Liquid treatment could stop cavities in children without drilling, study shows

A simple liquid that can be painted onto cavities could help stop tooth decay in young children without the need for drilling, injections or surgery, according to a new study. Researchers found that silver diamine fluoride (SDF), an inexpensive liquid applied directly to a decayed tooth, stopped cavities from worsening in more than half of affected baby teeth when applied every six months. The treatment is quick and painless. A dentist simply brushes the liquid onto the cavity using a small sponge applicator, with the process taking only a few seconds per tooth. Unlike conventional cavity treatment, it does not require the damaged part of the tooth to be removed, injections or sedation. The findings are from a Phase III clinical trial led by the University of Michigan and published in JAMA Pediatrics. The study involved 830 children under the age of six. Researchers say the treatment could reduce the number of children who suffer severe tooth pain and infections or require hospital visits because of untreated cavities. Every year, thousands of children in the United States visit emergency departments because of tooth decay, with many eventually requiring surgery under general anaesthesia. "This is a very effective and safe treatment, even in children as young as one year old," said Dr Margherita Fontana, the study's lead investigator and a professor at the University of Michigan School of Dentistry. Although silver diamine fluoride has been used in many countries for decades, it has only been used off-label in the United States since 2014, when it was approved to treat tooth sensitivity. Researchers say the new trial provides the strong evidence needed to support approval of the product as a treatment for tooth decay. Tooth decay is the most common chronic disease among children, affecting more than 40 per cent of children in the United States. If left untreated, cavities can cause severe pain, infections, difficulty eating and sleeping, missed school days and repeated medical visits. Researchers say the treatment could particularly benefit young children, older adults, people with disabilities, those with severe fear of dental procedures and people with limited access to dental care. The main drawback is cosmetic. The liquid permanently turns the decayed part of the tooth black, although it does not stain healthy tooth tissue. The researchers believe wider approval of the treatment could enable doctors and dentists to stop cavities before they become painful or require surgery. For some children, regular applications every few months could keep cavities under control until their baby teeth naturally fall out. For adults, the treatment could provide long-term protection or serve as a temporary solution until conventional dental treatment is available. According to the World Health Organisation (WHO), tooth decay remains the most common chronic disease affecting children worldwide and is largely preventable. Globally, an estimated 510 million children have untreated tooth decay in their baby (deciduous) teeth, while dental caries affects about 2.5 billion people in their permanent teeth. WHO also estimates that oral diseases affect nearly 3.7 billion people worldwide, making them among the most widespread health conditions. The burden is also significant in Kenya. According to the Kenya National Oral Health Strategic Plan 2022–2026, the overall prevalence of dental caries among children aged five, 12 and 15 years is 23.9 per cent. The burden is highest among younger children, with 46.3 per cent of five-year-olds affected by tooth decay in their primary teeth. The report also found that gum disease is widespread among children, with 75.7 per cent showing signs of gingival bleeding. WHO warns that untreated tooth decay can cause severe pain, infections, difficulty eating and sleeping, poor school attendance and reduced quality of life. The organisation says the disease is driven mainly by frequent consumption of foods and drinks high in free sugars, poor oral hygiene, inadequate exposure to fluoride and limited access to dental care. Although tooth decay is preventable, many low- and middle-income countries still lack adequate oral health services, leaving millions of children without timely treatment.