Bad Cavities

Dear Dr. Ellie:

Hi There, It sounds like the evidence is pretty clear that proper treatment can reverse small cavities. However, what about larger ones? My son has 4 cavities between two sets of molars. I plan to adopt your regime until he gets them crowned…but am curious to know to what extent you have seen a bad cavity reverse itself. 

Thank you! BS

Hi BS,

The answer depends on many factors. If cavities were found on a recent X ray then there is a good chance that the enamel structure (skeleton) is still in tact, and that only minerals have been lost.

It usually takes about a year for enough minerals to dissolve away from a tooth to create a dark spot (a “hole”) or cavity that becomes visible on X ray. (If you suddenly started drinking Mountain Dew daily this time line may be shorter!)

If the X rays did not detect a cavity one year ago and now they do this means that remineralization can most likely occur. This means the skeleton of the enamel should be sufficiently in tact to allow minerals to be built back into it.

Use ACT fluoride at least twice a day (possibly three times a day) rinse and spit make sure your child is able to do this properly: no drinking the fluoride please! Use xylitol at a dose of at least 6.4 grams daily and preferably split into 4 or more small doses and after meals, drinks and snacks is ideal.

Look into providing enough minerals from dairy products milk, yogurt, cheese all very good for teeth. Let me know if you have any other questions.

I have seen occlusal cavities ones that were not judged by a dentist to be able to reverse heal in six months completely. The examining dentist thought he had forgotten to document the fillings since he checked the teeth and they were perfect without a single pin prick hole in them.

If your child experiences pain on eating that continues after the food has gone: from hot, cold, sweet etc….then the cavities may already be too deep. If there are no symptoms you have a better chance.

In a few months, you should go back to your dentist and ask them to take a follow up X ray from the same angle as the one that showed the “cavities”.

If you compare the X ray results you should be able to see if the dark shadows (the “holes”) have become less dark remineralized and stronger ( i.e. healing). X rays bounce off minerals and make the film look whiter the cavities are diagnosed when the X rays travel through the tooth and make the film look black.

If there is evidence these teeth are healing then you should be able to continue your healing therapy taking X rays every now and again until healing is complete.

Good luck,

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