Decision to fund silver diamine fluoride for hospital services and the Health NZ Community Oral Health Service

12 November 2025

Medicines Decision

What we’re doing

We're pleased to announce we are funding silver diamine fluoride for treatment of dental cavities through public hospitals and the ‘Health New Zealand Community Oral Health Service’ for children and some adolescents.

Why we’re doing this

This decision follows an application(external link) to Pharmac to fund silver diamine fluoride in the Community Schedule (Section B) and Hospital Schedule (Section H).

Our clinical advisors have told us that silver diamine fluoride is an effective treatment that would reduce the need for more invasive dental treatments, such as drilling and restoration of teeth. In some cases, it would prevent people from needing a general anaesthetic and hospital admission.

Funding silver diamine fluoride is expected to improve the oral health of New Zealanders by providing a less invasive option to treat tooth decay, reducing the need for more uncomfortable dental procedures, and providing cost savings to the health sector.

Listing silver diamine fluoride in Section H of the Pharmaceutical Schedule will enable access to this treatment for people accessing dental services through Health New Zealand public hospitals, and the ‘Health New Zealand Community Oral Health Service’ for children and some adolescents.

Health New Zealand is responsible for funding of services under the Combined Dental Agreement (CDA). The CDA is primarily for adolescents (school year 9 and above) although it does include some specialised younger children oral health services. Pharmac is not responsible for funding of medicines under the CDA.

The part of the application relating to listing on Section B of the Pharmaceutical Schedule has been declined. This is because funding of medicines via private community dental clinics sits outside of Pharmac’s responsibility.

Any changes to the original proposal?

This decision was subject to a consultation letter dated 16 October 2025. No changes have been made to the proposal following consultation.

Who we think will be most interested

Parents and guardians of children who are treated under the ‘Health New Zealand Community Oral Health Services’
People of all ages who access public hospital inpatient and outpatient dental services
Oral health practitioners
Health New Zealand
Suppliers of dental products

Detail about this decision

From 1 December 2025, silver diamine fluoride, brand name Topamine, will be listed in Part II of Section H of the Pharmaceutical Schedule as follows:

Chemical	Formulation	Brand	Pack size	Price
Silver diamine fluoride	Oral application 38%	Topamine	5 ml	$139.00

Our response to what you told us

Thank you to those who took the time to give feedback. A summary of the main themes raised and our responses to the feedback received are below.

Theme	Pharmac Comment
Supportive of proposal
Highly supportive of the proposal and very happy to hear it is being funded as it will improve access to silver diamine fluoride for children, and some adolescents, as well as adults accessing oral care in public hospitals. Respondents advised that this proposal would help improve oral health and reduce pain and suffering from dental disease for some of their most vulnerable patients. Respondents also noted the advantages to the neurodiverse community who often have issues with teeth care and dental procedures. Respondents noted that cost savings were anticipated with less treatments required when silver diamine fluoride is used as a preventative.	We are pleased to be able to progress this application and list silver diamine fluoride for hospital and ‘Health New Zealand Community Oral Health Service’ use. We are also pleased to have done this with the support of Health New Zealand. This proposal would enable access for children and some adolescents, as well as people of all ages who access oral care through the public hospitals. Listing silver diamine fluoride in section H, as per this proposal, is an important step to improving access and equity for children, Māori and Pacific peoples.

Theme

Pharmac Comment

Supportive of proposal

Highly supportive of the proposal and very happy to hear it is being funded as it will improve access to silver diamine fluoride for children, and some adolescents, as well as adults accessing oral care in public hospitals.

Respondents advised that this proposal would help improve oral health and reduce pain and suffering from dental disease for some of their most vulnerable patients.

Respondents also noted the advantages to the neurodiverse community who often have issues with teeth care and dental procedures.

Respondents noted that cost savings were anticipated with less treatments required when silver diamine fluoride is used as a preventative.

We are pleased to be able to progress this application and list silver diamine fluoride for hospital and ‘Health New Zealand Community Oral Health Service’ use. We are also pleased to have done this with the support of Health New Zealand.

This proposal would enable access for children and some adolescents, as well as people of all ages who access oral care through the public hospitals.

Listing silver diamine fluoride in section H, as per this proposal, is an important step to improving access and equity for children, Māori and Pacific peoples.

Theme	Pharmac Comment
Supportive with considerations
Many respondents supported the proposal. Some of the responses recommended changes, primarily requesting that funding be extended to other groups, including: Children Adolescents Adults Older adults Disabled people All groups who face barriers and inequities in accessing dental care Several pieces of the feedback suggested this would be achieved through listing in the community schedule. With one respondent stating that including silver diamine fluoride in the Community Schedule would reduce pain and infection, lower demand for dental general anaesthesia and extractions, and improve equity for tamariki Māori, Pacific peoples, and those who face barriers to restorative dentistry. Some people told us that silver diamine fluoride should be made available for use by people in the community. Some respondents also commented that silver diamine fluoride should be funded for private dental use.	We are pleased to be able to progress this application and list silver diamine fluoride for hospital and ‘Health New Zealand Community Oral Health Service’ use. Health New Zealand is responsible for funding of services under the Combined Dental Agreement (CDA). The CDA is primarily for adolescents (school year 9 and above) although it does include some specialised younger children oral health services. Pharmac is not responsible for funding of medicines under the CDA. The proposal to list within the Community Schedule was not progressed as funding of medicines via private community dental clinics sits outside of Pharmac’s responsibility. Our decision to progress this application to list sliver diamine fluoride in the Section H will enable access to silver diamine for the following groups: Children (school year 8 and under) and some adolescents accessing the ‘Health New Zealand Community Oral Health Service’ People of all ages who receive oral health service via the Health New Zealand public hospitals. Listing silver diamine fluoride in section H, as per this proposal, improves the access and equity to children, Māori and Pacific peoples. We’ve passed on the feedback to Health New Zealand regarding silver diamine being available for use by people in the community.

Theme

Pharmac Comment

Supportive with considerations

Many respondents supported the proposal. Some of the responses recommended changes, primarily requesting that funding be extended to other groups, including:

Children
Adolescents
Adults
Older adults
Disabled people
All groups who face barriers and inequities in accessing dental care

Several pieces of the feedback suggested this would be achieved through listing in the community schedule. With one respondent stating that including silver diamine fluoride in the Community Schedule would reduce pain and infection, lower demand for dental general anaesthesia and extractions, and improve equity for tamariki Māori, Pacific peoples, and those who face barriers to restorative dentistry.

Some people told us that silver diamine fluoride should be made available for use by people in the community.

Some respondents also commented that silver diamine fluoride should be funded for private dental use.

We are pleased to be able to progress this application and list silver diamine fluoride for hospital and ‘Health New Zealand Community Oral Health Service’ use.

The proposal to list within the Community Schedule was not progressed as funding of medicines via private community dental clinics sits outside of Pharmac’s responsibility.

Our decision to progress this application to list sliver diamine fluoride in the Section H will enable access to silver diamine for the following groups:

Children (school year 8 and under) and some adolescents accessing the ‘Health New Zealand Community Oral Health Service’
People of all ages who receive oral health service via the Health New Zealand public hospitals.

Listing silver diamine fluoride in section H, as per this proposal, improves the access and equity to children, Māori and Pacific peoples.

We’ve passed on the feedback to Health New Zealand regarding silver diamine being available for use by people in the community.

If you have any questions about this decision, you can email us at enquiry@pharmac.govt.nz; or call our toll free number (9 am to 5 pm, Monday to Friday) on 0800 660 050.