Can Cavities Heal? Rethinking Tooth Decay and the Possibilities of Remineralization

James Odell, OMD, ND, L.Ac.

For generations, most of us have thought about cavities in fairly simple terms: decay appears, the dentist removes the damaged portion of the tooth, and a filling takes its place. But our understanding of tooth decay has evolved.

Dental caries is not simply a hole that suddenly appears in an otherwise inert structure.

Teeth are biologically connected to the body, and the development of decay is a

dynamic process involving bacteria, diet, saliva, minerals, and the tissues within the

tooth.

Most importantly, early tooth decay does not always progress inevitably toward a

filling. Under the right circumstances, early non-cavitated lesions can sometimes be

arrested or remineralized.

Your Teeth Are More Alive Than You May Realize

Although enamel itself contains no living cells, the tooth beneath it certainly does.

Underneath the enamel is dentin, a mineralized tissue containing thousands of

microscopic tubules. Deeper still is the dental pulp, which contains blood vessels,

nerves, connective tissue, and specialized cells called odontoblasts.

Odontoblasts produce dentin throughout life and can respond to irritation or injury by

forming additional dentin. This defensive process helps explain why a tooth is better

understood as a living organ than as an inert piece of mineral.

Enamel has its own form of repair.

Throughout the day, minerals move in and out of enamel. Acids produced in the mouth

can remove calcium and phosphate from the tooth—a process called demineralization.

Saliva can help return those minerals through remineralization.

A cavity develops when mineral loss consistently exceeds mineral replacement. During

the earliest stages, however, shifting that balance back toward remineralization may

allow a weakened area to harden again before an actual hole forms.

The Dentinal Fluid Transport Theory

Another intriguing area of dental research involves the movement of fluid within teeth.

Beginning decades ago, researchers Ralph Steinman and John Leonora at Loma Linda

University investigated what became known as dentinal fluid transport. Their animal

experiments suggested that fluid normally moves outward from the dental pulp through

microscopic dentinal tubules.

They proposed that this outward flow could be part of the tooth’s natural defense

system and that dietary and hormonal influences might alter it.

Some of their experiments suggested that high sugar intake could affect this process

even when sugar did not directly contact the teeth.

This research is fascinating, but it is important to distinguish it from today’s established

understanding of dental caries. Modern dentistry recognizes caries as a multifactorial

disease involving the oral biofilm, frequent exposure to fermentable carbohydrates,

saliva, mineral balance, and individual susceptibility. Dentinal fluid transport represents

an additional biological theory worthy of consideration rather than a replacement for

what is already known.

Tooth Decay Is a Process, Not Just a Hole

Modern dentistry increasingly recognizes the importance of distinguishing between an

early carious lesion and a cavitated lesion.

An early lesion—sometimes appearing as a chalky white spot—may still have an intact

surface. At this stage, interventions that reduce demineralization and encourage

remineralization can potentially arrest or reverse the lesion.

Once the tooth’s surface has physically collapsed and a cavity has formed, however,

remineralization alone generally cannot reconstruct the missing anatomy of the tooth.

That distinction matters.

It means that finding early decay does not necessarily mean that drilling is the only

possible next step. Depending upon the individual and the condition of the tooth, a

dentist may consider remineralization, antimicrobial therapies, dietary intervention,

monitoring, or minimally invasive treatment.

Hydroxyapatite: Giving Enamel Its Building Blocks

Hydroxyapatite is particularly interesting because it is one of the primary minerals from

which teeth are naturally constructed.

Nano- and micro-hydroxyapatite toothpastes are designed to supply mineral directly to

the tooth surface, potentially filling microscopic irregularities and supporting

remineralization.

Some hydroxyapatite toothpastes use extremely small particles known as nano-

hydroxyapatite (nHAp), which may enhance the mineral’s ability to interact with

microscopic defects in enamel. Because nanoparticles can behave differently

from larger particles, their safety deserves careful consideration.

Clinical research has increasingly investigated hydroxyapatite toothpastes for cavity

prevention and remineralization. Some randomized trials have found hydroxyapatite-

containing toothpastes comparable to fluoride-containing toothpastes for preventing

new decay, while other formulations combine hydroxyapatite with fluoride.

For people interested in supporting enamel mineralization, hydroxyapatite represents

one of the more promising areas of preventive dental research.

Can Peptides Help Rebuild Early Enamel Lesions?

An even newer approach attempts to encourage mineral formation inside an early

lesion.

A product known as Curodont Repair uses a self-assembling peptide called P11-4. When applied to an early, non-cavitated carious lesion, the peptide diffuses into the porous, demineralized enamel and self-assembles into a three-dimensional matrix. This matrix acts as a microscopic scaffold, creating an environment that attracts calcium and phosphate and supports the formation of new hydroxyapatite crystals within the weakened enamel.

This makes the approach fundamentally different from simply supplying hydroxyapatite particles at the tooth's surface. Instead, P11-4 is designed to support the tooth's own remineralization process from within the lesion, essentially providing a framework upon which lost mineral can be redeposited.

Clinical trials and systematic reviews have produced promising results. A 2023 systematic review and meta-analysis found that Curodont Repair likely increased the arrest of early caries and reduced lesion size, although the researchers also noted limitations in the available studies and called for longer-term trials.

Curodont cannot replace tooth structure that has already been substantially lost, and it is intended for early, non-cavitated lesions. Nevertheless, the technology represents an intriguing shift in dentistry—from simply removing damaged tissue and replacing it with restorative material toward supporting the biological repair and preservation of tooth structure whenever possible.

What About Ozone?

Ozone has long been used by some biological and integrative dentists because of its

antimicrobial properties.

Laboratory and clinical research has demonstrated ozone’s ability to reduce

microorganisms associated with dental disease. However, evidence that ozone alone

can reliably reverse established dental caries remains limited.

Earlier systematic reviews concluded that available studies were too small or

methodologically weak to establish ozone as an effective stand-alone treatment for

cavities.

That distinction is important: antimicrobial activity does not automatically prove that

a therapy can regenerate damaged tooth structure.

Ozone may therefore be better considered an adjunct within a broader biological or

minimally invasive treatment strategy rather than a proven replacement for restorative

treatment.

Chlorine Dioxide: Supporting a Healthier Oral Terrain

Chlorine dioxide is an antimicrobial compound that has attracted interest in biological

dentistry, particularly for its potential influence on the microbial environment of the

mouth.

Clinical studies of chlorine-dioxide-containing mouth rinses have reported reductions in

plaque, gingivitis, and certain oral microorganisms. Rather than viewing this solely as an

attempt to eliminate individual “bad” bacteria, another interesting possibility is that

reducing excessive microbial burden and disrupting problematic biofilms may help shift

the oral terrain toward conditions that are less favorable to decay-associated

microbial communities.

This is particularly relevant when we consider dental caries as an ecological process.

An acidic, sugar-rich oral environment can favor acid-producing and acid-tolerant

organisms. Supporting a healthier oral environment—along with improving diet, salivary

flow, mineral availability, and oral hygiene—may help move that microbial ecosystem in

a more favorable direction.

There are also anecdotal reports of individuals using chlorine dioxide, sometimes in combination with DMSO (dimethyl sulfoxide), in an effort to preserve deeply compromised teeth and avoid more invasive procedures.

DMSO is a sulfur-containing organic compound known for its unusual ability to penetrate biological membranes and enhance the movement of certain substances through tissues. It has also been studied for anti-inflammatory, analgesic, and antioxidant properties, which has contributed to interest in its use in a variety of experimental and integrative applications. Because DMSO can increase tissue penetration, however, it may also carry unwanted substances into tissues, making purity, concentration, and the substances used alongside it important safety considerations.

The proposed combination of DMSO with chlorine dioxide in dental applications remains largely anecdotal, and while these reports are intriguing, but they should not be interpreted as evidence that chlorine dioxide or DMSO can regenerate substantially damaged tooth structure or reliably replace appropriate treatment for an infected or structurally compromised tooth.

Chlorine dioxides potential value in dentistry, however, may extend beyond simply “killing germs.” By helping reduce excessive microbial burden and disrupt problematic biofilms, chlorine dioxide may have the potential to shift the oral environment toward conditions that better support microbial balance, remineralization, and long-term dental health. This broader ecological perspective makes its role in oral health an intriguing area for further research.

Saliva, the Oral Microbiome, and the Remineralization Balance

Saliva is one of the mouth’s most important natural defense systems. It helps wash away food debris, buffers acids, lubricates oral tissues, and supplies calcium and phosphate that can be reincorporated into enamel. When salivary flow is reduced—as can occur with dehydration, mouth breathing, certain medications, aging, or medical conditions—the mouth may have less capacity to neutralize acids and support remineralization.

The oral microbiome is equally important. Dental decay was once viewed primarily as an infection caused by a few specific organisms, particularly Streptococcus mutans. Today, the picture is more complex. The mouth contains a diverse microbial ecosystem, and cavities appear to be associated with an ecological shift, or dysbiosis, toward communities that thrive in an acidic environment.

Frequent exposure to sugars and fermentable carbohydrates can repeatedly lower oral

pH. Over time, that environment favors acid-producing and acid-tolerant

microorganisms, creating conditions that encourage further mineral loss.

From this perspective, oral health is not necessarily about eliminating bacteria. It is

about creating an environment in which a more balanced microbial community can

coexist with healthy teeth.

Saliva, diet, oral hygiene, mineral availability, and the microbiome therefore function

together in determining whether the balance tips toward demineralization or

remineralization.

Nutrition, Minerals, and the Oral Environment

Perhaps the most accessible way to influence dental health begins not in the dental

chair but at the dinner table.

The relationship between sugar and tooth decay is well established. Oral bacteria metabolize fermentable carbohydrates and produce acids that lower the pH around the teeth. Repeated acid exposure encourages minerals to leave the enamel, while reducing the frequency of sugar and refined-carbohydrate exposure gives saliva more opportunity to neutralize those acids and return minerals to the tooth surface.

But remineralization requires more than simply removing sugar. The body must also have an adequate supply of the minerals and nutritional cofactors needed to build and maintain healthy teeth. Calcium and phosphorus form the principal mineral structure of enamel and dentin, while magnesium participates in mineral metabolism and influences the formation and organization of mineralized tissues. Protein provides amino acids needed throughout connective and structural tissues, while vitamins A, D, and K participate in processes involved in tissue development, calcium regulation, and normal mineralization.

Unfortunately, many modern diets are remarkably rich in calories while comparatively poor in micronutrients. Refining grains, sugars, and other foods can remove substantial portions of their naturally occurring minerals, while highly processed foods frequently displace more nutrient-dense foods such as vegetables, legumes, nuts, seeds, eggs, dairy products, seafood, and traditionally prepared whole foods.

There is also evidence that the concentrations of certain minerals in some crops have changed over time. Agricultural practices, soil conditions, crop varieties, fertilizer use, and the pursuit of higher yields can influence the mineral content of food. The often-discussed “dilution effect” describes how rapidly growing, high-yield crops may contain lower concentrations of some nutrients per unit of food. This does not mean that modern produce is devoid of minerals, but it reinforces the importance of dietary diversity, soil quality, food selection, and an overall nutrient-dense diet.

Mineral absorption and utilization matter as well. Simply consuming calcium, magnesium, phosphorus, or other minerals does not guarantee that they will be effectively absorbed and incorporated into tissues. Digestive health, vitamin status, mineral balance, and compounds within foods that enhance or inhibit absorption can all influence bioavailability.

Vitamin D deserves particular attention because of its central role in calcium and phosphate metabolism and normal mineralization. Observational research has associated lower vitamin D status with greater caries prevalence, particularly in children, although this does not establish that vitamin D supplementation can reverse an existing cavity. Vitamins A and K also work within the broader physiology governing mineralized tissues, illustrating why focusing on a single nutrient may miss the larger nutritional picture.

Ultimately, teeth do not exist independently of the body's nutritional environment. Saliva, enamel, dentin, bone, immune defenses, and the tissues supporting the teeth all depend upon adequate nutrition. Maintaining sufficient mineral and vitamin status should therefore be viewed not as a stand-alone treatment for dental decay, but as part of creating the biological conditions in which remineralization, repair, and long-term oral health are best supported.

The Observations of Weston A. Price

Nearly a century ago, dentist and researcher Weston A. Price traveled to communities

around the world studying the relationship between traditional diets, dental health, and

the introduction of modern processed foods.

Price reported remarkably low rates of tooth decay among many populations consuming

their traditional diets. When refined flour, sugar, sweets, and other processed foods

became more prominent, he observed substantially more dental decay.

He was particularly interested in the nutrient density of traditional diets and emphasized

minerals and the fat-soluble vitamins A, D, and what he called “Activator X,”

subsequently associated by his followers with vitamin K2.

Price’s work was largely observational and predates modern randomized clinical trials,

so it cannot establish that a particular traditional diet prevents or reverses cavities.

Many aspects of lifestyle also differed between the populations he observed.

Nevertheless, one of his central observations remains remarkably relevant: the

condition of our teeth is influenced by far more than brushing alone, and

profound dietary changes can alter the oral environment.

Modern research has independently established the importance of mineral balance, saliva, microbial ecology, and overall nutrition in the prevention of dental caries.

Remineralization Is Not the Same as Regeneration

The idea that teeth can “heal” needs an important qualification.

Remineralization occurs when minerals such as calcium and phosphate are

redeposited into weakened enamel. This can strengthen an early, non-cavitated lesion

and potentially arrest its progression.

Repair can also occur internally. Odontoblasts within the tooth can produce tertiary or

reparative dentin in response to injury.

But neither process means that a large section of a missing adult tooth will simply grow

back. Once enamel has physically collapsed and substantial tooth structure has been

lost, remineralization cannot recreate the tooth’s original anatomy.

Regeneration is something different again: stimulating the body to replace complex

dental tissues—or potentially an entire tooth. That is the frontier scientists are now

beginning to investigate.

Understanding these distinctions allows us to appreciate the tooth’s remarkable

capacity for repair without overstating what current therapies can accomplish.

Could We Someday Regrow Entire Teeth?

Perhaps the most remarkable development is research aimed not merely at

remineralizing enamel—but at growing an entirely new tooth.

Japanese researchers led by Katsu Takahashi have been investigating a protein called

USAG-1, which appears to suppress tooth development. Animal studies found that

blocking this protein with an antibody could stimulate additional tooth formation.

This research ultimately led to development of an investigational antibody therapy and

early human testing.

The initial goal is not to replace ordinary fillings. Researchers are focusing first on

people with congenital tooth agenesis, a condition in which individuals are born

without one or more permanent teeth.

If the approach proves both safe and effective, however, it could eventually open an

entirely new chapter in regenerative dentistry.

A New Philosophy: Preserve Before You Replace

None of this means that fillings, crowns, or extractions are never necessary. A severely damaged tooth can harbor infection, and untreated dental infections can become serious.

A large cavitated lesion cannot simply be wished back into an intact

tooth. But there is an important middle ground between ignoring decay and immediately

removing tooth structure.

When decay is discovered, useful questions to discuss with your dentist may include:

•  Is the lesion cavitated or non-cavitated?

•  Is it currently active or arrested?

•  Could remineralization be attempted before drilling?

•  Would SDF be appropriate?

•  Could a minimally invasive restoration preserve more healthy tooth structure?

•  Is hydroxyapatite or another remineralizing strategy appropriate?

•  For an early lesion, is a peptide-based treatment such as P11-4 an option?

•  Is dry mouth, mouth breathing, or inadequate salivary flow contributing?

•  What dietary, nutritional, salivary, or oral-microbiome factors may be contributing

  to continued decay?

The Bigger Picture

The most exciting development in modern dentistry may not be a single product or

procedure. It may be a change in how we think about the tooth itself.

Teeth participate in an active biological environment. Dentin can respond to injury.

Enamel continuously exchanges minerals with saliva. The oral microbiome responds to

changes in its environment. Nutrition and mineral availability influence the larger

biological terrain, and early decay can sometimes be arrested or remineralized.

New materials can encourage remineralization, and scientists are even investigating

whether the body’s tooth-development pathways can someday be reactivated.

The goal should therefore be broader than simply filling holes. Whenever possible, dentistry can ask a more biological question: What can we do to change the environment that allowed the disease to develop—and preserve as much of the natural tooth as possible?

That shift—from replacement toward prevention, preservation, and regeneration—may

ultimately prove to be one of the most important advances in oral health.

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