A painted-on liquid stopped cavities in half of young children — no drill required

A liquid that takes seconds to brush onto a tooth can stop cavities from getting worse in young children — no drill, no injection, no sedation required. That is the finding of a major Phase III clinical trial led by the University of Michigan, published in JAMA Pediatrics, which researchers say provides the large-scale U.S. evidence needed to push the treatment toward formal FDA approval for tooth decay.

The 830 participants, all under age 6, were drawn from dental clinics, pediatric medical practices, and Head Start and Early Head Start programs across Michigan, New York, and Iowa. Researchers applied a 38% silver diamine fluoride (SDF) solution to affected baby teeth every six months using a tiny sponge-tipped applicator. The treatment stopped decay from progressing in more than half of the treated teeth.

This is a very effective and safe treatment — even in children as young as 1.— Margherita Fontana, professor of dentistry, University of Michigan School of Dentistry and lead investigator

Dentists call this "arresting" decay: the damaged area stops deteriorating rather than being removed and replaced. SDF does not restore tooth structure already lost to decay, but it prevents existing cavities from worsening. The silver component combats the bacteria associated with tooth decay; the fluoride strengthens the remaining mineral structure of the tooth.

The stakes are significant. According to Science Daily, tooth decay ranks as the most prevalent chronic disease in children, touching more than 40% of those in the United States. Each year, untreated cavities send thousands of young American children to emergency departments, where physicians typically lack the ability to carry out the dental procedures the condition requires. Some children ultimately require dental surgery under general anesthesia.

SDF is not a new invention. Dentists have used it to manage cavities in Japan, China, Australia, and other countries for decades. The FDA approved it in the United States in 2014 — but only as a treatment for tooth sensitivity. Since then, dentists have turned to it off-label as a cavity-arresting tool, applying an approved product in a way that goes beyond the purpose for which it was originally cleared. What has been missing is the kind of rigorous, large-scale clinical data from U.S. populations that regulators and insurers require.

Removing SDF from off-label status would be an important innovation which could lead to increased utilization by providers, enhanced payments by insurers and more consistent product quality.— Dr. Amr Moursi, co-principal investigator

The trial, which began in 2018 and continued through the disruptions of the COVID-19 pandemic, was designed specifically to fill that evidentiary gap. Fontana said the data could also open the door to SDF being administered in pediatric medical settings — a meaningful shift, because many young children see a pediatrician years before they ever visit a dentist.

In medicine, clinicians want high-quality evidence before changing practice. It is important to have data they can refer to because young children often see pediatricians years before they ever visit a dentist, broader acceptance could allow many more cavities to be treated while a referral to a dental home is successful, and before they become painful, infected or require surgery.— Margherita Fontana, professor of dentistry, University of Michigan School of Dentistry and lead investigator

One notable tradeoff comes with the treatment: the decayed portion of any tooth it touches turns permanently dark. The discoloration is cosmetic rather than medically harmful, but it can be especially noticeable on front teeth and may influence whether patients and families choose the treatment. For children, whose affected baby teeth will eventually fall out, this matters less. For adults, SDF could serve as a way to manage decay over a longer period or as a bridge before a conventional filling.

Fontana said the benefits of the treatment could extend well beyond young children. Among those who could benefit are older adults, people with developmental or physical disabilities, individuals with severe dental anxiety, and patients who struggle to reach conventional dental care. The treatment does not work for every cavity and will not prevent all future dental work, but for many patients the tradeoff — a dark stain versus drilling, sedation, or surgery — may be straightforward.

Head Start and Early Head Start receive federal support to deliver early childhood education and related services to eligible families. The term "dental home" describes an ongoing relationship with a dental care provider who offers preventive care, treatment, and follow-up services.

Why it matters — If the new evidence prompts FDA approval for cavities and broader insurance coverage, a treatment that takes seconds and costs little could reach millions of children and adults who currently go without dental care until pain or infection forces emergency intervention.

Reported by sciencedaily.com, news.umich.edu, dnyuz.com