Tooth decay begins when acids produced by bacteria in the mouth cause mineral loss in the enamel, and if untreated it progresses towards the inner layers of the tooth. Decay is often silent; by the time pain starts, it has usually reached an advanced stage. That is why recognising the early signs is important.
Stages of decay
- Enamel loss (white spot): Dull, chalky white spots appear on the surface. At this stage decay is reversible.
- Enamel decay: The spots turn brown and a small cavity may form on the surface.
- Dentine decay: Decay passes through the enamel to the softer dentine; sensitivity begins.
- Pulp involvement: Decay reaches the nerve; pain, inflammation and the need for root canal treatment may arise.
Signs to watch for
- A brief twinge with sweet, hot or cold things
- White, brown or black spots on the tooth surface
- Food getting stuck between teeth, floss shredding
- Pain when biting
- Pain that starts on its own or gets worse at night (may indicate advanced decay)
- Bad breath
How does a dentist diagnose decay?
- Visual examination: Dried tooth surfaces are examined under good light.
- Probe check: Rough areas on the surface are assessed.
- X-ray: Decay between teeth and under old fillings can often only be seen on an X-ray.
- Additional methods: In some cases, light transmission or fluorescence-based aids may be used.
How is decay treated?
Decay at the white-spot stage can be stopped with fluoride applications and better care habits. If a cavity has formed, the decayed tissue is removed and a filling is placed. If decay has reached the nerve, root canal treatment may be needed. For larger losses of tooth structure, restorations such as an inlay or onlay may be considered.
What to pay attention to in daily care
- Brush at least twice a day with fluoride toothpaste.
- Clean between your teeth with floss or an interdental brush.
- Do not have sugary foods and drinks often between meals.
- Rinse your mouth with water after acidic drinks.
- Have a check-up every six months.
If you are having orthodontic treatment, your tooth surfaces need extra care; in our clear aligner wear guide we explain oral care while wearing aligners in detail.
