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Stages of Tooth Decay

Stages of Tooth Decay

Tooth decay is one of the leading causes of tooth loss today. You may not be aware that you or one of your loved ones have tooth decay until it is too late. When cavities in the teeth are left untreated, decay not only leads to pain but can also cause infection and, eventually, the loss of your tooth. While tooth decay is not reversible, tooth decay is preventable and, when treated early, typically requires minimal treatment. The best way to ensure you and your loved ones keep their teeth for a lifetime is by preventing dental decay.

Tooth decay, or dental cavities, is when the tooth’s enamel becomes weakened and begins to break down. A chemical reaction occurs when plaque and bacteria left on your teeth combine with sugary or starchy foods and beverages. This reaction causes an acid to form, which weakens the enamel. Over time, a break in the enamel called a cavity, begins to form. While initial stages are slow, tooth decay in its later stages can escalate quickly into a painful dental emergency, leaving you with no other option than to remove the tooth or receive a root canal treatment to save the tooth.

Signs of Tooth Decay

You may be completely unaware that you have dental decay. While a common symptom of decay is sensitivity to cold or sweet, not all cavities begin with these symptoms. Other things to look for are white patchy spots, yellowish areas or dark spots. Healthy tooth enamel has a smooth and uniform appearance.

People often believe they can self-diagnose dental cavities based on the symptoms they’re experiencing, such as sensitivity to temperature and pain in their teeth. However, it’s important to remember that the best and only way to properly diagnose a dental cavity is by visiting a qualified dental professional for a proper examination. Dentists have the experience, training and diagnostic tools necessary to assess and diagnose your dental health. Self-diagnosis is often inaccurate and could lead to ineffective treatments since not all cavities are visible or cause pain. As such, you must visit a dentist as soon as possible if you suspect a dental cavity.

Tooth Decay Causes

There are several risk factors that put you at a higher risk for developing tooth decay. Poor oral hygiene habits, such as not brushing adequately or not flossing regularly, will leave decay-causing bacteria on your tooth surface. Since plaque removal is key to preventing cavities, good oral hygiene and routine dental checkups are essential. Most people benefit from a dental exam and cleaning twice a year; at these visits, we can screen for risk factors and discuss ways to reduce your risk of dental decay.

Eating a diet high in sugar or starch and consuming acidic foods and beverages regularly increases your risk for dental decay. This is because the bacteria left behind on your teeth use sugary, acidic food and drinks as fuel to break down your enamel. Frequent snacking throughout the day increases plaque and acid exposure on teeth, increasing your chances of developing a cavity.

While tooth decay is not reversible, treating decay in its earliest stages will prevent further damage and more invasive treatment needs. For example, placing a small filling in your tooth instead of the area requiring a crown and/or root canal.

Stage 1: White Spots on Teeth

In its earliest stage, dental decay can often appear as a white spot on the tooth surface. A white spot occurs when tooth enamel has weakened due to bacteria left on the teeth. These spots are commonly seen after orthodontic treatment due to a lack of good home care. White spots are typically asymptomatic and are slow to change in appearance. Early diagnosis and treatment of white spot lesions is minimally invasive and prevents further tooth damage.

White spots on teeth indicate that the tooth enamel is beginning to erode due to bacterial or acid exposure. Left unaddressed, these spots on teeth can and often do evolve into active cavities.

Stage 2: Enamel Erosion

Tooth enamel is the hardest, outermost layer of your tooth structure. It protects the softer, weaker dentin layer underneath. Although the strongest substance in the body, tooth enamel is not completely resistant to acids and bacteria.

As the tooth’s enamel surface continues to weaken, it may show a glassy, bright white or yellow appearance. Enamel erosion occurs when the outermost layer of the tooth surface becomes too thin. Erosion is a form of tooth decay that can worsen quickly into severe sensitivity and tooth loss when left untreated. Many common causes for enamel erosion include over-aggressive toothbrushing or a diet high in acidic foods and beverages. Oral habits such as clinching and grinding can also increase your risk for enamel erosion.

Bacterial plaque exposure can cause enamel to erode, creating weak spots that eventually form an opening or cavity. Ideally, it’s best to catch cavities in this stage before the decay ruptures through to the next layer of the tooth.

Stage 3: Dentin Erosion

Enamel erosion can quickly develop into dentin erosion. Dentin is the layer of the tooth that is just beneath the enamel. It makes up the bulk of tooth structure and provides a cushion that protects the tooth’s nerve chamber. Dentin is very yellow in appearance and is much softer than the hard outer layer of enamel. When decay has progressed through the enamel and entered the dentin layer, treatment must be done immediately. Not only will you experience more serious symptoms, but decay progresses much more quickly through the dentinal layer putting you at risk of needing a root canal or tooth removal.

If you’re experiencing gum recession and have visible root structures, these yellow surfaces are made up of dentin. People with receding gumlines are typically more at risk for tooth decay because no soft tissues or enamel protect the exposed dentin.

Stage 4: Tooth Pulp Pain

Earlier stages of tooth decay can present symptoms such as a quick sensitivity to sweets and cold. This pain is usually sharp and goes away quickly. As tooth decay worsens, symptoms of sensitivity can change. As decay travels through the enamel into the softer dentin layer, you may experience a more dull, longer-lasting pain or sensitivity to hot temperatures. This type of symptom is caused when decay approaches the tooth’s nerve chamber and causes the nerve to become inflamed. At this point, you are at high risk for a dental emergency and treatment is needed as soon as possible.

Once the nerve or pulp of a tooth becomes infected by a cavity, treatment options are limited to endodontic therapy; it’s impossible to place a filling or crown over a tooth if there is compromised pulp tissue.

Stage 5: Tooth Abscess Formation

An abscess is an infection in the tooth’s nerve and can be considered a dental emergency. Symptoms often include pain, a large swelling inside or outside the mouth, and/or a foul taste from the tooth. A dental abscess cannot be ignored and cannot be treated with over-the-counter medications or antibiotics, which only reduce initial symptoms. When left untreated, infection will cause permanent destruction of the bone tissue. When tooth decay reaches this point in which the tooth’s nerve is infected, the only treatment options are a root canal or tooth extraction.

Not all abscessed teeth are painful. However, some may be so severe that it is impossible to bite or chew on that side of your mouth. As long as the infected nerve tissue goes unaddressed, recurring abscesses may form along the gum tissues next to the tooth roots.

Stage 6: Tooth Loss

With the final stage of tooth decay, the only option is a tooth extraction. In most cases, this will require a surgical procedure to safely remove the tooth and repair any bone that has been damaged with bone grafting material.

Ideally, it’s best to treat tooth decay before it reaches this stage. If there are large, visible holes in your tooth or most of the tooth structure has broken off, the tooth may need to be removed because it is non-restorable.

How To Prevent Tooth Decay

The best way to protect yourself and your loved ones from being at risk of tooth decay is through prevention. Maintaining good oral home care habits, including brushing and flossing, is key to keeping tooth enamel strong and decay-free. Limiting sodas, candies, frequent daytime snacking, and highly acidic foods will also help prevent cavities from forming. Since decay does not always present symptoms, visiting your dentist regularly for an exam and cleaning can help you reduce your risk of dental disease. By screening for and identifying decay in its earliest stages, you can prevent further damage to the tooth and limit the treatment needed to restore your smile.

Tooth Decay Treatment

The treatment of dental decay is more conservative the earlier the cavity is diagnosed. Based on the stage of decay and its severity, treatment options can vary. When treatment is delayed, decay can worsen, causing more aggressive treatment needs. When decay is found in its earliest stages, treatment can be minimally invasive and preserve a larger amount of tooth structure.

In most cases, small areas of decay can be removed and treated with small tooth-coloured resin material. Small fillings prevent the spread of decay and reduce the amount of tooth structure involved. As the decay stages progress, the restoration size also increases. In these cases, a full coverage crown may be required once the decay is removed. If decay has progressed into the later stages of infection, in which the tooth pulp or nerve is affected, a root canal treatment is most likely needed. A root canal is a process in which the tooth’s nerve is removed, and the nerve chamber is medicated and sealed off. This procedure sometimes requires an endodontic specialist and typically involves multiple appointments.

Since dental decay does not always present symptoms until the later stages, maintaining good oral home care and scheduling frequent dental checkups are the key to keeping you and your loved ones safe from tooth loss. You may be unaware you have dental decay until symptoms worsen; however, by that point, it may be too late to save your tooth.

Prevention is your best defence against tooth decay. If it’s been six months or longer since your last scale and clean—or you have a sensitive tooth—be sure to schedule an exam today.

Dr. Mahima Krongold

Dr. Mahima Krongold

Dr Krongold has been practicing dentistry for over twenty years. She has background experience dealing with a diverse range of dental issues, which vary significantly from individual to individual. Her experience has been built upon by her endless thirst for practical and technological advancement in the field of crowns, implants, bridge work, root canals, endodontics, teeth whitening and cosmetic work. Dr Krongold is a family dentist with three children. Children's dentistry is a specialised area for her, particularly encompassing oral hygiene and dental comfort.

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