduces the incidence of recent caries and advancement of current caries by about Eighty percent,” said Dr. Niederman, who is updating an evidence overview of silver diamine fluoride published last year.

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

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

That’s why some children should have dental care under anesthesia twice.

Bacterial infections also cause acne, but a “dermatologist doesn’t have 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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