The short answer: Minimally invasive dentistry means finding decay early and treating it with as little drilling as possible, so more of your natural tooth survives. Early decay can often be stopped with fluoride varnish, sealants or resin infiltration; silver diamine fluoride can halt cavities without drilling but stains them black; and for deep cavities, removing only part of the decay leads to fewer complications than removing all of it. Lasers and drill-free methods can reduce the need for numbing injections, but they take longer and the evidence is of low certainty. Current ADA guidelines support these conservative approaches.
Tooth decay is a dynamic process: minerals are lost and regained over time, so early decay can be stopped or even reversed if it is caught soon enough (Featherstone, 2004). That is the idea behind minimally invasive, or minimal intervention, dentistry, and an FDI World Dental Federation task group has urged dentists to move away from a purely surgical “drill and fill” approach to decay (Frencken et al., 2012).
This guide explains what minimally invasive dentistry is, which non-drilling and low-drilling treatments have good evidence, how techniques for deep cavities and children’s teeth compare, whether lasers and drill-free methods work, and what to ask your dentist.
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What is minimally invasive dentistry?
It is an approach to decay that focuses on early detection and prevention, and on treating problems with the least intervention needed to keep teeth healthy (Frencken et al., 2012). In practice, that means managing early lesions without fillings where possible, and removing as little tooth as possible when a filling is needed.
Current guidelines from the American Dental Association reflect this. One recommends non-restorative treatments, such as sealants, fluoride varnish and silver diamine fluoride, for many cavities (Slayton et al., 2018), and another conditionally recommends conservative removal of decayed tissue, especially for advanced lesions, because it may reduce the risk of complications (Dhar et al., 2023).
Can decay be treated without drilling?
Often, if it is caught before a hole forms. Finding it early is the first step; our guide to how dentists find cavities early explains how X-rays and other tools are used.
Sealants
Sealants are thin coatings painted onto the grooves of the back teeth. A Cochrane review found that resin sealants on the permanent molars of children and teenagers prevent decay, reducing it by between 11% and 51% compared with no sealant at 24 months, based on moderate-quality evidence (Ahovuo-Saloranta et al., 2017).
Resin infiltration
For early decay between the teeth, a dentist can soak the weakened enamel with a liquid resin that seals it without drilling. A Cochrane review found that resin infiltration and similar “micro-invasive” treatments cut the odds of these lesions getting worse by about three-quarters compared with fluoride varnish or flossing advice alone (odds ratio 0.24), although 7 of the 8 trials were at high risk of bias (Dorri et al., 2015).
Silver diamine fluoride
Silver diamine fluoride (SDF) is a liquid painted onto decay that can stop or slow it in baby and adult teeth without removing any healthy tooth. Its main drawback is that it permanently stains the treated decay black (American Dental Association, 2026). In the US it is cleared by the FDA for tooth sensitivity, so using it for decay is off-label (American Dental Association, 2026).
A 2026 meta-analysis of 8 randomized trials in children found no significant difference in how often decay was arrested with SDF compared with conventional fillings, but the results varied so much between trials that the authors could not conclude the two are equivalent (Chang et al., 2026). SDF is often considered for young children, older adults and people with special care needs (American Dental Association, 2026).
For more on what fluoride varnish and other treatments can do for early decay, see can a cavity heal on its own?.
What if you have a deep cavity?
Traditionally, dentists removed all the decayed tissue before placing a filling. A Cochrane network meta-analysis of 27 trials found that removing less had fewer failures. In permanent teeth with deep cavities, complete removal had about twice the odds of failure, such as exposing the nerve or needing a root canal, compared with removing the decay in two stages (odds ratio 2.06), based on moderate-certainty evidence; selective removal, which leaves some softened tissue over the nerve, also appeared to do better than complete removal, although that evidence was of very low certainty (Schwendicke et al., 2021).
This is why the 2023 ADA guideline favors conservative removal, especially in advanced lesions (Dhar et al., 2023). If you need a filling, our article on mercury fillings covers the materials used.
What minimally invasive options are there for children?
The Hall technique
In the Hall technique, a preformed metal crown is pushed over a decayed baby molar without numbing, drilling or removing any decay. In a Cochrane review, crowns on baby molars reduced the long-term risk of major failure (risk ratio 0.18) and pain (risk ratio 0.15) compared with fillings, and crowns fitted with the Hall technique caused less discomfort at the time of treatment, all based on moderate-quality evidence (Innes et al., 2015).
Atraumatic restorative treatment (ART)
ART removes decay with hand instruments only, usually without numbing or electric equipment, and fills the cavity with an adhesive material. A Cochrane review found that, in baby teeth, ART with glass ionomer may have a higher risk of the filling failing than conventional treatment with the same material (odds ratio 1.60), although it may cause less pain during the procedure; the evidence was of low quality (Dorri et al., 2017). Our parent’s guide to kids’ teeth covers prevention in the early years.
Do lasers and drill-free methods work?
A systematic review of alternative ways to remove decay, including chemical gels, lasers and air abrasion systems, found that they tended to take longer but reduced the need for anesthesia, and the fillings placed afterward performed about as well. Chemical gels, which soften decay so it can be scooped out by hand, seemed the best minimally invasive option, with good patient acceptance (Cardoso et al., 2020).
For lasers specifically, a Cochrane review found low-quality evidence of less pain and less need for anesthesia than a drill, but not enough evidence to recommend lasers as a replacement (Montedori et al., 2016). A 2025 meta-analysis of 20 clinical studies found that lasers didn’t affect how long fillings lasted or whether the tooth’s nerve stayed healthy, reduced the need for anesthesia and pain, but took longer; the evidence was of low to very low certainty (Esteves-Oliveira et al., 2025).
Newer tools, such as AI software that reads X-rays, may help find decay earlier, but they still need to prove their value in practice; see how AI is used in dentistry.
What it means for you
If your dentist finds an early spot between your teeth
Ask whether it can be monitored and treated with fluoride varnish or resin infiltration rather than a filling (Slayton et al., 2018; Dorri et al., 2015).
If you have a deep cavity
Ask whether selective or stepwise removal is an option to lower the risk of nerve exposure (Schwendicke et al., 2021; Dhar et al., 2023).
If your child has decay in a baby tooth
Ask about sealants, silver diamine fluoride and the Hall technique, and weigh the black staining from SDF against avoiding drilling (Innes et al., 2015; American Dental Association, 2026).
If you’re anxious about the drill
Chemical gels and lasers can reduce the need for numbing injections, but they take longer (Cardoso et al., 2020; Esteves-Oliveira et al., 2025). Ask what your dentist offers.
Questions to ask your dentist
- Has this spot broken through the enamel, or can it be stopped without a filling?
- Would sealants, fluoride varnish or resin infiltration work for me?
- If I need a filling, how much tooth will you remove?
- Is silver diamine fluoride an option, and where would the staining show?
- Do you offer drill-free decay removal, and how long does it take?
When to see a dentist
Book a dental visit if (NHS, 2025):
- You have toothache or a sharp pain when eating or drinking hot, cold or sweet things
- You notice white, brown or black spots on a tooth
- Your gums are painful, swollen or bleed when you brush
Catching decay early gives you the most minimally invasive options. For a knocked-out or broken tooth, facial swelling or other urgent problems, see what to do in a dental emergency.
The bottom line
Minimally invasive dentistry treats decay as a process that can be stopped, not just drilled out. The best evidence supports sealants and resin infiltration for early decay, removing less tissue in deep cavities, and crowns fitted with the Hall technique for baby molars; silver diamine fluoride can arrest decay but stains it black. Lasers and drill-free methods reduce the need for injections but take longer, with low-certainty evidence (Schwendicke et al., 2021; Dorri et al., 2015; Dhar et al., 2023).
References
Ahovuo-Saloranta A, Forss H, Walsh T, Nordblad A, Mäkelä M, Worthington HV. (2017). Pit and fissure sealants for preventing dental decay in permanent teeth. Cochrane Database of Systematic Reviews, 7(7), CD001830. https://doi.org/10.1002/14651858.CD001830.pub5
American Dental Association. (2026). Silver diamine fluoride. https://www.ada.org/resources/ada-library/oral-health-topics/silver-diamine-fluoride
Cardoso M, Coelho A, Lima R, Amaro I, Paula A, Marto CM, et al. (2020). Efficacy and patient’s acceptance of alternative methods for caries removal—a systematic review. Journal of Clinical Medicine, 9(11), 3407. https://doi.org/10.3390/jcm9113407
Chang P, Liang YY, Li XL, Wang T, Li R. (2026). Silver diamine fluoride versus conventional restorative treatment for dental caries in primary teeth of children: A meta-analysis. Quintessence International. Advance online publication. https://doi.org/10.3290/j.qi.b7049750
Dhar V, Pilcher L, Fontana M, González-Cabezas C, Keels MA, Mascarenhas AK, et al. (2023). Evidence-based clinical practice guideline on restorative treatments for caries lesions: A report from the American Dental Association. Journal of the American Dental Association, 154(7), 551–566.e51. https://doi.org/10.1016/j.adaj.2023.04.011
Dorri M, Dunne SM, Walsh T, Schwendicke F. (2015). Micro-invasive interventions for managing proximal dental decay in primary and permanent teeth. Cochrane Database of Systematic Reviews, 2015(11), CD010431. https://doi.org/10.1002/14651858.CD010431.pub2
Dorri M, Martinez-Zapata MJ, Walsh T, Marinho VC, Sheiham A, Zaror C. (2017). Atraumatic restorative treatment versus conventional restorative treatment for managing dental caries. Cochrane Database of Systematic Reviews, 12(12), CD008072. https://doi.org/10.1002/14651858.CD008072.pub2
Esteves-Oliveira M, Schaffrath K, Wierichs RJ. (2025). Efficacy of laser-assisted caries removal and hard tissue preparation: A meta-analysis. Journal of Dentistry, 156, 105697. https://doi.org/10.1016/j.jdent.2025.105697
Featherstone JD. (2004). The continuum of dental caries—evidence for a dynamic disease process. Journal of Dental Research, 83(Spec No C), C39–C42. https://doi.org/10.1177/154405910408301s08
Frencken JE, Peters MC, Manton DJ, Leal SC, Gordan VV, Eden E. (2012). Minimal intervention dentistry for managing dental caries – a review: Report of a FDI task group. International Dental Journal, 62(5), 223–243. https://doi.org/10.1111/idj.12007
Innes NP, Ricketts D, Chong LY, Keightley AJ, Lamont T, Santamaria RM. (2015). Preformed crowns for decayed primary molar teeth. Cochrane Database of Systematic Reviews, 2015(12), CD005512. https://doi.org/10.1002/14651858.CD005512.pub3
Montedori A, Abraha I, Orso M, D’Errico PG, Pagano S, Lombardo G. (2016). Lasers for caries removal in deciduous and permanent teeth. Cochrane Database of Systematic Reviews, 9(9), CD010229. https://doi.org/10.1002/14651858.CD010229.pub2
NHS. (2025). Tooth decay. https://www.nhs.uk/conditions/tooth-decay/
Schwendicke F, Walsh T, Lamont T, Al-Yaseen W, Bjørndal L, Clarkson JE, et al. (2021). Interventions for treating cavitated or dentine carious lesions. Cochrane Database of Systematic Reviews, 7(7), CD013039. https://doi.org/10.1002/14651858.CD013039.pub2
Slayton RL, Urquhart O, Araujo MWB, Fontana M, Guzmán-Armstrong S, Nascimento MM, et al. (2018). Evidence-based clinical practice guideline on nonrestorative treatments for carious lesions: A report from the American Dental Association. Journal of the American Dental Association, 149(10), 837–849.e19. https://doi.org/10.1016/j.adaj.2018.07.002
References checked October 2026 · Editorial policy · Report a correction
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