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Silver Diamine Fluoride Now available in gel formulation!

Arrests the progress of an already formed cavity in permanent and primary teeth


Mechanism of action

Upon application to the decayed surface, a layer of silver protein conjugate and silver minerals increase resistance to acid dissolution and enzymatic digestion—the treated lesion increases in mineral density and overall hardness. The silver acts as an antimicrobial, the fluoride acts to remineralize, and the proteins that break down the dentin are inhibited. The ammonia performs as a stabilizer, keeping silver and fluoride ionic in solution. SDF will permanently discolour anything with exposed collagen and decayed or demineralized sites and soft-tissues – but not healthy tooth structure.

Zombie Effect on SDF
The Superfloss Technique Video credit: Jeanette MacLean, DDS, Affiliated Children's Dental Specialists, www.kidsteethandbraces.com
Video credit: Jeanette MacLean, DDS, Affiliated Children's Dental Specialists, www.kidsteethandbraces.com
Video credit: Jeanette MacLean, DDS, Affiliated Children's Dental Specialists, www.kidsteethandbraces.com
Video credit: Jeanette MacLean, DDS, Affiliated Children's Dental Specialists, www.kidsteethandbraces.com
Video credit: Dr. Jeanette MacLean


*Based on a 5 mL bottle at $195

Advantages of the new gel

How deep does it penetrate?

Clinical uses

Clinical situations


Arrests the progress of an already formed cavity in permanent or primary teeth.


Medicinal Ingredient
38% Silver Diamine Fluoride
(25% Silver, 5.5% Fluoride, 8% Ammonia)

Non-Medicinal Ingredient
Water, FD&C Blue No 1




Before application: take care of your patient: Show them the consent form, inform them about the staining and protect their eyes.

SDF treatment without restoration placement:

  1. Provide protective eyewear. Apply vaseline to lips and surrounding tissues to avoid staining skin.
  2. Isolate the affected area with a cotton roll and/or dri-angle.
  3. Dry the lesion or surface.
  4. Dispense 1 drop into a disposable dish (1 drop treats up to 5 tooth surfaces).
  5. Apply Advantage Arrest to the lesion.
  6. Allow it to soak in for 60 seconds and up to 3 minutes for cooperative patients.
  7. Remove excess with a cotton pellet or roll and then cover the treated area with a thin layer of fluoride varnish (FluoriMax).This will create a barrier and keep the silver in contact for as long as possible. It will also give your patient a nice flavour rather than the metallic taste of SDF.
  8. Initial application arrests approximatively 74.1%, a second application within 1–2 weeks arrests ~91%.
  9. To optimize caries arrest, reapply at intervals of every 3–6 months OR apply a self curing Glass Ionomer restoration to help prevent bacterial reinfection.
  10. There are no SDF post op patient instructions.

SDF treament with restoration placement:

  1. Follow steps 1 to 5 above.
  2. Rinse and dry the treated area.
  3. Proceed with your restorative steps for the material type you are using.
    To reduce staining of the filling, use a self cure Gl, or “sandwich” technique of opaque GI at deeper levels and then composite. Please be aware, light curing will discolour more areas than just decay.
  4. There are no SDF post op patient instructions.

Interproximal decay
Interproximal decay can be treated using a Superfloss Technique.

illustration showing application of the product

Direction for use for children 0-3 years ol

Maximum of 1 drop per 10 kg of bodyweight per treatment visit 3.

Video credit: Jeanette MacLean, DDS, Affiliated Children's Dental Specialists , www.kidsteethandbraces.com

Educate your patients on staining!

Staining is an indicator of antimicrobial effectiveness.
The functional indicator of effectiveness is when the silver oxide is bound to the diseased collagen and intrinsic pigmentation of a carious lesion occurs. These oxides don’t polish away because the blackened lesion retains its dark color for a long period, which is why the antimicrobial effect is long lasting.

SDF stains demineralized areas and soft-tissues. Stains can be reduced by gentle polishing with tincture of weak iodine solution or by being covered with Glass Ionomer.
The staining is not immediate but will be noticed within hours. It will be limited to direct areas of contact. For soft-tissue, it will fade over a period of 24 to 72 hours.

SDF does not stain sound or healthy enamel or dentin.
SDF stains clothing, counters, floors and instruments.

Example of application

Black mat is an indicator that the lesion is static.

photos of advantage arrest in action illustration showing application of the product

History of silver diamine fluoride

Ohaguro, a custom of dyeing one's teeth black, was practiced in Japan and other countries. It was also beneficial, as it prevented tooth decay.

Advantage Arrest is cleared by the U.S. Food & Drug Administration (FDA) for dentinal hypersensitivity.

Advantage Arrest is commercially available in the United States through Elevate Oral Care, LLC. Since then, it has been used extensively by oral health professionals in the U.S., off-label for the arrest of tooth decay.

FDA logo

Advantage Arrest is granted the 1st Breakthrough Therapy Designation by the FDA for an oral care product. This designation represents the FDA’S effort to address an unmet, serious, life-threatening medical need where there is no available therapy and to expedite the review of such products. The designation was granted based on the FDA review of 10 worldwide randomized clinical trials evaluating silver diamine fluoride for caries arrest in children aged 3-9 or adults aged 60-89. Collectively these trials involved 1,500 subjects who were monitored for 1-3 years.

New York Times logo

Advantage Arrest is the subject of hundreds of lectures, online posts and articles. It is featured on major consumer media outlets including the New York Times, which published a whole story entitled “A Cavity-Fighting Liquid Lets Kids Avoid Dentists’ Drills”.

Advantage Arrest is granted the Health Canada indication of an anti-caries agent.

Reason to switch

Reason to switch table


My daughter, age 4, had a successful application of silver diamine fluoride (SDF) in Calgary to arrest decay in her primary molars. Even though I ensured limiting sugar intake, eating healthy homemade meals and following a strict dental hygiene, I was shocked when decay was diagnosed in her one tooth, and six months after that three other teeth were affected too. I was thrilled when I found out that Health Canada approved SDF for caries treatment under the product name Advantage Arrest, which is distributed by Oral Science. Our pediatric dentist has just ordered SDF product and I was happy we were able to try it with amazing early results. The decay was treated and arrested in all four teeth. The SDF application was easy; all four teeth were treated in 5-7 minutes. No tears, no fear, only smiles and a gift to take - the part my daughter enjoys the most. I believe it can truly revolutionize the dental care in young patients.

- Inna from Calgary, AB

Consent form

Patient brochure

Volume 1 / Volume 2 / Volume 3 / Volume 4 / Volume 5 / Volume 6

Featured Publications

Controlling caries in exposed root surfaces with silver diamine fluoride: A systematic review with meta-analysis

Controlling caries in exposed root surfaces with silver diamine fluoride: A systematic review with meta-analysis

UCSF Protocol for Caries Arrest Using Silver Diamine Fluoride: Rationale, Indications and Consent

UCSF Protocol for Caries Arrest Using Silver Diamine Fluoride: Rationale, Indications and Consent

Top 5 Misconceptions About Silver Diamine Fluoride

Top 5 Misconceptions About Silver Diamine Fluoride

Silver Diamine Fluoride 38% Scientific Literature Review January 2018

Silver Diamine Fluoride 38% Scientific Literature Review January 2018

IHS-SIA Guideline OPHG Chapter 4 Section V

IHS-SIA Guideline OPHG Chapter 4 Section V

Effect of Silver Diamine Fluoride and Potassium Iodide Treatment on Secondary Caries [...]

Effect of Silver Diamine Fluoride and Potassium Iodide Treatment on Secondary Caries [...]

Silver diamine fluoride: The newest tool in your caries management toolkit

Silver diamine fluoride: The newest tool in your caries management toolkit

Evidence-based clinical practice guideline on nonrestorative treatments for carious lesions: A report from the American Dental Association

Evidence-based clinical practice guideline on nonrestorative treatments for carious lesions: A report from the American Dental Association

Minimally Invasive Treatment for Molar Incisor Hypomineralization

Minimally Invasive Treatment for Molar Incisor Hypomineralization

Clinical Uses for Silver Diamine Fluoride

Clinical Uses for Silver Diamine Fluoride


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