830 children, a small sponge, and no drill
What happened
A large clinical trial has confirmed that a liquid painted onto a decayed baby tooth can stop the decay getting worse, with no drilling, no injection and no sedation. The liquid is called silver diamine fluoride, usually shortened to SDF. The trial used a 38% solution. A dentist dabs it onto the cavity with a small sponge-tipped applicator. The whole thing takes seconds. The study enrolled 830 children under the age of six. They were recruited through dental clinics, children’s practices and Head Start and Early Head Start programmes in Michigan, New York and Iowa. It was a Phase III trial, which is the stage where a treatment is tested on a large group to confirm how well it works. The result: when SDF was applied every six months, it stopped decay in more than half of the affected baby teeth. The work was led by the University of Michigan, with New York University, the University of Iowa and Indiana University taking part. The National Institute of Dental and Craniofacial Research, part of the US National Institutes of Health, put in more than $12 million. The findings were published in JAMA Pediatrics, and the University of Michigan set them out in a press release reported on 25 October 2026. There is one clear trade-off, and the researchers do not hide it. SDF permanently darkens the decayed part of the tooth it treats. On a back tooth, few people would notice. On a front tooth, it shows.
Why this matters
Treating tooth decay in a very young child is difficult, and not mainly for dental reasons. A drill needs a child who can sit still, keep their mouth open and cope with the noise. A one-year-old cannot do that. So the traditional options have often been general anaesthetic in hospital, or waiting and hoping. General anaesthetic for a toddler is safe in skilled hands, but it is not a small thing. It means a hospital visit, a wait for a slot, a day off work for a parent, and a small but real set of risks. Anything that avoids it for some children is worth taking seriously. That is what makes this trial useful. Margherita Fontana, professor of dentistry at the University of Michigan School of Dentistry and the lead investigator, said: “This is a very effective and safe treatment — even in children as young as 1.” There is a regulatory angle too. The US Food and Drug Administration approved SDF back in 2014, but only for tooth sensitivity. Dentists have used it for cavities “off-label” ever since, meaning outside the official licence. This trial gives the evidence needed for a formal application covering decay arrest. Amr Moursi, professor of paediatric dentistry at NYU College of Dentistry and a co-principal investigator, said: “Our results support FDA approval of SDF for managing arrest of tooth decay in young children.” That is an American process. But UK dentists read the same journals, and strong Phase III evidence tends to travel.
What the evidence actually says
The headline figure needs reading carefully. SDF stopped decay in more than half of treated baby teeth. That is not all of them. So this is not a cure, and it is not a replacement for everything a dentist does. It is a way of halting decay in a tooth that would otherwise keep getting worse, in a child who cannot easily be treated any other way. Some teeth will still need conventional work. The applications were repeated every six months. That matters. This is not one dab and done; it is an ongoing programme that depends on the child actually coming back. The discolouration is permanent, and it is not a stain that polishing removes. It is mainly a cosmetic issue, and the researchers describe it as such. Parents of a child with visible front-tooth decay deserve to have that explained clearly before treatment, not afterwards. Finally, the trial was run in the United States, in specific programmes serving young children. That is a real population, but it is not identical to a UK one, and NHS dental provision for young children works differently. The journal reference is Fontana M, Moursi A, et al., “Efficacy of Silver Diamine Fluoride on Young Children With Severe Early Childhood Caries”, JAMA Pediatrics, 2026.
Practical advice
If your child has visible decay in a baby tooth, book a dental appointment rather than waiting for the next check-up. Decay does not pause. It is fine to ask your dentist directly whether silver diamine fluoride is an option in your case, and what they think of it. Dentists in the UK are aware of it. Ask two follow-up questions: how dark will the tooth go, and how often will it need redoing? If a general anaesthetic has been suggested for a very young child, you can reasonably ask whether anything less invasive would do the same job. A good dentist will not mind the question. None of this replaces the ordinary, dull, effective things. Brush twice a day with a fluoride toothpaste, help children brush until they are around seven, and keep sugary drinks to mealtimes rather than all day. Decay that never starts needs no treatment at all. NHS dental care is free for children in the UK. If you are not registered with a dentist, it is worth asking locally now rather than when something hurts.
What to know
A Phase III trial in 830 children under six found that silver diamine fluoride, a liquid painted onto a decayed baby tooth, stopped decay in more than half of treated teeth when applied every six months. No drilling, injection or sedation was needed. The trade-off is that the treated part of the tooth goes permanently dark. That is cosmetic, and most noticeable on front teeth. The work was led by the University of Michigan with NYU, Iowa and Indiana, funded with more than $12 million from the US National Institutes of Health, and published in JAMA Pediatrics. The researchers say the results support a formal US licence for using SDF to arrest decay in young children. If your child has visible decay, see a dentist and ask what the options are, including this one. Children’s NHS dental care is free in the UK. Sources: University of Michigan, “A simple liquid can stop cavities without drilling, major study confirms”, ScienceDaily, 25 October 2026, https://www.sciencedaily.com/releases/2026/10/261025222339.htm; Fontana M, Moursi A, et al., “Efficacy of Silver Diamine Fluoride on Young Children With Severe Early Childhood Caries”, JAMA Pediatrics, 2026, https://doi.org/10.1001/jamapediatrics.2026.2567 This article is for general information and does not replace advice from a doctor, pharmacist or other qualified healthcare professional.
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