Can Dental Cavities Heal?
Yes, dental cavities can heal, but only if they are non-cavitated lesions confined to demineralized enamel or early dentine—once a frank cavity forms with structural breakdown, the tooth cannot regenerate the lost tissue and requires restoration.
Understanding the Healing Potential
The critical distinction lies in the stage of caries progression:
Non-Cavitated Lesions (Can Heal)
- Demineralized but intact enamel and dentine can be remineralized through fluoride exposure and biofilm control, effectively reversing the carious process 1
- Both enamel and dentine possess inherent healing potential when exposed to fluoride, allowing conservation of tooth structure through remineralization 2
- The metabolic activity of dental plaque drives mineral loss, but this process can be reversed by disturbing the biofilm through brushing with fluoride-containing toothpaste 3
Cavitated Lesions (Cannot Heal)
- Once a frank cavity has formed with structural breakdown through enamel into dentine, the tooth cannot regenerate the lost tissue 4
- When cavitation occurs, infected dentine must be removed and the defect restored to eliminate further plaque accumulation 2
- The goal shifts from healing to restoration—removing carious dentine and overlying unsupported enamel, then placing restorative material 4
Clinical Management Algorithm
For Early/Non-Cavitated Lesions:
- Use non-surgical treatment exclusively: fluorides, antimicrobials, and patient education 4
- Apply fluoride varnish every 3-6 months to arrest or reverse non-cavitated lesions 5
- Monitor lesions radiographically and clinically for progression
For Frank Cavitated Lesions:
- Restore immediately while simultaneously addressing caries risk through patient education 4
- Remove infected dentine and unsupported enamel using minimal intervention principles 2, 1
- Select restorative material based on moisture control capability—traditional glass ionomer cement when moisture control is compromised, as it tolerates moisture during setting 6
Important Caveats
The "extension for prevention" philosophy proposed by G.V. Black is obsolete 1. Modern understanding demands:
- Minimal cavity preparation preserving maximum tooth structure 2
- No need to remove all bacteria—sealing infected dentine does not result in caries progression, pulpitis, or pulp death 3
- Focus on restoring surface integrity so patients can maintain proper oral hygiene 3
Common pitfall: Confusing arrested caries (hard, dark lesions that are inactive) with active progressive caries. Arrested lesions do not require operative intervention even if they appear cavitated, as long as the surface can be cleaned 3.