How do I know if a cavity is remineralizing?

Hi Dr. Ellie, 

I have question for you. How do I know if a cavity is remineralizing?? Does it look the same or does the appearance change?? I also saw a question on your blogs asking about a dentist in Hawaii. I know of a great dentist, his name is Dr. Gary Umeda. I saw that you mentioned him also. He has helped both myself and my sister overcome a lot of our dental anxiety. He also believes in being ultra conservative when it comes to teeth, and he specializes in gold restorations. He is a perfectionist when it comes to his work too! I could go on and on about him, but bottom line is he gives his patients top quality work and he is a fantastic human being and dentist! Highly recommended! Anyway, thanks again for everything you do and thank you for your website. I will probably have more questions in the future since I find this quite fascinating! Aloha!

Hi B,

How interesting that you have experience of the only dentist I know if Hawaii!I have never met Dr. Umeda but he sounds wonderful. Next time you see him say “hi” from Internet dentist Ellie Phillips! I hope I will meet him in person in the future. As for your question how do you know if a cavity is healing? Good question! It somewhat depends on the way that you discovered the cavity did the problem have “symptoms” and at what stage you began healing and reversal. A cavity always starts as a softening then there are gradual steps of progressive destruction. The minute you start my program you will halt/freeze the process but see my answers below to figure out if you are actually reversing the damage:
Initial lesions early cavities: All cavities begin as soft spots areas where minerals have dissolved away from the outer enamel shell.At this stage your tooth may be sensitive to hot and cold. As this softening heals (by remineralization) the sensations of hot and cold will gradually start to go away. If you can see the enamel in a mirror hard and healthy enamel always looks shiny and smooth. A dentist looks for a rough, matt surface when he is searching for early lesions. Your dentist would know a tooth surface had remineralized if it became smooth and glazed in appearance.

Next stage development of a white spot: A white spot is seen when so many minerals have dissolved from the tooth surface that the tooth no longer can reflect light so the tooth becomes opaque in color and looks like a white spot on the tooth. White spots can go away but this usually takes about 6 months of continuous remineralization.
A Real Cavity the caving in of the tooth structure: At this stage the surface of the tooth has broken and on a microscopic level the skeleton of the tooth has broken down. Now liquids and saliva can reach nerve endings inside the tooth and people feel pain with sweet, sour, hot and cold. This pain usually lasts for a few minutes but as the disease spreads the pain will get worse and last longer.Bacteria burrow into the tooth and start breaking down the inside of the tooth making it infected and soft. The combination of xylitol and dilute fluoride will work in harmony at this stage. First the combined use of these products will inactivate intruder bacteria, put minerals back into the weak spots and gradually block off pore-holes with minerals. The sensations of pain should start to go away over time this may take a couple of months to go away completely. If you can see the cavity or hole, it may be light tan to chocolate brown in color. As bacteria die off they may stain the cavity and turn it darker in color. If your tan color cavity starts to look chocolate brown or black this is a good thing! If you keep working at this and there is no more pain the entire area may “scab” over a bit like a wound healing. If you visit a dentist at this time, he will have an easy time to separate the “scab” from the clean tooth underneath. A filling put in at this stage will have a much better chance to stay healthy for the rest of your life it is going to be put into a clean, healthy, strong tooth and not into an infected, porous, soft tooth. (In my own practice I would insist that patients did a three month session to control and heal cavities like this themselves before I started any fillings or other tooth repairs). If you did not go back to your dentist for some reason this healing process would continue slowly if you continued on the xylitol/fluoride program. The “scab” would stay on the surface but healing would take place underneath. In many situations the tooth can rebuild itself and even occlusal (cavities on the top of teeth) have healed up with this method and gone away completely. If a tooth is ever throbbing, painful to bite down on or has a pimple on the gum alongside it this would indicate that the problem is worse than just a cavity. The bacterial infection has killed the tooth and the bacteria has infected the space within the tooth forming an abscess. At this time my system cannot save or reverse the problem. It may be time to consider removing the tooth.
Hope this answers your question. It is quite amazing how cavities can reverse and heal themselves under the correct mouth conditions.
Ellie Phillips, DDS

Categories: Remineralization, Uncategorized, Xylitol

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  • Laura says:

    Dr. Ellie,We spoke recently via email about my dark brown staining on my teeth which you indicated is probably dead bacteria. Today I had a strawberry seed stuck in between my back molars and in trying to get it out I used a small dental mirror. I noticed that around my back molars there is EXTENSIVE dark brown staining. This is where I was told I had two cavities at a dental visit in January although I never had any symptoms. I am really hoping that this is the scabbing that you were talking about because I have been so diligent using the rinses and xylitol. If you think there is a possibility it is something else though I will go back to the dentist immediately. Thanks so much for your help!Laura

  • Dr. Ellie says:

    Hi Laura,It sounds as if you are worried about these areas and without seeing the teeth, I would be very wrong to tell you not to return to your dentist. On the other hand, if you told me that you could not see a dentist for a few months, I would tell you that I believe you are safe with this system – and that you will not be making anything worse – and that a stain is often experienced as bacteria die off the first time. I think you mentioned that your gum health had improved – and that you no longer have bleeding.If this is correct, then I am pretty confident that your stain would likely have come from the shrinking down of dead plaque bacteria.The timing is about exactly what I would expect for the production of this stain. Why not make an appointment and go in for a cleaning in a little while? – and see what they say.Don’t be concerned if they look at this stain and are puzzled – few people improve their oral health this quickly- so it is quite rare to see this staining.Once it is removed it should not return if you stay on the system. Hope this helps – my bet is that they will clean off the stain and you will feel great about your teeth!Ellie

  • Maria says:

    Dr Ellie, I have a 1 1/2 years old toddler who has white spot lesions on her front teeth. When I took her to the dentist, he prescribed GC tooth mousse to be applied to her teeth twice a day. And I did so, brushed her teeth diligently 3x a day. However, after about 2 months of using the tooth mousse, I noticed the teeth now has black stain (or more like a line) forming on the top of the white spot lesion (near the gumline). Does this mean the spot has become cavities? Or is it the dead bacteria you were talking about? The teeth is still a hard surface. I am really interested to know also, whether I can use a drop of ACT in her toothbrush, and then the GC tooth mousse? What about xylitol? Thank you very much!

  • Dr. Ellie says:

    Hi,I have worked quite hard to try and find out if anyone has really positive results from GC tooth mousse. I am familiar with the product name but have no experience with it – it may help in some cases, but it may be causing the stains – I am not sure. I would suggest using ACT on a soft brush and brusing these teeth with one drop – morning and night.You do not need to use toothpaste for a child of this age – I would use a drop of ACT on the brush in place of toothpaste. Xylitol can be a big asset to help these lesions. I would dissolve two grams ( half a 4gram packet) into 2-4 oz of water. I would use this as a sipping drink at the end of meals or after snacks or other drinks. You should try and do this twice a day – using up the 4 gram packet each day. The combination of xylitol and ACT has been remarkable in my experience. I have seen white spots dissappear completely in about three to six months.Xylitol helps transport calcium into the deeper layers and ACT works on the outside "skin" of the tooth. I am not sure if you should use the tooth mousse in conjunction with this – especially if it is causing the staining. Perhaps give ACT and xylitol a couple of months test and see what you think. I thnk you will be surprised and happy with the results. As you child gets older you may want to use the Zellies fruit candy mints in place or in addition to the xylitol in water. Zellies are delicious and kids quickly learn that they are good for teeth. The kids gum is another option if that works for your family. My last suggestion is to try and figure out why these white spots exist – is it from apple juice, soda, citrus drinks like lemonade or orange juice? If so, you need to take extra precautions after every drink to protect the teeth – by eating a Zellie mint or washing the acidic drink off the teeth with the xylitol dissolved in water.

  • AN says:

    Can cavities at the gum line heal? Will they scab over? Does the scab eventually come off and reveal healed enamel beneath it? Thanks!

    • If you have a cavity at the gum line, in an adult tooth, then yes, correct use of xylitol and the Complete Mouth Care System can help remineralize and repair this area. A reasonable size cavity will take 6+ months to heal – but it depends on lifestyle factors including what you eat and drink etc. I’d suggest you use the Complete Mouth Care System three times a day – and always at night. Think about what you drink…and be sure to use xylitol after every one! Try to limit sugar as much as possible -especially candies and sugary drinks.

      • AN says:

        If the enamel has worn off and there’s a large hole at the gum line that is a brown color, will the new enamel grow beneath the brown color and then that will eventually scab off?

  • Michelle Holser says:

    What about leaky fillings that have started to decay at the margin between tooth and filling? Can this type of decay be reversed? I used to eat a junky diet (low fat, free pass for sugar), but for the last 4 or 5 years I’ve been eating a much healthier diet (whole grains, whole milk dairy mostly cultured, virtually no processed food, etc.). As a result of my younger foolish years I have a mouth full of fillings (many around 15 years old) and apparently some are starting to leak. One of the leaky fillings is quite large and may need a crown when he goes to replace it. What’s your advice for me? Thank you so much for your thoughts!

    • If you walked into my office – we would check your teeth and think carefully about the “urgency” of replacing these leaking fillings. It’s urgent if they cause sensitivity each time you eat. Otherwise, I suggest you use the Complete Mouth Care System exactly – with xylitol after every meal, snack and drink (even water) – for at least 3-4 months. Then go back and ask your dentist to give you an honest evaluation about things he believes are urgent and what can wait. Try to wait long enough to save up for crowns/fillings/overlays of the highest possible quality – so this will be the last treatment you ever need. Gold fillings are always my choice….yes, they are expensive – but one day I will have my old fillings covered with gold….because then they will surely outlast me!

  • Jarafel says:

    Hello, I have a pretty big crack in my tooth that doctors want to but crown on. Could I heal it naturally with your system or should I get the crown?

    • If I were in your shoes, I would definitely try to heal this crack naturally. The secret lies in the fact that my system of care helps teeth absorb minerals and in this way the defect can heal naturally. Why not give it a try for the next 6-12 months before your next check up? You have nothing to loose and you may save thousands of dollars on a crown. Make sure you follow the system EXACTLY with the EXACT products – and Zellie’s mints and gum after every meal, snack and drink. Download the booklet and ensure you get the correct toothpaste and rinses!

  • sandupama says:

    Doctor if I use xylitol sugar what is the best way to use it?

    • I recommend pure xylitol mints and gum at the conclusion of every meal, snack and drink – every day.You need at least 3 grams daily to have any oral health benefit and benefits tend to plateau at 10 grams per day.

  • Badchi says:

    Hi Dr Ellie, I have question about cavities I hope you can help me with. I have been looking at my X-rays from 2011 till now and in one of my back tooth I can see on the X-ray a dark shadow that looks like a cavity under a old white filling (I think must over 10 years plus old). When I pointed it out to my dentist he was concerned and wanted to fill it, I went for a second opinion and the other dentist said leave it as it could be just how it looks on an X-ray. Do you think it is really a cavity and is it possible that a cavity never changes in size? (Unfortunately the oldest X-ray I have is from 2011 otherwise I would know if it was like this from day 1). If it helps I can email you the X-ray. Thanks

    • A cavity creates problems if it is alive with bacteria – but if the bacterial problem has been addressed and stopped – the actual “damage” area can remain as a defect in the tooth for the rest of your life without causing any problems. Cavity bacteria feed on liquids from your mouth – especially any that contain sugar or carbohydrates. Xylitol and my system of care employs a strategy designed to wash over teeth and under crowns etc to inactivate cavities. Often they harden up and become inactive areas that cause no more problems. My system could help you -if you control the amount of sugar you are eating etc. To answer your question completely I would need a lot more information – your age, how long the crown has been there and the state of the rest of your mouth etc..

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