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This is a protocol for treating asymptomatic carious teeth without using a high-speed handpiece. Aerosols from high-speed handpieces have the potential of contaminating every surface of a dental operatory.
Silver Diamine Fluoride (SDF) will reduce 80% of tooth decay if applied twice yearly. However, the permanent black stain it causes has limited the clinical use of SDF to deciduous teeth and root caries in the elderly.
Riva Star involves an extra step of applying potassium iodide (KI) after SDF application. However, when combined with a glass ionomer cement (GIC) overlay on caries, there are signifi cant benefi ts over just applying SDF.

  • Tooth decay is arrested 100%, turning existing caries into a decay resistant base beneath a future restoration.*
  • There is no staining, making Riva Star an ideal medicament for both permanent and deciduous teeth.
  • The time required to triage teeth with Riva Star and GIC is a fraction of the time required to conventionally restore a tooth, especially as the tooth is not required to be anaesthetised.
  • Systematic reviews in the dental literature confi rm that a single surface cavity restored with an ART GIC may be considered to have a similar life expectancy as an amalgam or composite resin restoration.
    Application of Riva Star prior to placing a GIC enhances the clinical outcomes of ART.
  • Multiple-surface cavities restored with a GIC have a limited prognosis. A GIC/composite resin sandwich restoration provides a long-term outcome either at initial placement or in the near future.
  • This technique dramatically reduces the possible complications of exposing the pulp, necessitating an extraction or root canal.

*Frencken J E. The art and science of Minimal Intervention Dentistry and Atraumatic Restorative Treatment. 2018 Handcocks Publishing.


Due to potential staining if the instructions are not closely followed, it is strongly advised not to treat teeth in the aesthetic zone until practitioners are comfortable with the clinical use of Riva Star.

  • Riva star cap kits must be stored in the fridge.
  • Riva star bottle may be kept in the cupboard.

Please refer to Riva Star FAQs here…

Cavity pre-treated with Silver Diamine Fluoride

Cavity pre-treated with Silver Diamine Fluoride and restored with conventional glass-ionomer cement (after 4 yrs) storage in water.

Cavity pre-treated with Silver Diamine Fluoride / Potassium lodide

Cavity pre-treated with Silver Diamine Fluoride / Potassium lodide and restored with conventional glass-ionomer cement (after 4 yrs) storage in water.



  • Prepare the cavity by scraping away any badly broken down tooth structure and bioload with a blunt dental explorer
  • Etch the decay for 15 seconds with 37% phosphoric acid, wash and dry
  • Apply Riva Star SDF (limiting application to the lesion)
  • Immediately apply Riva Star KI until the white reactant becomes clear
  • Flush the preparation with water and dry
  • Isolate the preparation from moisture with cotton rolls as for a restoration
  • Place the auto cure GIC to slightly overfill the preparation
  • Place a small amount of petroleum jelly on a gloved index finger and smear over the surface of the unset GIC so as to free the surface from the any occlusal interference
  • Trim any small overhangs of the setting GIC with a suitable plastic instrument
  • Dismiss the patient
  • This technique can be done in quadrants on multiple cavities further speeding up the procedure and reducing any potential discomfort a patient may have sitting in a dental chair.



If petroleum jelly is not required Riva Coat is designed for the prevention of saliva and water contamination to exposed surfaces of glass ionomer cements during the first 24 hours immediately after placement.



Dr Geoff Knight is a general dentist and internationally noted dental speaker with special interests in Minimal Intervention Aesthetic Dentistry.

He has pioneered a number of innovative clinical procedures in aesthetic dentistry and the pharmacological management of caries and is named on several patents.



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