Is "Drill immediately" outdated? | 医療法人社団EPSDC

Introduction: Have you ever been told “Let’s keep an eye on it” at the dentist?

When a cavity is found during a dental checkup, you may have been advised to “monitor it for a while” instead of drilling right away—and felt uneasy. You might wonder, “Won’t it get worse if we leave it?” In fact, this reflects a major paradigm shift in global dentistry.
Where “cavity = immediate drilling” used to be the norm, the standard is shifting—based on scientific evidence—toward “tooth-preserving care” that avoids drilling as much as possible. From the perspective of a dental health information scientist, this article explains where we stand now, drawing on the latest research data that tracked trends for over a decade (Lundbeck et al., 2026).
Striking data: Fewer dentists are drilling occlusal caries on molars
A recent systematic review (an update to 2016 research, published in 2026) that examined when dentists decide to drill shows a dramatic shift in how occlusal (biting) surfaces of molars are treated.
Two data points stand out:

Very early caries (E1/E2: confined within the outer enamel layer): Before 2016, 15% of dentists drilled; since 2016, that has dropped to just 5%.
Early dentin caries (D1: reaching the entrance to dentin, the inner layer): Before 2016, 78% said they would “drill immediately”; since 2016, that has plunged to 40%. Why has “not drilling” become so prevalent on occlusal surfaces? Because they are directly observable to dentists, making it easier to accurately assess progression. As a result, an approach that maximizes the chance to avoid drilling—through fluoride-induced remineralization and sealing pits and fissures with sealants—has become established.

Caution: Are “between-teeth” caries still treated early?
In contrast to occlusal surfaces, a somewhat concerning trend appears for “interproximal” (between-teeth) caries. For patients who wish to preserve their natural teeth as much as possible, the numbers may be surprising: there is a stronger tendency to drill earlier than before.
For caries confined to enamel (E1/E2), the proportion of dentists choosing to drill increased from 19% to 27%. Moreover, once the lesion reaches the enamel–dentin junction (EDJ)—the practical “decision point”—those opting to drill surged from 39% to 61%.
Why such divergent decisions?
“Interproximal caries are difficult to visualize directly, and diagnostic limitations plus progression risk tend to drive more invasive (drilling) choices.”
Because interproximal areas cannot be seen directly, diagnosis relies mainly on the radiographic shadow on bitewing images. But from radiographs alone, it’s hard to be 100% certain whether drilling is truly necessary, so to avoid risk, many adopt a cautious (or proactive) stance of “drill at EDJ.”
The concept you should know: Minimally Invasive Dentistry (MID)
To address this and protect patients’ teeth for life, a new standard—MID (Minimally Invasive Dentistry)—has emerged. This is not merely “delaying drilling,” but a scientific strategy to actively manage lesions.
MID consists of three steps:

Prevent new lesions: Improve diet and use fluoride to create a low-caries environment.
Non-surgical and micro-invasive care: Do not treat early caries as drillable; instead, promote remineralization with topical fluoride (non-invasive) and arrest progression or return an active lesion to health with sealants (micro-invasive).
Minimal operative intervention: If drilling is truly necessary, remove only the infected tissue in a highly targeted manner. “Let’s keep an eye on it” does not mean “do nothing.” MID is proactive care using non-surgical interventions to keep your teeth in a stage where drilling can be avoided.

Why do dentists differ on whether to drill? Treatment decisions depend not only on the lesion itself, but also on patient factors and regional context.

Risk differences: Patients with high sugar intake or limited fluoride exposure (higher caries risk) are more likely to be drilled even for enamel lesions (29% at low risk vs. 44% at high risk).
Regional practice culture: For enamel lesions, drilling rates are very conservative (non-drilling) in Scandinavia at just 3–9%, but reach 22% in North America. In other words, there is no single “correct” answer—your habits and your dentist’s philosophy can shape the decision.

Conclusion: What we can do to protect our own teeth This review highlights that while “non-drilling” options for early occlusal caries are spreading worldwide, interproximal caries still tend to receive cautious or earlier intervention. Knowing these data isn’t meant to cause anxiety—it’s to help you build a better partnership with your dentist. At your next checkup, if a cavity is found, consider asking—armed with scientific insight: “Is this lesion at a stage where we can manage it non-operatively with remineralization?” That one question may become a turning point that extends the life of your teeth.

Reference

Lundbeck, H. J., Pitchika, V., Wilson, P., Raggio, D. P., Galloway, J., Al-Yaseen, W., … & Innes, N. (2026). Dental practitioners’ thresholds for restorative intervention in carious lesions: a survey-based systematic review update. Caries Research, 60(1), 65-79.

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