BSPD releases resources to support the use of Silver Diamine Fluoride

A comprehensive set of resources to support the use of Silver Diamine Fluoride (SDF) as a treatment to arrest dental caries in the primary dentition is available on the BSPD website. The technique is expected to be more widely used in the coming months as dental teams find ways to minimise aerosol generating procedures. These resources can be found here:

Included among the resources is a Patient Information Leaflet (PIL) which has been made editable so hospitals and dental practices can add their own logo. A Standard Operating Procedure and a Consent Form have also been developed. A powerpoint explaining the background to the technique as well as a demonstration video to show how SDF is applied has been created and are on our YouTube channel.

The resources have been compiled by Laura Timms, an Academic Clinical Fellow at the University of Sheffield Dental School with an interest in SDF. She has just won a prestigious joint grant from RCS and BSPD to make a video to explain the SDF technique to children.

She was motivated to understand more about the technique having been troubled by the extent of decay in some of her young patients; she wanted to find a treatment that would help keep them out of discomfort.

SDF is licensed in the UK for the treatment of sensitivity but Laura was aware of research which shows it has good results when painted onto dental decay in the primary dentition. “Using SDF can buy time for children who cannot manage dental treatment by stopping the decay getting worse until they can have further dental treatment. It’s simple, quick and effective.” 

Without treatment, the children would be at risk of requiring extractions under general anaesthetic and suffering from pain and abscesses while waiting for a hospital appointment. SDF contains both silver and fluoride in a solution of ammonia. It arrests caries until the child is older and more compliant with dental treatment. 

The disadvantage of the technique is that it stains the dental decay black. Some parents find the staining reassuring, however, as it shows that the treatment is working on the decay. If the child is subsequently able to cope with more demanding treatment, fillings or preformed metal crowns may be placed over the SDF. 

There is another option for the biological management of children with dental caries and that is the Hall technique. Preformed crowns are placed over decayed teeth and will also arrest the progress of caries. These are usually well tolerated but may be more challenging to place in very young children.

Laura added: “Ideally, I hope that the new SDF resources will help dental teams treat children in the family dental practice with which they are familiar and either delay or eliminate a referral into hospital.”

Claire Stevens, spokesperson for BSPD and a Consultant in Paediatric Dentistry, said: “All paediatric dental teams working in hospital departments want to keep procedures under general anaesthetic to a minimum currently which makes Laura’s work timely. Ideally, more children will be treated in their family dental practice instead of being referred into secondary care for a general anaesthetic. We are very grateful to Laura for her hard work.“

Laura says she distilled the new guidance from pre-existing resources from Sheffield University and Sheffield Teaching Hospitals, University College London Eastman Dental Hospital, Glasgow Dental Hospital and School and Dundee Dental Hospital teams. She is now working with children on a patient-centred video thanks to the grant awarded by BSPD and RCS.

 Links to resources:




Children call the shots for a new dental video funded by RCS/BSPD

A team at the University of Sheffield dental school led by Academic Clinical Fellow Laura Timms is preparing to make an information video aimed at children aged 3-10. The topic of the video is Silver Diamine Fluoride (SDF), a technique that helps arrest dental decay.

Laura has just won a grant of £5460 awarded jointly by the RCS (Eng) Faculty of Dental Surgery (FDS) and BSPD for her proposal to make a video to help explain the SDF technique to children and their parents. The video will be made by children who will be recruited to act as filmmakers and presenters and use fun activities to share information on SDF.

The University of Sheffield Dental School began introducing SDF towards the end of 2019. With significant waiting lists for general anaesthetics and very young children needing treatment and suffering toothache, the possibility of applying SDF to arrest caries in primary teeth seemed an attractive option. In some cases, use of SDF avoided the need for a general anaesthetic.

SDF is widely used overseas and at the International Association of Paediatric Dentistry (IAPD) meeting in 2019, Laura attended sessions on the technique. She remembered the simplicity of application from a student elective trip in Cambodia in 2014 and considered how useful it could be for some of her patients. She decided to research SDF and with colleagues in Sheffield and Newcastle wrote a paper published (1) in May this year, examining why SDF is not being used more widely in the UK.

SDF stains teeth black but in her experience, parents often welcome a treatment which stops the decay and may avoid extractions under general anaesthetic. Discussion with the child and parent is vital, she says.

Working with Connect Trainees she led a research project exploring paediatric dentists’ attitudes to SDF and in May she delivered a webinar on the topic to the group. Soon afterwards, she heard that she had been awarded the RCS/BSPD research pump-priming grant for the educational video.

Sheffield has an established reputation for child-centred research and the plan that she evolved with colleagues was to recruit children to help script, film and edit the video. It will be used to explain the treatment to families and also to recruit children to further research to help understand their thoughts and feelings on the technique.

Laura added: “I also want to get the views of dentists and dental therapists on SDF. It’s an easy and simple treatment with the right case selection and if it prevents children suffering with the pain of toothache and needing hospital treatment, it can only be a good thing.”

Professor Helen Rodd is a Sheffield-based Consultant in Paediatric Dentistry and one of Laura’s supervisors along with Profs Paul Hatton, Chris Deery, and Zoe Marshman. She also happens to be a member of the RCS FDS Board and was of course excluded from judging Laura’s grant entry.

She said that the impact of Covid-19 and the move to minimising Aerosol Generating Procedures (AGPs) meant that SDF was more valuable than ever for treating very young children and keeping them out of pain. She welcomed warmly the news of Laura’s grant.

Sarah McKaig, President of BSPD, commented: “We are very proud of Laura. Her work on this technique will help us understand the wants and needs of children and their families as well as the attitudes of dental practices.”