Silver diamine fluoride (SDF) is a clear solution with two reasonably well-known ingredients: silver and fluoride. This therapeutic recently received United States Food and Drug Administration (FDA) approval as a dentin desensitizing agent. However, a growing body of scientific evidence supports the use of SDF for the arrest and prevention of caries.
There is even an American Dental Association-approval insurance code (D1354) for “interim caries arresting medicament application – per tooth”. Paralleling the emergence of SDF as a caries arresting agent has been the growth of interest in its use among practicing dentists.
SDF has not been linked to any consistent adverse pulpal effects and systemically, fluoride and silver levels in the blood post-application seem to be low.
The primary adverse effect is that lesions arrested by SDF exhibit staining/darkening. This is not surprising for those familiar with color changes in arrested lesions. While non-caries-affected tooth structure does not stain, you and especially your patients may be concerned about esthetic consequences of stained lesions.
NOTE: SDF can not only stain carious dentin, but it can also stain skin and clothes, so be careful when handling it.