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How do I know if a cavity is remineralizing?

Posted May 06 2009 1:33pm 1 Comment
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 yourwebsite. 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

This site is privately and personally sponsored, funded and supported by Dr. Ellie Phillips. There are no financial or personal ties to Johnson and Johnson or to Pfizer Corporation and the endorsement of their products is based on clinical observation, and independant ADA endorsement. To contact Dr. Ellie, email
Comments (1)
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Hi Dr. Ellie,

I have a question to ask. is it possible to have a black spot lesion be located at the contours of the cusp tip of the lower 1st molar, since there is healthy saliva flow and occlusion all the time. i try using a tooth brush and tooth pick but the small black spot just remains there.

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