The Gentle Side of Pediatric Dentistry: Embracing Minimally Invasive Techniques

Dentistry has changed a lot in recent years. Today there is a growing focus on treatments that are gentle on teeth and still get the job done. This approach, called minimally invasive dentistry, aims to save as much of your child’s natural tooth as possible while treating problems with precision. It can also make dental visits easier and less scary for children.

Why does this work? We know that a cavity is driven by a sticky film of bacteria (plaque) that feeds on sugar and makes acid. If we cut that film off from its food supply, or make the tooth surface too hostile for the bacteria, the decay can stop growing, often without drilling it all out [1].

In this article, I’ll explain three tools that make minimally invasive care possible: Hall crowns, silver diamine fluoride, and glass ionomer. I’ll cover what each one is, why it works, and what to expect.

Hall Crowns

Imagine a protective cap for a baby molar that goes on with very little fuss. That’s what a Hall crown is. It is a ready-made, stainless steel (“silver-colored”) crown used on back baby teeth that have cavities. Unlike a traditional crown, the Hall technique does not require numbing shots, drilling out the decay, or shaving down the tooth [1, 2].

How it’s done. The dentist chooses a crown that fits, fills it with a tooth-friendly cement (usually a type of glass ionomer, described below), and presses it over the tooth. Your child often helps by biting down. If the baby teeth are packed tightly together, the dentist may first place tiny rubber spacers between them. These are left in for a few days to make room for the crown [5].

Why it works. The crown seals the cavity off from the mouth. The bacteria inside lose access to the sugars they feed on, so the decay slows or stops [1, 5].

What the research shows. A Scottish randomized trial compared Hall crowns with dentists’ usual fillings in the same children [2–4]:

  • After about two years, 77% of children, 83% of parents, and 81% of dentists who had a preference chose the Hall technique [2].
  • At two years, only 2% of Hall crowns had serious problems (pain or infection of the nerve), compared with 15% of conventional fillings [2].
  • Hall crowns kept outperforming the fillings at five years [3] and over the remaining life of the baby teeth [4].

Is it right for every tooth? No. The Hall technique is only used on back baby teeth (primary molars) that have small or moderate sized cavities. It is not used when the cavity is close to or into the nerve, or if there in abscess[5]. Your child’s bite may feel slightly “high” at first; this usually settles on its own within a few weeks as the teeth adjust [1].

Silver Diamine Fluoride (SDF)

Silver diamine fluoride, or SDF, is a clear liquid that can stop many cavities in their tracks. It is painted onto the decayed spot with a tiny brush. There are no needles and no drilling, and the whole thing takes only a minute or two [6, 8].

Why it works. SDF combines two ingredients that each fight decay in a different way [6, 12]:

  • Silver kills the bacteria in the cavity and helps keep new bacteria from settling in.
  • Fluoride helps the softened tooth re-harden (re-mineralize), making the treated area tougher and more resistant to acid.

What the research shows. SDF has been studied for decades and is supported by both the American Academy of Pediatric Dentistry (AAPD) and the American Dental Association® (ADA) [6, 7, 9]. A 2009 review found SDF stopped and prevented cavities far more effectively than fluoride varnish [11]. In a three-year school study, SDF also lowered the number of new cavities on nearby tooth surfaces [10]. The amount of fluoride used to treat a tooth with SDF is less than in a standard fluoride varnish [6].

Who is it good for? SDF is a great option for young children who are not yet ready for traditional fillings, for children with many cavities, and for people with special health care needs. It can help avoid or delay the need for sedation or general anesthesia [6, 7]. It also works in teens and older adults.

What are the trade-offs?

  • Black staining. SDF permanently turns the decayed part of the tooth dark brown or black. Healthy enamel does not stain [6]. Because of this, many families prefer other options for front teeth. A tooth-colored filling can often be placed over the area later to cover the stain [6].
  • It needs repeat visits. One application is usually not enough. Most children need SDF reapplied, often every six months, to keep the decay stopped [6, 8, 9].
  • Other effects. It can have a brief metallic taste, may irritate the gums, and can stain skin and clothing on contact [6, 8]. It is not used in children with a silver allergy [8].
  • It doesn’t rebuild the tooth. SDF stops decay, but it does not fill the hole. A larger cavity may still need a filling or crown later [6].

In the United States, SDF is FDA-cleared to treat tooth sensitivity. Using it to stop cavities is a common, well-researched “off-label” use [6].

Glass Ionomer (GI)

Glass ionomer is a tooth-colored material and one of the most versatile tools in children’s dentistry. We use it for sealants, small fillings, temporary fillings, and as the “glue” that holds crowns (including Hall crowns) and space maintainers in place [13, 15, 16].

Why it works. Glass ionomer has two special abilities:

  • It bonds to the tooth chemically. Most filling materials need a separate glue. Glass ionomer instead forms a direct chemical bond with the tooth’s own minerals [13, 14]. This means the dentist usually needs to remove less healthy tooth to hold it in place.
  • It releases fluoride. The glass contains fluoride that slowly seeps out into the surrounding tooth. Even better, it can soak up fresh fluoride from toothpaste or fluoride treatments and release it again, acting like a small, rechargeable fluoride reservoir [13, 14].

It is also more forgiving of moisture than many other filling materials. That makes it a good choice for wiggly young patients, or for teeth that are only partly grown in and hard to keep dry [17].

What are the trade-offs? Glass ionomer is not as strong or wear-resistant as some other materials. It works best for small fillings, areas that don’t take heavy chewing forces, sealants, and cementing crowns. For large cavities on back baby teeth, a crown is usually the longer-lasting choice [14, 15]. Newer “resin-modified” or reinforced versions are stronger than the original formulas [13, 14].

A team player. Glass ionomer works well alongside SDF. SDF can stop the decay, and glass ionomer can then be placed over it to restore the tooth’s shape and help cover the dark stain. SDF does not appear to weaken glass ionomer’s bond to the tooth [6, 18].

The Bottom Line

Minimally invasive dentistry is about keeping your child’s smile healthy while treating problems as gently as possible. Hall crowns, silver diamine fluoride, and glass ionomer each do this in a different way: by sealing decay away from its food supply, by stopping it chemically, or by bonding to the tooth and releasing fluoride.

None of these is right for every tooth or every child. The best choice depends on the size and location of the cavity, your child’s age and comfort level, and how long the baby tooth needs to last before it falls out naturally [15]. So the next time you visit, don’t be surprised if we recommend one of these options. We’ll always walk you through the reasons, the trade-offs, and the alternatives so you can decide together with us.

~Dr. Richman and the Dino Kid’s Dentistry Crew

This article is for general information only and is not intended as medical or dental advice. Please talk with your or your child’s medical or dental provider about specific questions.

Schedule An Appointment

We invite you to call our team today at 253-220-7345 to schedule your appointment with our dentist and learn more about minimally invasive dentistry in Covington, Washington. We look forward to helping your child enjoy a healthy smile!

 

References

  1. Innes NPT, Evans DJP, Bonifacio CC, et al. The Hall Technique 10 years on: questions and answers. Br Dent J. 2017;222(6):478-483. doi:1038/sj.bdj.2017.273
  2. Innes NP, Evans DJ, Stirrups DR. The Hall Technique; a randomized controlled clinical trial of a novel method of managing carious primary molars in general dental practice: acceptability of the technique and outcomes at 23 months. BMC Oral Health. 2007;7:18. doi:1186/1472-6831-7-18
  3. Innes NPT, Evans DJP, Stirrups DR. Sealing caries in primary molars: randomized control trial, 5-year results. J Dent Res. 2011;90(12):1405-1410. doi:1177/0022034511422064
  4. Innes N, Stewart M, Souster G, Evans D. The Hall Technique; retrospective case-note follow-up of 5-year RCT. Br Dent J. 2015;219(8):395-400. doi:1038/sj.bdj.2015.816
  5. MacLean J. The Hall technique. Dentaltown. March 2020. Available online
  6. American Dental Association, Research Services and Scientific Information. Silver diamine fluoride. Oral Health Topics. Updated September 1, 2026. Accessed October 26, 2026. org
  7. Crystal YO, Marghalani AA, Ureles SD, et al. Use of silver diamine fluoride for dental caries management in children and adolescents, including those with special health care needs. Pediatr Dent. 2017;39(5):E135-E145. org
  8. American Academy of Pediatric Dentistry. Chairside guide: silver diamine fluoride in the management of dental caries lesions. The Reference Manual of Pediatric Dentistry. Chicago, IL: AAPD. org
  9. Slayton RL, Urquhart O, Araujo MWB, et al. Evidence-based clinical practice guideline on nonrestorative treatments for carious lesions: a report from the American Dental Association. J Am Dent Assoc. 2018;149(10):837-849.e19.
  10. Llodra JC, Rodriguez A, Ferrer B, et al. Efficacy of silver diamine fluoride for caries reduction in primary teeth and first permanent molars of schoolchildren: 36-month clinical trial. J Dent Res. 2005;84(8):721-724.
  11. Rosenblatt A, Stamford TC, Niederman R. Silver diamine fluoride: a caries “silver-fluoride bullet.” J Dent Res. 2009;88(2):116-125.
  12. Mei ML, Lo ECM, Chu CH. Arresting dentine caries with silver diamine fluoride: what’s behind it? J Dent Res. 2018;97(7):751-758.
  13. Sidhu SK, Nicholson JW. A review of glass-ionomer cements for clinical dentistry. J Funct Biomater. 2016;7(3):16. doi:3390/jfb7030016
  14. Cho SY, Cheng AC. A review of glass ionomer restorations in the primary dentition. J Can Dent Assoc. 1999;65(9):491-495. cda-adc.ca
  15. American Academy of Pediatric Dentistry. Pediatric restorative dentistry. The Reference Manual of Pediatric Dentistry. Chicago, IL: AAPD; 2024:452-465.
  16. International Association of Paediatric Dentistry. IAPD foundational articles and consensus recommendations: restorative dentistry in children. 2022. org
  17. Berg JH. Glass ionomer cements. Pediatr Dent. 2002;24(5):430-438. org
  18. Jiang M, Mei ML, Wong MCM, Chu CH, Lo ECM. Effect of silver diamine fluoride solution application on the bond strength of dentine to adhesives and to glass ionomer cements: a systematic review. BMC Oral Health. 2020;20(1):40.