Nobody anticipates developing a cavity drilled and filled by a dentist. Now there’s an alternative: an antimicrobial liquid that can be brushed on cavities to prevent cavities – painlessly.

The liquid is named silver diamine fluoride, or S.D.F. It’s been useful for decades in Japan, but it’s been for sale in the us, underneath the name Advantage Arrest, for merely a year.

The foodstuff and Drug Administration cleared silver diamine fluoride to be used being a tooth desensitizer for adults 21 and older. But studies show it might halt the advancement of cavities and prevent them, and dentists are increasingly making use of it off-label for those purposes.

“The upside, the great one, is that you simply don’t need to drill and you also don’t need an injection,” said Dr. Margherita Fontana, a professor of cariology with the University of Michigan.

Silver diamine fluoride has already been utilized in numerous dental practices. Medicaid patients in Oregon are receiving treatments, and a minimum of 18 dental schools have started teaching the next generation of pediatric dentists how to use it.

Dr. Richard Niederman, the chairman from the epidemiology and health promotion department with the Nyc University College of Dentistry, said, “Being capable to paint it on in A few seconds with no noise, no drilling, is best, faster, cheaper.”

“I would encourage parents to inquire about it,” he added. “It’s less trauma for that kid.”

The primary bad thing is aesthetic: Silver diamine fluoride blackens the brownish decay on the tooth. That may not matter on the back molar or a baby tooth that will fallout, but a majority of people are likely to end up deterred with the prospect of an dark spot on a visible tooth.

Until more insurers get it, patients must also cover the cost. Still, it’s affordable. Dr. Michelle Urschel, an anesthesiologist, was very happy to pay $25 to have Dr. Jeanette MacLean, a pediatric dentist in Glendale, Ariz., paint more than a cavity that her son Knox, 4, had recently developed.

A cavity that had to get drilled cost $151. The liquid “was very affordable,” Dr. Urschel said.

The noninvasive treatment might be ideal for the indigent, elderly care residents yet others who have trouble finding care. And several anxious dental patients need to dodge the drill.

However the liquid might be especially useful for children. Nearly 1 / 4 of 2- to 5-year-olds have cavities, according to the Cdc and Prevention.

Some preschoolers with severe cavities has to be treated in a hospital under general anesthesia, even though it may pose risks for the developing brain.

“S.D.F. gives us a chance to reduce the variety of toddlers with cavities going to the O.R.,” said Dr. Arwa Owais, an affiliate professor of pediatric dentistry with the University of Iowa.

Dr. Laurence Hyacinthe, a pediatric dentist in Harlem, used silver diamine fluoride on eight uncooperative children whose parents planned to delay a visit to the operating room.

Dr. MacLean said, “People think that parents will reject it due to poor aesthetics.” But “if it implies preventing a kid from having to be sedated or having their tooth drilled and filled, there are lots of parents they like S.D.F.,” she added.

Alejandra Bujeiro, 32, was delighted that her 3-year-old daughter, Natalia, didn’t have to have two cavities completed the back of her mouth. Instead Dr. Eyal Simchi, a pediatric dentist in Elmwood Park, N.J., brushed silver diamine fluoride for the decay.

Two front teeth, however, were drilled. Next time, Ms. Bujeiro said, she’d select silver diamine fluoride. “I would use it in baby teeth even though it’s right in front,” she said. As for the discoloration? “You can’t view it excessive.”

Silver diamine fluoride has an additional advantage over traditional treatment: It kills the bacteria that can cause decay. A second treatment applied six to 18 months as soon as the first markedly arrests cavities, studies show.

“S.D.F. cuts down on incidence of the latest caries and advancement of current caries by about 80 percent,” said Dr. Niederman, that’s updating an evidence overview of silver diamine fluoride published during 2009.

Fillings, by contrast, don’t cure an oral infection.

“There’s nothing which goes on in the operating room that treats the root problem,” said Dr. Peter Milgrom, a professor of pediatric dentistry with the University of Washington who had been instrumental in receiving F.D.A. clearance for silver diamine fluoride and it has a monetary stake in Advantage Arrest.

That’s why some children must have baby teeth under anesthesia twice.

Microbe infections also cause acne, but a “dermatologist doesn’t take a scalpel and cut-off your pimples,” said Dr. Jason Hirsch, a pediatric dentist in Royal Palm Beach, Fla. Yet “that’s how dentistry has approached cavities.” Dr. Hirsch has a Facebook page called SDF Action, where dentists can discuss individual cases.
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