Do all cavities have to be filled?

Most of the time, once decay is observed, it should be cleaned out and restored. Although this post is not meant to encourage people to not have their cavities filled, there are some exceptions to the rule. Some patients, usually in middle age or older have small shallow proximal lesions that are visible on their bitewing radiographs. These appear to be "just into dentin" and if yearly radiographs are taken , it can be observed that these lesions, although once active, do not appear to be growing on the radiographs.

When on occasion, I have cleaned some of these out, I have observed that the area in dentin that was affected is dark black and quite calcified. It is my opinion that this indicates that the decay which had once been active has arrested and probably would not be likely to enlarge further. The problem is that without excavating these lesions one can not be sure, but instead just infer that the lesion may be "in remission". This is why periodic yearly bitewing radiographs maybe recommended, since careful examination of check up X-rays is needed to affirm that no visible change has occurred in the area of dentin that was affected. For this reason I keep my digital bitewings on my Dexis screen going back for years so that I may compare newly taken X-rays with older series.  By comparing Bitewings I can be reasonably sure that a proximal lesion is not changing and causing more damage.

I should add as an aside that finding dark and hardened old decay doesn't  always indicate that there is no active decay beneath it, since when excavating some longstanding cavities I sometimes find a hardened "outer layer" but if I  remove it , often there is softer lighter colored decay below which must be removed. Usually these lesions are fairly deep on the radiographs , unlike the small proximal lesions I previously mentioned. For this reason I tend to remove the blackened hardened dentin when I am excavating lesions, especially when I am not in close proximity to the pulp.

from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2018/09/do-all-cavities-have-to-be-filled.html - http://lspindelnycdds.blogspot.com/

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