SMART Dental Treatment for Children in Apex
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Silver Modified Atraumatic Restorative Treatment, or SMART, is a minimally invasive approach that combines silver diamine fluoride with a glass ionomer restoration. Green Level Pediatric Dentistry & Orthodontics may recommend SMART to help manage selected cavities while preserving healthy tooth structure.
Dr. Michael Kim evaluates the cavity’s depth, location, symptoms, remaining tooth structure, and the child’s ability to participate in treatment before recommending SMART.
What Is SMART?
SMART typically begins with the application of silver diamine fluoride to help control cavity-causing bacteria and arrest active decay. A glass ionomer material is then placed over the treated area to seal the cavity, restore part of the tooth’s shape, and protect the treated surface.
Unlike SDF alone, SMART includes a restoration. Depending on the tooth and cavity, it may serve as an interim treatment or remain in place as the tooth continues to be monitored.
Benefits of SMART
Minimally Invasive Care
SMART may require less removal of tooth structure than conventional restorative techniques. Treatment can often be completed with hand instruments and limited use of a dental handpiece.
Cavity Arrest and Sealing
SDF helps manage active decay, while the glass ionomer restoration seals the area and limits the cavity’s exposure to food and bacteria.
Restored Tooth Shape
The glass ionomer material covers the cavity and restores part of the tooth’s contour, which may support easier cleaning and more comfortable function.
Did You Know…
A 2026 systematic review and meta-analysis estimated a 94.9% mean SMART success rate at three months across the included pediatric studies. The estimated rate decreased with longer follow-up, demonstrating the importance of continued monitoring. Journal of Clinical Pediatric Dentistry
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The SMART Process
1
Evaluate the Tooth
The dentist examines the cavity and may take digital images to assess its depth. Teeth with uncontrolled pain, swelling, infection, or pulp involvement may require another treatment.
2
Apply SDF
The tooth is cleaned and isolated. Silver diamine fluoride is applied to the cavity to help control bacteria and harden affected tooth structure.
3
Place the Restoration
Glass ionomer material is placed over the treated area and shaped to restore the tooth. Follow-up visits allow the dentist to evaluate the seal, material wear, and cavity activity.
“SMART combines the cavity-arresting properties of silver diamine fluoride with a restoration that seals and reshapes the tooth. It can be a helpful option for selected children, but continued monitoring remains an important part of treatment.”
Dr. Michael Kim
Read Verified Reviews From Apex Parents
“My kids have been going to this practice since they were toddlers, and having one doctor who understands their complete dental history and growth patterns has made such a difference. Dr. Kim treats them like they’re his own children and recommends only what’s truly necessary. The convenience of having both their regular checkups and orthodontics in one place has been a game-changer for our family.”
“What impressed me most was how honest the doctor is about treatment recommendations. He explained exactly why each step was needed and never pushed unnecessary procedures. Having someone I trust completely managing both my kids’ dental and orthodontic care gives me peace of mind. The staff is incredibly kind and patient with nervous children.”
“We switched practices specifically because we wanted someone who could handle both pediatric dentistry and orthodontics under one roof. The continuity of care is amazing, and our kids actually look forward to their appointments. The whole team treats every patient like family, and the clinical expertise is evident in every interaction.”
Research-Reported Outcomes for SMART
SMART Success at Three Months Across Pediatric Studies
94.9%
Cavity-Preventive Effect After 36 Months in MIH-Affected Permanent Molars
94.7%
Cavity-Preventive Effect After 24 Months in MIH-Affected Permanent Molars
97.6%
Cavity-Preventive Effect After 12 Months in MIH-Affected Permanent Molars
100%
SMART Success at Six Months Across Pediatric Studies
82%
SMART Success at 12 Months Across Pediatric Studies
69.5%
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| SMART Treatment Outcome | Percentage | What the Research Shows |
|---|---|---|
| Three-month SMART success | 94.9% success | A systematic review and meta-analysis of pediatric SMART studies calculated a weighted mean success rate of 94.9% after three months. |
| Cavity-preventive effect after 36 months | 94.7% maintained | In a study of molar-incisor hypomineralization-affected permanent molars, SMART-treated teeth maintained a 94.7% cavity-preventive effect after 36 months. |
| Cavity-preventive effect after 24 months | 97.6% maintained | The same study reported a 97.6% cavity-preventive effect for SMART-treated permanent molars after 24 months. |
| Cavity-preventive effect after 12 months | 100% maintained | SMART-treated hypomineralized permanent molars demonstrated a 100% cavity-preventive effect at the 12-month evaluation. |
| Six-month SMART success | 82% success | The pediatric systematic review calculated a weighted mean SMART success rate of 82% at six months. |
| Twelve-month SMART success | 69.5% success | The systematic review calculated a weighted mean success rate of 69.5% at 12 months, with differences among studies and outcome criteria. |
Sources: Lin et al., “Outcomes of Silver-Modified Atraumatic Restorative Treatment in Children,” Journal of Clinical Pediatric Dentistry, 2026; Unverdi et al., “Clinical Comparison of Silver Diamine Fluoride or Silver-Modified Atraumatic Restorative Treatment,” 2024; Aly et al., “Survival Analysis and Cost Effectiveness of Silver Modified Atraumatic Restorative Treatment,” Journal of Dentistry, 2023; Natarajan, “Silver Modified Atraumatic Restorative Technique,” 2022; American Academy of Pediatric Dentistry, “Pediatric Restorative Dentistry”.
Key Findings About SMART
SMART is different from SDF alone. SDF is applied to help arrest decay, while SMART adds a glass ionomer restoration that seals and reshapes the treated area.
The restoration may reduce visible staining. Glass ionomer can cover some of the darkened cavity, but discoloration may remain visible around or through the restoration.
Not every cavity can be treated with SMART. Teeth with infection, pulp exposure, significant pain, or insufficient remaining structure may require pulp therapy, a crown, extraction, or another treatment.
SMART can be interim or longer-term care. The role of the restoration depends on the tooth, cavity size, material wear, eruption pattern, and the child’s future treatment needs.
Glass ionomer can wear or fracture. Follow-up examinations allow the dentist to determine whether the material needs repair, replacement, or coverage with another restoration.
Home care remains essential. SMART treats an existing cavity but does not eliminate the child’s risk of developing new decay elsewhere.
Schedule a SMART Evaluation
SMART may provide a conservative option for selected cavities in children who would benefit from a minimally invasive approach. Contact Green Level Pediatric Dentistry & Orthodontics in Apex to schedule an evaluation with Dr. Michael Kim.
Questions Apex Families Ask About SMART
How is SMART different from a regular filling?
A conventional filling generally involves removing damaged tooth structure before placing a restorative material. SMART uses SDF to help arrest the cavity and glass ionomer to seal the area, often with less tooth preparation.
Does SMART require drilling or an injection?
SMART can frequently be performed with limited or no drilling and without local anesthesia. However, the exact procedure depends on the cavity, tooth, and child’s comfort. Some tooth preparation may still be necessary.
Will SMART turn the cavity black?
The SDF used during SMART permanently darkens decayed tooth structure. The glass ionomer restoration covers much of the treated area, but some darkening may remain visible.
Is SMART a permanent restoration?
It may function as an interim or longer-term restoration depending on the clinical situation. The dentist monitors the material and tooth to determine whether future repair or replacement is needed.
Can SMART treat a painful or infected tooth?
SMART is generally intended for selected cavities without signs of irreversible pulp damage or infection. A tooth with spontaneous pain, swelling, an abscess, or pulp exposure may need another treatment.
Is SMART safe for children?
SMART uses materials commonly applied in pediatric dental care. Before treatment, Dr. Michael Kim reviews the child’s health history, cavity, expected benefits, dark staining, limitations, and alternative treatment options.