Efficacy of Silver Diamine Fluoride in the Prevention of Caries Induced by Radiation: A Preliminary Investigation

By
Amal A.K. Noureldin
Amerian Sones
Luz Mendoza
Lloyd Mancl
Peter Milgrom
July 16, 2026

Journal Of The American Dental Association

At a Glance

Category	Detail
Condition	Radiation-induced caries (RIC)
Key Mechanisms	Silver diamine fluoride (SDF) combines high-concentration fluoride with antimicrobial activity. Silver ions suppress cariogenic bacteria, while fluoride promotes mineral formation and resistance to acid challenge.
Target Population	Adults receiving radiotherapy involving the maxilla or mandible for head and neck cancer
Care Setting	Dental evaluation and professionally delivered preventive care before and after head and neck radiotherapy

Key Highlights

Median caries increment was significantly lower with 38% SDF than placebo at 1, 3, and 6 months.
At 1 month, 72.2% of SDF recipients developed no new caries compared with 23.5% of placebo recipients.
At 3 months, 47.1% of SDF recipients developed no new caries compared with 5.9% of placebo recipients.
Stimulated salivary flow declined significantly in both groups, with no between-group differences.
SDF reduced RIC progression despite substantial declines in salivary flow.
No adverse or unanticipated treatment-related effects were reported.

Guideline-Based Recommendations

Diagnosis

Perform comprehensive dental evaluation before radiotherapy and assess coronal and root-surface caries during follow-up.

Management

Consider professionally applied 38% SDF as an addition to oral care before and after head and neck radiotherapy.

Monitoring & Follow-up

Assess caries, salivary function, gingival inflammation, and oral health–related quality of life before radiotherapy and at follow-up visits.

Risks

Screen for reported allergies to silver, fluoride, or ammonia before treatment.
Counsel patients about the characteristic dark discoloration associated with SDF.

Patient & Prescribing Data

Eligible adults were scheduled to receive radiotherapy involving the maxilla or mandible and had at least 6 permanent teeth.

Five drops of 38% SDF or placebo were applied to all tooth surfaces before radiotherapy and at 1 and 3 months afterward. Application typically required less than 1 minute.

Clinical Best Practices

Complete indicated restorative or preventive dental treatment before radiotherapy.
Provide standardized oral hygiene and dietary counseling.
Provide 1.1% neutral fluoride toothpaste for daily use throughout treatment.
Monitor patients regularly because RIC can progress rapidly after radiotherapy.

Related Resources & Content

Moore C, McLister C, Cardwell C, O’Neill C, Donnelly M, McKenna G. “Dental Caries Following Radiotherapy for Head and Neck Cancer: A Systematic Review.” Oral Oncol. 2020;100:104484.