No Drill, No Needle: Trial Stops Cavities in 830 Kids
A US phase 3 trial found that a silver fluoride liquid, brushed on twice a year, stopped decay in more than half of the affected baby teeth, with no drilling and no anesthesia.
Can a three-year-old’s cavity be stopped without a drill? It can, in more than half of the affected baby teeth. That is the headline number from a phase 3 clinical trial in 830 children under the age of six, published on July 28, 2026 in JAMA Pediatrics.
There is no bur involved. Silver diamine fluoride at 38 percent goes straight onto the decayed spot with a small sponge-tipped applicator, and the whole thing takes seconds per tooth. No injection, no sedation, and none of the diseased tooth structure is cut away. That last part is what separates it from a conventional filling, where the tooth has to be drilled first.
How the trial was run
The study started in 2018 and was led by Margherita Fontana, professor of dentistry at the University of Michigan School of Dentistry. Children were enrolled across three states, Michigan, New York and Iowa, through three routes:
- dental offices
- pediatric practices
- the Head Start and Early Head Start programs
The liquid was reapplied every six months. New York University, the University of Iowa and Indiana University took part alongside Michigan. Funding came from the National Institute of Dental and Craniofacial Research at the National Institutes of Health, more than 12 million dollars in total. The product itself, Advantage Arrest 38 percent, was supplied by Elevate Oral Care.
In a University of Michigan statement, Fontana described the treatment as safe even for the youngest patients: “This is a very effective and safe treatment, even in children as young as 1.”
What “more than half” leaves out
It leaves out the rest. In some teeth the decay kept advancing despite the coating, so a single visit settles nothing here. The six-month reapplication is part of the treatment rather than an add-on, and a child who gets the liquid stays on the recall list.
The catch is visible from across the room. Silver permanently darkens the decayed portion of the tooth, and that stain does not come off. On a baby tooth, which is going to fall out anyway, the cosmetic price is smaller than it would be on a permanent one. For a parent the choice narrows to a short calculation: a dark patch you can see when the child opens up, or drilling on a three-year-old who cannot sit still.
An approval twelve years in the making
The compound is not new in the United States. It was cleared in 2014, but for tooth sensitivity, not for cavities. Ever since, dentists treating decay with it have been working off-label, on clinical judgment rather than an approved indication.
That is where the sharpest consequence of this trial sits. The data feed the manufacturer’s application to the Food and Drug Administration (FDA) for approval to treat caries. If it clears, painting cavities stops being a practice that runs ahead of the paperwork and becomes a registered therapy.
Twelve years separate the sensitivity clearance from the first large-scale proof on decay, and eight of those went into the trial itself. The paper is indexed under DOI 10.1001/jamapediatrics.2026.2567.
Until the FDA rules, nothing changes in the chair. What changes is that a dentist who suggests the silver liquid now has 830 children behind the suggestion, not just the experience of one practice.
