Silver Diamine Fluoride in Pediatric Dentistry: Current Evidence, Clinical Applications, Safety and Global Public-Health Perspectives

Dental caries remains one of the most prevalent chronic diseases of childhood and disproportionately affects children with limited access to conventional dental care. Silver diamine fluoride (SDF) has emerged as a minimally invasive option for arresting active carious lesions and, in selected settings, supporting prevention. This narrative review critically synthesizes contemporary evidence on SDF in pediatric dentistry, with emphasis on biological mechanisms, clinical effectiveness, indications, application protocols, safety, parental acceptance, comparative effectiveness, economic implications, and global public-health relevance. A structured narrative search prioritized systematic reviews, randomized and pragmatic clinical trials, prospective studies, pharmacokinetic investigations, economic evaluations, and international guidance published primarily from 2014 through September 2026. The strongest evidence supports 38% SDF for arresting cavitated dentinal lesions in primary teeth without pulpal involvement, with repeated application generally providing more sustained control than a single application. Advantages include rapid delivery, absence of drilling and injectable local anesthesia, low equipment requirements, and suitability for very young children, patients with behavioral or medical challenges, and community-based programs. Permanent black staining of carious tissue remains the principal limitation and materially affects caregiver acceptance, especially for anterior teeth. Available pharmacokinetic evidence is reassuring when small quantities are professionally applied. SDF should be integrated into comprehensive, risk-based caries management rather than used as a universal substitute for restorative care.