Hi Dr. Ellie!
Thank you so much for your great information about remineralizing cavities. It’s wonderful to see dentists who try to empower their patients to let their bodies heal themselves. I have several questions for you. My questions concern the extent of decay that must exist before it can no longer remineralize. I know that as great as your system is, it obviously cannot heal everything yet. So how far would the cavity have to be before your system would either not work or at least not be as effective? For example, does it only work for cavities that have only formed in the enamel and have not yet reached the dentin? Another related question of mine is, what happens if the enamel heals but the dentin does not? Is the decay still able to reverse? Thank you so much again for all of the assistance that you provide to people.
Hi and thanks for your question many people have this question: my answer is long, guarded but optimistic!
Cavity forming bacteria soften a tooth to the point that it becomes a hole, and populate open tubules that radiate through soft dentin towards the inside of the tooth. If “cavity forming” infection goes away progression of the cavity will stop. If they reach the center of a tooth this live tissue will become infected and then die (now the only treatment is a root canal or extraction). So the race is on to stop the nasty bacteria burrowing their way into the center of the tooth before they reach the inside!
How do you remove cavity forming bacteria?
Evidence Based studies show: Eating a steady amount (6.5 – 10 grams of xylitol each day) will eradicate the bacteria that cause cavities over a period of six months from saliva, oral mucosa, and tooth surfaces. Without xylitol, the only way we know to remove these bacteria is to cut away tooth material “decay” with a drill to “clean it” before putting in a filling.
Since saliva is the vehicle that transported bacteria into the dentin in the first place, it would seem reasonable to suggest that bacteria “killing” xylitol will percolate inside these dentin tubules just as well as everywhere else in the oropharynx! If xylitol can stop the progression of the disease then the cavity will not get bigger.
Remineralization: Remineralization / repair happens when there is a positive balance on the side of building up ( not dissolving away) minerals in a tooth (acids dissolve minerals acids come from the diet and from cavity forming bacteria). We must tip the scales in the direction of repair!!
First we must find a way (xylitol) to stop bacteria in the cavity from producing acids that grow the cavity. We must find a way (xylitol) to encourages a flow of alkaline saliva over teeth to reduce the cavity.
Studies show that xylitol helps encourage mineralization of deeper parts of enamel. Dilute fluoride will help to encourage remineralization of the outer part of the tooth.
What do we learn from all of these facts?
Dentists used to hope that fluoride alone would remineralize teeth ( in the 1970s and 1980s).
Dentists discovered that with fluoride only the outer surface would remineralize leaving a mushy, decayed area below the healing. Fluoride did not kill off the infection and did not stop the progression of the deeper cavity.
Since the “infection” had not been stopped decay continued to spread in deeper layers, while the outer “shell” of the tooth enamel was repairing over the area. The result was the tooth looked OK from the surface perhaps a small hole in the center.
If the dentist opened up the small hole he often found a huge mushy area of decay underneath.
If you combine adequate amounts of xylitol with dilute fluoride rinsing you get control of the infection, remineralization of deeper layers and the benefits of fluoride heal the outer surface. Studies show that fluoride and xylitol work in synergy.
How deep will this heal? I do not know and I do not think studies have evaluated this.
I know that if sorbitol is mixed with xylitol studies showed that this healing did not happen.
I have a view of dentistry gained by years of geriatric experience. It is common to see elderly people who once had a cavity but the infection stopped. Although the tooth still shows a defect, it is hard and “healed” itself. The inside of the tooth deposits minerals to block off the openings and protect itself. This process may take years, but it can allow teeth (even one with a cavity in it) to survive and continue for ever without any problems. The secret is getting rid of the infection and allowing the tooth to remineralize.
This is not a scientific study but a friend of mine. His son was told he needed four large occlusal cavities filled and if they were not immediately filled they would need root canal treatments.
The father chose to wait 6 months and use the Complete system that I recommend.
The child was diligent and used it exactly as recommended day and night with adequate amounts of xylitol and controlling acidity in his mouth with good diet. In six months the four molar occlusal cavities had completely healed and he never had a cavity in them.
I cannot tell you that this will happen for you. I think there are many factors.
I do believe that many teeth are filled that could heal themselves given six months and the use of my regimen. I do believe, based on my clinical experience, that if an occlusal cavity does not get bigger there is a good chance that in time it will go away. I do believe that if the cavity has not broken the surface of the tooth that it can go away: if the cavity is on a lingual or buccal surface of the tooth, it may go away; if the problem is the corner or side of a tooth this has no way to rebuild.
Hope this helps you!