Cavities/ Tooth Decay: 5 Stages and How to Treat Them

Tooth Decay

Table of Contents

Cavities or tooth decay is a dental problem that affects people of all ages. It is a result of bacterial activity in the mouth that leads to the demineralization of tooth enamel, which is the hard outer layer of the tooth. If left untreated, tooth decay can progress to more severe stages, causing pain, discomfort, and even tooth loss. In this article, we will discuss the five stages of tooth decay, its symptoms, causes, treatment options, and prevention techniques.

What is Cavities/ Tooth Decay? An overview of Cavities

Tooth Decay

Tooth decay, also known as dental caries, is a common dental problem that affects millions of people worldwide. It occurs when bacteria in the mouth produce acid that erodes the enamel, the hard, protective outer layer of the tooth. As the enamel breaks down, a cavity or hole forms in the tooth. If left untreated, the decay can spread to the inner layers of the tooth, leading to more serious dental problems.

5 stages of Tooth Decay

Stage 1: White Spots

In the first stage, white spots or chalky areas appear on the tooth’s surface. This is the earliest sign of tooth decay and occurs due to a loss of minerals in the tooth’s enamel. These white spots may be sensitive to temperature changes or sweet foods and drinks. At this stage, the decay can be reversed with the help of proper oral hygiene, including brushing twice a day, flossing, and using fluoride toothpaste. Your dentist may also recommend fluoride treatments to help re-mineralize the enamel.

Stage 2: Enamel Decay

If left untreated, the decay will progress to the enamel, and a cavity will form. The cavity may appear as a dark spot or a hole in the tooth. At this stage, the decay is irreversible, and the cavity must be filled to prevent further damage. Your dentist will remove the decayed area and fill the cavity with a dental filling material such as composite resin, amalgam, or gold.

Stage 3: Dentin Decay

If the decay continues to progress, it will reach the dentin, the inner layer of the tooth. The cavity becomes deeper, and the tooth becomes more sensitive to hot and cold temperatures. The decay in this stage can cause pain or discomfort. Your dentist may recommend a root canal treatment if the decay has reached the pulp, or a dental crown may be necessary to restore the tooth’s structure and prevent further decay.

Stage 4: Pulp Damage

In this stage, the decay reaches the pulp, the soft tissue inside the tooth that contains blood vessels and nerves. The tooth becomes painful and sensitive to pressure, and root canal treatment may be necessary to save it. During a root canal treatment, your dentist will remove the infected pulp and fill the space with a filling material. A dental crown may be placed on the tooth to protect it and restore its function.

Stage 5: Abscess

In the final stage, the infection has spread beyond the tooth to the surrounding tissues, causing an abscess. The tooth may be beyond saving at this point and may need to be extracted. If the abscess is not treated, it can lead to more serious health problems. Your dentist may prescribe antibiotics to treat the infection before extracting the tooth. After the tooth is removed, your dentist may recommend tooth replacement options such as dental implants, bridges, or dentures.

Tooth decay in Children

Tooth Decay

The Centers for Disease Control and Prevention (CDC) reports that tooth decay is a prevalent chronic condition among children in the United States. Children are more susceptible to tooth decay than adults because the enamel of their primary teeth is thinner and more vulnerable. Just like in adults, tooth decay in children occurs when bacteria convert sugars into acids that corrode tooth tissues. Therefore, it is essential to monitor your child’s intake of sugary foods and drinks and ensure that they brush their teeth regularly. 

While baby teeth will eventually fall out, maintaining their health is crucial. Baby teeth play a vital role in chewing and speaking, and they also serve as placeholders for permanent teeth. If primary teeth are lost prematurely due to decay, adult teeth may not grow in correctly.

Furthermore, studies have linked poor oral health in children to a range of other health issues, including diabetes, heart disease, and respiratory infections. This highlights the importance of early detection and treatment of tooth decay in children to prevent negative health outcomes and promote overall wellness.


  • Toothache or spontaneous pain that occurs without any apparent cause
  • Tooth sensitivity, especially to hot or cold temperatures
  • Pain while eating or drinking something sweet, hot, or cold, which can range from mild to sharp
  • Visible holes or pits in the teeth
  • Discoloration of the tooth surface, including brown, black, or white staining
  • Pain when biting down on the affected tooth

It is important to note that these symptoms may not always be present, and sometimes a cavity can be detected only during a routine dental examination.

What causes Tooth Decay?

Several factors can increase the risk of tooth decay, including:

Poor Oral Hygiene

One of the primary causes of tooth decay is poor oral hygiene. Failure to brush and floss regularly allows food particles to stay in the mouth, providing a breeding ground for bacteria. The bacteria then produce acid, which breaks down the enamel on the teeth, leading to decay.

Sugary and Acidic Foods and Drinks

Tooth Decay

Consuming sugary and acidic foods and drinks increases the amount of acid produced by the bacteria in the mouth. The acid attacks the teeth, breaking down the enamel and leading to decay. It is essential to limit the consumption of sugary and acidic foods and drinks and brush your teeth after eating them.

Dry Mouth

Saliva plays a vital role in neutralizing the acid produced by bacteria. Dry mouth reduces saliva production, increasing the risk of dental decay. Several factors can cause dry mouth, including certain medications, aging, and medical conditions. It is important to stay hydrated and use saliva substitutes to alleviate dry mouth.


Some people may be more susceptible to decay due to inherited traits, such as enamel thickness, tooth shape, and the presence of certain bacteria in the mouth.


As we age, the enamel on our teeth wears down, making them more vulnerable to decay. Additionally, older adults are more likely to have other medical conditions that may affect their oral health, such as dry mouth and gum recession, which increase the risk of decay.

Infant feeding before bedtime can lead to tooth decay. When babies are given bottles of milk, formula, juice or other sugary liquids at bedtime, the liquids stay on their teeth for a long time while they sleep, providing a food source for bacteria that cause decay. Toddlers who walk around with sippy cups filled with these liquids can also experience similar damage.

Medical Conditions

Certain medical conditions can also increase the risk of this problem. Acid reflux, which causes stomach acid to flow back into the mouth, can erode the tooth enamel, leading to decay. Eating disorders, such as bulimia, can also increase the risk of decay due to the frequent exposure of the teeth to stomach acid. Diabetes, which affects the body’s ability to process sugar, can also increase the risk of tooth decay.

Gum Recession

When the gums recede, the roots of the teeth become exposed, which can increase the risk of tooth decay. Gum recession can be caused by a variety of factors, including poor oral hygiene, genetics, age, and gum disease.

Worn dental fillings or devices 

As time passes, fillings and dental devices can become weakened, develop rough edges, or break down. This creates an environment where plaque can build up more easily and be harder to remove. When this occurs, tooth decay can develop underneath these devices.

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Tooth Decay
Tooth Decay

There are several ways to treat cavities and prevent them from getting worse:

  1. Fluoride: Fluoride can treat early stage cavities. Dentists apply a concentrated fluoride gel or varnish to the affected tooth to remineralize the enamel and stop decay from progressing. This non-invasive and painless procedure can prevent the need for more extensive treatments.
  2. Dental fillings: A dental filling is the most common way to treat a cavity. During this procedure, the dentist will remove the decayed part of the tooth and fill the hole with a filling material such as amalgam or composite resin.
  3. Root canal: If the decay has spread to the pulp of the tooth, a root canal may be necessary. During this procedure, the dentist will remove the infected pulp and fill the root canal with a special material.
  4. Crown: If the decay has caused extensive damage to the tooth, a crown may be necessary to restore its shape and function. A crown is a cap that is placed over the remaining part of the tooth.
  5. Extraction: In severe cases where the decay has caused irreparable damage to the tooth, it may need to be extracted. The tooth can then be replaced with a dental implant, bridge, or denture.

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To prevent oral diseases and other health problems, there are some things you can do:

  1. Eat a healthy diet: A diet that’s high in sugary foods and drinks can increase the risk of tooth decay and other health problems. Instead, choose a well-balanced diet that’s low in free sugars (such as candy, soda, and baked goods) and high in fruits, vegetables, and whole grains. Drinking water instead of sugary drinks can also help prevent dental decay and promote overall health.
  2. Stopping use of all forms of tobacco, including chewing of areca nuts: Tobacco use in any form is harmful to oral health. It can cause staining of teeth, bad breath, and gum disease. Chewing areca nuts, commonly used in some cultures, is also harmful as it contains alkaloids that can cause oral cancer. Quitting tobacco use can significantly reduce the risk of oral diseases.
  3. Reducing alcohol consumption: Alcohol consumption can increase the risk of oral cancer, especially when combined with tobacco use. It can also cause dry mouth, which can lead to an increased risk of tooth decay and gum disease. Drinking in moderation (no more than one drink per day for women and two drinks per day for men) can help reduce these risks.
  4. Wear protective gear: When playing sports or riding bikes or motorcycles, wearing protective gear such as helmets and mouth guards can help prevent facial injuries, including broken or knocked-out teeth.
  5. Use fluoride: Fluoride is a mineral that helps prevent cavities and can even reverse early stages of tooth decay. You can make sure you’re getting enough fluoride by using toothpaste that contains fluoride (look for 1000 to 1500 ppm) and brushing your teeth twice a day. Additionally, some public water supplies contain fluoride, so drinking tap water can also help prevent cavities.
  6. Visit your dentist regularly: It is important to see your dentist on a regular basis for professional teeth cleanings and oral exams. This can prevent issues or detect them early on. Your dentist can advise you on the best schedule for your needs.

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When you need to see a dentist

 You should schedule an appointment with a dentist if you experience:

  • Bleeding gums: Bleeding gums can be a sign of gum disease, which can lead to tooth decay. When the gums are inflamed and infected, they can pull away from the teeth, creating pockets where bacteria can thrive and cause decay. It’s important to see a dentist if you experience bleeding gums to prevent further damage to your oral health.
  • Difficulty chewing: decay can weaken a tooth or cause it to break, making it difficult or painful to chew
  • Signs of infection: fever or swelling may indicate that decay has progressed to the point where it has caused an infection in the affected tooth or gums.
  • Toothache or mouth pain: Toothache or mouth pain may indicate that decay has reached the inner layers of the tooth, causing irritation or inflammation of the nerve.

Questions to ask your dentist

Here are some questions you might want to ask your dentist:

  • Why did I get a cavity?
  • What is the best treatment for this cavity?
  • What steps can I take to lower the risk of getting more cavities?
  • Should I look out for signs of complications?
  • What oral health products do you recommend?

Tooth Decay can cause other Health Problems

Research has suggested that poor oral health, including tooth decay, can be linked to other health issues such as heart disease, diabetes, and respiratory infections. This is because the bacteria from the mouth can spread throughout the body and cause inflammation in other areas. Inflammation is a natural response of the body’s immune system, but chronic inflammation can lead to long-term health issues such as those mentioned above. Therefore, maintaining good oral health is crucial not only for a healthy smile but also for overall well-being.

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What are cavities/tooth decay?

They are the result of the destruction of the tooth enamel and the underlying layer of dentin due to acid produced by bacteria.

What are the causes of cavities/tooth decay?

The main cause of cavities is poor oral hygiene, which allows bacteria to accumulate and produce acid that erodes tooth enamel. Other factors include sugary and acidic foods and drinks, dry mouth, and certain medications.

What are the symptoms of cavities/tooth decay?

Tooth pain, sensitivity to hot or cold food and drinks, visible holes or pits in the teeth, dark stains on the tooth surface.

How are cavities/tooth decay diagnosed?

Dental decay can be diagnosed by a dentist during a routine dental exam. The dentist will use a small mirror to examine the surfaces of your teeth and may also take X-rays to see areas of decay that are not visible to the naked eye.

What are the treatments?

Treatment for this dental condition depends on the severity of the decay. Early-stage cavities can often be treated with fluoride treatment or dental fillings, while more severe cases may require a root canal or tooth extraction.

How can cavities/tooth decay be prevented?

It can be prevented by practicing good oral hygiene, such as brushing your teeth twice a day, flossing daily, avoiding sugary and acidic foods and drinks, and visiting the dentist regularly for cleanings and checkups.

Can cavities/tooth decay lead to other health problems?

Research has shown that poor oral health, including tooth decay, can lead to other health problems such as heart disease, diabetes, and respiratory infections. It’s important to take care of your oral health to maintain overall health and wellbeing.

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