D1354 — Silver diamine fluoride (caries arrest)
Silver diamine fluoride is a liquid painted onto a cavity to stop it getting worse.
D1354 — silver diamine fluoride, caries arrest — is a preventive procedure code.
Three things matter when this code turns up on paperwork: what it obliges the practice to have actually done, what it is worth, and which nearby code it is not. All three are set out below.
What silver diamine fluoride involves
Silver diamine fluoride is a liquid painted onto a cavity to stop it getting worse. The silver is antibacterial and the fluoride drives remineralisation; together they harden the softened dentine and arrest the lesion. No drilling, no injection, no noise — roughly a minute per tooth with a microbrush. It has one significant cosmetic consequence: arrested decay treated with silver diamine fluoride turns black. Not grey, not dark — black, permanently, in the treated area. On a back baby tooth nobody will ever see it. On a front tooth it is very visible, and that trade-off has to be explained clearly before treatment rather than discovered afterwards.
When this treatment is used
It has transformed care for three groups in particular: very young children with decay who would otherwise need sedation or general anaesthesia to be treated, frail or medically compromised elderly patients for whom conventional restorative treatment is difficult or unsafe, and patients with root-surface decay that is hard to access. It is also used to buy time — arresting a lesion now and restoring it conventionally later when circumstances allow.
How it changes the decision for a small child
The alternative for a three-year-old with several cavities has historically been treatment under general anaesthesia: a hospital visit, a real if small anaesthetic risk, and considerable cost. Silver diamine fluoride offers a genuine middle path — arrest the lesions now, keep the child comfortable and out of theatre, and restore conventionally in a few years when they can cooperate in a normal dental chair. It is not a substitute for restoration in every case. A cavity that has reached the pulp, or a tooth with an abscess, needs definitive treatment. But for arrestable lesions it has changed the standard of care substantially.
Application schedule and staining
Most protocols apply it twice in the first year — often at an initial visit and again a few weeks later — and then reassess. Reapplication every six months is common for ongoing high risk. Each application is reported separately per tooth. The staining is confined to the demineralised area, so healthy enamel does not darken. It can be masked with a restoration later if appearance matters.
Questions about D1354
Does silver diamine fluoride really stop cavities?
For arrestable lesions, yes — it hardens softened dentine and halts progression, with good evidence behind it. It does not work for decay that has already reached the pulp.
Why does silver diamine fluoride turn teeth black?
The silver compound stains the demineralised part of the tooth permanently. Healthy enamel is unaffected, so the black area is limited to the arrested decay.
Is silver diamine fluoride better than a filling?
It is different, not better. It avoids drilling and anaesthetic entirely, which is decisive for some patients, but it leaves a dark mark and does not rebuild the tooth's shape.
How often does silver diamine fluoride need reapplying?
Usually twice in the first year, then every six months while risk remains high. Each application is billed separately.
What procedure is D1354?
Silver diamine fluoride, caries arrest, reported under a single preventive code.
What should I expect to pay for D1354?
The usual range is $25–$90. Anything well outside it is worth a question rather than an assumption.
Also known as: silver diamine fluoride, SDF, caries arrest, non-invasive cavity treatment.