It’s welcome news any time there’s a step forward in dental technology. Not only are healthy teeth incredibly important, but nobody complains when a trip to the dentist gets even easier. One recent dental development is the use of silver diamine fluoride. When you decode the name, you find that it’s made of silver and fluoride ions that re-mineralize enamel and slow decay, plus ammonia to keep the mixture stable and safe for use.

After being used overseas for more than 40 years, silver diamine fluoride was approved in 2009 by the United States FDA and has been adopted by groups like the World Health Organization. It’s also being used by the staff at Bellingham Pediatric Dentistry, including their newest care provider, Dr. Marc Horton.

After serving the adult population, Dr. Marc Horton decided he wanted to focus on prevention and education. Photo courtesy Bellingham Pediatric Dentistry

Dr. Horton grew up in Bellevue and attended undergraduate and resident programs in Boston. During his residency, he worked with a population that had significant dental needs—many of whom weren’t older adults. “My perspective was that if they had learned some better habits when they were younger, made some different choices or maybe had different circumstances in life, they could have prevented a lot of that,” he says. “There’s great technology in terms of repairing dental and oral diseases once they occur, but I wanted to be on the prevention and education side, to help children and their families get off on the right foot.”

He returned to the West Coast in 2019 to complete his residency in pediatric dentistry at the University of Washington. Trusted faculty members put him in touch with Bellingham Pediatric Dentistry’s Dr. Sawyer, and he’s been working with patients there since August of 2020.

The tiny brush used to apply the silver diamine fluoride solution makes quick and easy work when treating a small child. Photo courtesy Bellingham Pediatric Dentistry

Dr. Horton is well-versed on the use—and the history—of silver diamine fluoride. “It was first used as a desensitizing agent, primarily in adult patients who have root exposure associated with periodontal disease and is also used to help arrest cavities that have started to form,” he says. “It was relatively recently approved in the U.S. as a device for reducing tooth sensitivity, and we also use it on ‘caries,’ or decay.”

It’s important to know that silver diamine fluoride doesn’t replace prevention or regular maintenance but might help avoid more serious treatments. “It’s often used in pediatrics as a bridge. We may have identified some decay in a young child, and we can use this as an effective way of slowing down the progression of the decay,” says Dr. Horton. “The hope is that we can get the child to a point where they’re a little older, and they can cooperate for more traditional dental treatment, like a restoration or a fill.”

Bright, open spaces and a selection of books, toys and games help make the Bellingham Pediatric Dentistry office a happy place for children. Photo courtesy Bellingham Pediatric Dentistry

Part of Dr. Horton’s job is helping new parents learn how to care for their baby’s teeth, as well as intervene in case of trouble. “Unfortunately, we see some really young children—two, three, four—that have cavities on their back molars that are going to be in their mouths until they’re 10 or 12,” he says. “We’re trying to get another 8 to 10 years out of these teeth and help parents understand that, unless there’s a pretty significant change in diet or home care, we will need to still do some traditional treatment in the future.”

One of the best parts about silver diamine fluoride treatment is how quickly and easily it can be accomplished. “It’s non-invasive or minimally invasive. It’s a liquid we apply to the teeth using a very small brush, and we can apply it safely and effectively on a young—and maybe uncooperative—child in a manner of a minute or less,” Dr. Horton says. “Then our recommendation is a repeat application, typically at six-month intervals.

Children should see a dentist by their first birthday, partly so that parents can begin getting educated on best dental practices for small ones. Photo courtesy Bellingham Pediatric Dentistry

Parents like the fact that it’s non-invasive compared to traditional dental treatment. The downside is that, because of the silver content in the liquid, the areas where they have decay or cavities are stained a dark brown or black color. In some ways, it can be a nice visual indicator of an area where they haven’t been as diligent as they could be.

Stains on baby teeth are a temporary drawback, and it should not be used on people with a silver allergy, but otherwise silver diamine fluoride gets high marks for safety.

Four front teeth were treated with silver diamine fluoride (left) for over a year, and were then able to be saved (right), thanks to the treatment, once the child was old enough for surgery. Photo courtesy Bellingham Pediatric Dentistry

“Applying this to the baby teeth has no effect on the color of the permanent teeth. That’s a common question I get,” says Dr. Horton. ‘It’s becoming more common, and I think that if parents ask around, they’re going to find other parents in the community whose children who have had this applied. It’s becoming more widely used, and the Academy of Pediatric Dentistry supports its use as a part of a comprehensive plan for tooth decay.”

Dr. Horton also stresses the importance of parents having a comprehensive plan to start paying attention to dental health early.

“The official recommendation is [a visit] within six months of the first tooth erupting, or by the first birthday,” says Dr. Horton. “I would say we’d love to see all of them on or around their first birthday. Parents can get into a good habit and find a dental routine for their child.”

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