Development of the AAP Silver Diamine Fluoride (SDF) Guidance

The burden of dental disease disproportionately affects some people more than others. All too often, children end up with rampant decay that requires treatment in the operating room under general anesthesia. The consequences of untreated disease are far-reaching, harmful and result in more than physical discomfort. Cavities often lead to missed school days and affect a child’s ability to learn, eat, and sleep. Restorative procedures are costly and perpetuate economic disparities for families with low incomes. These collateral effects underscore the importance of promoting oral health and improving prevention to achieve equitable access to comprehensive dental care. 

Guiding Knowledge  

Silver diamine fluoride in the medical setting has emerged as a promising mechanism to improve oral health outcomes. SDF provided during routine medical visits buys much needed time until patients can access comprehensive dental care. This innovative approach will have particular impact on those at highest risk for caries, providing a chance for them to avoid the preventable consequences of untreated decay. By adopting SDF treatment in pediatrics, we will begin to bridge the gap between medical and dental care. 

The July 2023 introduction of a Category III code (Code 0792T) for silver diamine fluoride led the AAP to form a work group to draft guidance on its application by medical professionals. The work group consisted of pediatric medical and dental professionals, family representation, and AAP staff. Throughout the process, the group focused on developing clear and concise guidance to prepare pediatricians and other primary care professionals to offer SDF treatment to children, especially those without access to a dentist 

Assumptions of the Work Group 

• Interventions to prevent disease and combat caries are imperative.
• With focused training, medical professionals can learn to differentiate between cavities that will benefit from SDF and those for which SDF is not appropriate treatment.
• This guidance is intended to inform SDF management of dental decay in primary dentition only (through age 5).
• Caries risk is multifactorial. Even with SDF treatment, caries progression will likely occur in the absence of caries-preventing habits. It is critical to assess caries risk factors and counsel families on proper self-management goals on nutrition and oral hygiene. (English | Spanish) 
• Application of SDF is part of caries management by the medical team and requires appropriate follow up with dental professionals. Helping families establish a dental home is a critical part of  coordinating care for your patients.
• Severe dental disease or special healthcare needs should be managed by a pediatric dentist. However, families who are unable to establish timely care with a pediatric dentist may benefit from SDF application in the primary care setting while navigating the referral process.