Tooth Decay: Stages, Complications, and Treatment (2022)

Tooth decay occurs when bacteria in the mouth produce acids that attack the enamel, or protective outer layer of the tooth. If left untreated, tooth decay could lead to gum disease, cavities, and possibly tooth loss.

Unfortunately, tooth decay is very prevalent in the United States. According to the Centers for Disease Control and Prevention (CDC), more than 1 in 4 adults have untreated tooth decay. Knowing the signs and symptoms of tooth decay can lead to treatment to restore healthy teeth and gums. It’s also crucial to learn how to maintain good oral hygiene to ward off tooth decay.

This article will discuss the causes and risk factors of tooth decay, signs and symptoms, stages, and how tooth decay is treated.

Tooth Decay: Stages, Complications, and Treatment (1)

Tooth Decay Stages

Tooth decay doesn’t happen immediately. Instead, it occurs over time in a series of stages due to poor oral hygiene.

Stage 1: White Spots of Demineralization in Enamel

As acids break down the tooth’s enamel, white spots may start to appear on the tooth as a result of the minerals lost in the process. If the enamel is repaired at this point, the white spots could disappear as the tooth regains lost minerals.

Stage 2: Cavity Formation and Enamel Decay

If the tooth enamel is not repaired when white spots start to appear, it could continue to weaken as the mineral loss increases. At this point, a cavity could start to form. Initially, it could appear as a light brown spot on the tooth. If not treated, a hole will develop in the tooth. Once the cavity is formed, it cannot be reversed, only repaired by inserting a filling.

Stage 3: Dentin Decay

Underneath the enamel, the dentin covers the pulp at the center of the tooth. Because it’s softer than enamel, dentin typically decays much faster than enamel does. Once tooth decay moves into the dentin, it’s important to get treatment right away or the tooth decay will move into the center of the tooth.

Stage 4: Damage to Pulp

Inside the tooth is soft tissue containing nerves and blood vessels; this is called the pulp. Once tooth decay spreads to the pulp, it is likely that it will require root canal treatment. The patient may be referred to a specialist known as an endodontist to receive this treatment.

Stage 5: Infection, Abscess, and Gum Disease

Once tooth decay reaches the pulp, it evolves into a full infection that affects the nerves and blood vessels in the tooth and can move into the jawbone and other teeth. This could lead to an abscess, or a pus pocket. If not treated, the tooth could die.

How to Ease Tooth Pain From a Cavity

Tooth Decay Symptoms

Tooth decay symptoms include:

  • Toothache; pain can range from mild to severe
  • Sensitivity to hot or cold foods or beverages
  • Sensitivity to sweets
  • White or brown spots on the tooth
  • Cavities
  • Infection or abscess
  • Bad breath
  • Bad taste in your mouth

When to See a Dentist

If you are in between regular dental check-ups and notice any signs of tooth decay or start to experience any tooth decay symptoms, you should schedule an appointment with your dentist for an exam. The sooner your dentist can identify any signs of tooth decay, the sooner you can start treatment, which can prevent more serious tooth decay in the future.


During a dental exam, your dentist will look for any white or brown spots on the tooth as well as any soft or sticky areas that indicate weakened enamel. If necessary, your dentist also may take an X-ray to look for areas of tooth decay that may not be readily apparent.

(Video) Tooth decay and cavities - causes, symptoms, diagnosis, treatment, pathology

Why Does You Dentist Need to Take Dental X-Rays?

Causes and Risk Factors

There are a number of causes and risk factors that could lead to tooth decay.

  • Location of teeth: Teeth located in the rear of the mouth may be more susceptible to tooth decay because they are hard to reach when brushing and flossing.
  • Diet: A diet rich in sugar and starch can lead to more tooth decay because the bacteria in tooth plaque use these to make the acids that can eat away at tooth enamel.
  • Frequency of eating and drinking: If you eat or drink often throughout the day, the tooth enamel on your teeth does not have time to recover from acid attacks that lead to lost minerals.
  • Feeding infants at night: If you put your baby down at night with a bottle, there’s a higher risk of the formula or breast milk lingering in the mouth on the teeth. The longer it lingers on the teeth, the more opportunity for acids to form and attack the tooth enamel.
  • Dry mouth: Saliva plays an important role in removing the bacteria in the mouth that leads to acids attacking tooth enamel. If you don’t have enough saliva to prevent dry mouth, you are at a higher risk for tooth decay because you have more bacteria in the mouth.
  • Poor oral hygiene: Brushing and flossing teeth twice a day goes a long way in removing bacteria, plaque, and acids that could lead to tooth decay. This includes brushing and flossing correctly so the tooth surface is thoroughly cleaned, and flossing is able to remove all food particles between teeth and along the gum line.
  • Age: As we age, our teeth experience more wear and tear, which could lead to tooth decay. Also, if you have receding gums, the teeth are more exposed to bacteria and acids that lead to tooth decay.
  • Insufficient fluoride: Fluoride, a mineral that builds up resistance to acid, is necessary to help protect the tooth enamel from acid attacks that lead to tooth decay. If you are not getting enough fluoride through such efforts as brushing twice a day with fluoride toothpaste, your teeth are more susceptible to tooth decay.
  • Eating disorders: Proper nutrition is key to building strong, healthy teeth and gums. If you aren’t receiving the nutrients needed for good oral health due to an eating disorder, you could develop tooth decay. Also, frequent vomiting exposes teeth to stomach acids that can damage tooth enamel, leading to tooth decay.
  • Heartburn and GERD: Acids produced by heartburn or GERD, a digestive disorder wherein stomach acids move back up into the mouth, can move into the mouth and over the teeth. This can harm the enamel, resulting in tooth decay.
  • Old, worn, or broken dental work: Over time, fillings could break down, with acids and bacteria leaking into cracks around those fillings.


Treatment for tooth decay varies based on how far the tooth decay has progressed. Treatments include:

  • Fluoride treatments: If you are in the early stages of tooth decay, your dentist could recommend fluoride treatments to help fight off acid and restore and protect the enamel.
  • Filling cavities: If the tooth decay has evolved into a hole in the tooth (a cavity), your dentist will need to remove any decayed tissue in the tooth and replace it with a filling.
  • Dental crowns: If the tooth decay has progressed beyond a cavity and is affecting the interior of the tooth—the dentin and possibly the pulp—your dentist will remove all tissue affected by the tooth decay and cover the tooth with a crown, a cap that replicates the tooth’s appearance.
  • Root canal: Once tooth decay spreads to the pulp, an endodontist will need to go inside the tooth to remove all tooth decay and infection in the nerves and blood vessels. Once the decay is gone and the tooth is healed from the infection, your dentist likely will cover the tooth with a crown.
  • Treat infection, possible tooth extraction: If the tooth is beyond repair, your dentist likely will remove it and replace it with an artificial tooth.

What to Expect During a Root Canal

Outlook and Prevention

If tooth decay is treated early, it can prevent serious oral hygiene problems. Taking steps to prevent tooth decay is the best defense for protecting your teeth.


In most cases, tooth decay can be readily treated. Of course, the earlier it is diagnosed and treated, the better for preventing more serious complications of tooth decay.


There are a number of options for preventing tooth decay:

  • Brush twice a day with fluoride toothpaste. Drinking fluorinated water and using a fluoride mouth rinse also can help prevent tooth decay.
  • Floss your teeth at least twice a day.
  • Limit sugary and starchy foods, and don’t snack or drink a lot between meals.
  • Don’t use tobacco products.
  • See your dentist for regular check-ups and dental cleanings.

Facts You Should Know About Your Oral Health


Tooth decay occurs when bacteria and acids attack the tooth’s enamel and could lead to more serious dental problems if not treated early on. Many factors can contribute to tooth decay, such as the location of the teeth, diet, age, eating disorders, heartburn, general oral hygiene, and more. Symptoms of tooth decay include tooth sensitivity, pain or discomfort, white or brown spots on the teeth, and bad breath.

There are many treatments for tooth decay, which vary based on how far the decay has progressed. They can range from fluoride treatments to removal of the tooth.

A Word From Verywell

Oral hygiene often gets overlooked, but it’s an important part of our overall health. As such, taking care of your teeth and gums is necessary in order to avoid tooth decay. Brushing teeth twice a day with fluoride toothpaste, flossing regularly, and eating a healthy diet can help keep teeth healthy.

If you have any concerns that you have may have tooth decay, schedule an appointment with your dentist as soon as possible for an exam. The earlier tooth decay is diagnosed, the easier it is to treat.

Frequently Asked Questions

  • Can tooth decay go back to normal?

    (Video) Tooth Decay / Cavities / Dental Caries

    Yes, you can reverse tooth decay with proper and timely treatment.

  • How do dentists remove decay?

    It depends on how severe the tooth decay is. The early stages could be treated with dental cleaning and fluoride treatments. As it progresses, you may need a dental filling, root canal, or extraction to fully eliminate tooth decay.

  • How can I remove tooth decay myself?

    If you are in the early stages of tooth decay, you can brush twice a day with fluoride toothpaste and use a fluoride mouth rinse to help remove tooth decay and rebuild tooth enamel.

    Learn More:Which Mouthwash Is Best for You?

8 Sources

(Video) Tooth Decay (Treatment for a Tooth Cavity)

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

  1. Centers for Disease Control and Prevention. Adult oral health.

  2. Ctvrtlik R, Tomastik C. Tooth wear - fundamental mechanisms and diagnosis. IOSR Journal of Dental and Medical Sciences. 2016;15(5):84-91. doi:10.9790/0853-1505088491

  3. MedlinePlus. Tooth decay.

  4. American Dental Association. Baby bottle tooth decay. MouthHealthy.

  5. Marchesan JT, Byrd KM, Moss K, et al. Flossing is associated with improved oral health in older adults.J Dent Res. 2020;99(9):1047-1053. doi:10.1177/0022034520916151

  6. National Eating Disorders Association. Dental complications of eating disorders.

  7. American Dental Association. Fluoride.

  8. American Dental Association. Decay. MouthHealthy.

Tooth Decay: Stages, Complications, and Treatment (2)

By Karon Warren
Karon Warren has been a freelance writer for more than two decades, covering a range of lifestyle and business topics for print and online lifestyle and consumer publications.

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(Video) AMAZING Save of A Tooth w/ A Very BIG and DEEP Cavity #4k #C28

(Video) Stages of Tooth Decay


What is the best treatment for decayed tooth? ›

Fillings. Fillings, also called restorations, are the main treatment option when decay has progressed beyond the earliest stage. Fillings are made of various materials, such as tooth-colored composite resins, porcelain or dental amalgam that is a combination of several materials.

What stage of tooth decay is painful? ›

Stage Four: Painful Infection

If bacteria travels all the way through your dentin without treatment, your pulp will become infected. This is called a root canal infection, which can damage the nerves at the root of your tooth. At this stage of decay, you will experience intense toothache and difficulty chewing.

What are stages of tooth decay? ›


During the first stage of tooth decay, the outer layer of your teeth — the enamel — starts to weaken due to the presence of plaque. Enamel is the toughest substance in your body — harder than your bones. However, the acid produced by plaque can demineralize and weaken enamel.

Can badly decayed teeth be repaired? ›

If tooth decay has spread to the pulp (in the centre of the tooth, containing blood and nerves) – this may be removed in a process known as root canal treatment. If the tooth is so badly damaged that it can't be restored – it may need to be removed.

Can a rotten tooth make you sick? ›

Can a bad tooth make you sick? The short answer is yes, eventually. Poor oral health allows bacteria to build up in your mouth and potentially cause infections. An infection in the tooth is called an abscess, and if left untreated, it can have serious consequences.

When is it too late to reverse a cavity? ›

In most cases, by the time you notice the symptoms of tooth decay, it will be too late to reverse the damage with natural methods. You will need to consult your dentist to prevent the damage from spreading to other areas of the tooth.

How long will a rotten tooth hurt? ›

This is temporary, and should go away on its own as long as you practice good oral hygiene. You should see your dentist for a follow-up if the pain lasts longer than three days.

How do you know if your tooth decay is irreversible? ›

Once decay progresses to the dentine below the enamel, it is irreversible. If your dentist spots the decay in its very early stages, you might be able to avoid the drill. Fluoride varnish can be applied to help prevent damage from progressing past the enamel, while also 're-mineralising' the tooth.

How do doctors treat tooth decay? ›

Fillings. If you have a typical cavity, your dentist will remove the decayed tooth tissue and then restore the tooth by filling it with a filling material. Root canal. If the damage to the tooth and/or an infection spreads to the pulp (inside of the tooth), you might need a root canal.

When is a cavity an emergency? ›

If left untreated, the cavity will expand until it opens up the pulp chamber or causes the tooth to break apart. Both scenarios are classified as dental emergencies.

How do you know if a cavity reaches a nerve? ›

If you have a cavity that has reached the nerve tissue, you may experience some or all of the following symptoms:
  1. Toothache when pressure (such as chewing) is applied to the tooth.
  2. Tooth sensitivity to heat or cold.
  3. Discoloration of the tooth.
  4. Swelling or tenderness of the gums.
1 Jul 2019

Do rotten teeth smell? ›

A decaying tooth results in a foul smell. If you develop bad breath or notice an odd odor coming from your mouth, you might have one or several rotten teeth. Halitosis is one of the most common indications of decayed teeth. Visit us as soon as possible for an analysis, cleaning, filling or other dental restoration.

What diseases can cause your teeth to fall out? ›

Periodontitis (per-e-o-don-TIE-tis), also called gum disease, is a serious gum infection that damages the soft tissue and, without treatment, can destroy the bone that supports your teeth. Periodontitis can cause teeth to loosen or lead to tooth loss. Periodontitis is common but largely preventable.

What happens if tooth decay is left untreated? ›

An untreated cavity can lead to an infection in the tooth called a tooth abscess. Untreated tooth decay also destroys the inside of the tooth (pulp). This requires more extensive treatment, or possibly removal of the tooth. Carbohydrates (sugars and starches) increase the risk of tooth decay.

How do I know if my tooth infection has spread to my heart? ›

What Are The Symptoms of a Tooth Infection Spreading to the Body?
  1. Feeling Unwell. The first thing you may notice is that you start to feel unwell. ...
  2. Fever. Fever is your body's natural defense against infection. ...
  3. Swelling. ...
  4. Increased Heart and Breathing Rate. ...
  5. Dehydration and Stomach Pain.
19 Jan 2019

What are the symptoms of a tooth infection spreading to the body? ›

Signs and Symptoms of a Tooth Infection Spreading to The Body
  • Nausea and vomiting.
  • High fever.
  • Confusion.
  • Shortness of breath.
  • Drooping eyelids.
  • Pain in the tongue or mouth.
  • Swelling in the face or cheeks.
  • Severe, persistent headache.
7 Sept 2021

How do I know if I have sepsis from a tooth infection? ›

Signs of bacteremia could be slight fever, nausea and distal infection. Rarely, bacteremia may resolve on its own. It also may progress into septicemia, a more serious blood infection that is always accompanied by symptoms such as chills, high fever, rapid heartbeat, severe nausea, vomiting and confusion.

Is there a toothpaste that heals cavities? ›

Conclusion. If you're looking for a powerful fluoride-free option for healing and preventing cavities in your family, hydroxyapatite toothpaste is for you. HAp toothpaste is a safe, non-toxic product that not only heals and prevents cavities but also makes your teeth whiter and “glossier.”

Can a cavity go away with brushing? ›

When a cavity is just starting to form, you may be able to reverse it by brushing several times a day with a fluoride toothpaste. But if the cavity has grown and has been there for a while, the short answer is you really can't make it go away.

When is it too late for a root canal? ›

Root Canals Aren't Possible with Severe Infection

If the deepest layers of the pulp become infected, it may be too late to save the tooth. In addition, if a large portion of the tooth is lost and a crown cannot be placed on what's left, root canal treatment is no longer a viable solution.

How long will toothache last before nerve dies? ›

How Long Does Nerve Pain Last in A Tooth? On average, a tooth nerve pain can last from as little as just a few days to as long as 4-6weeks or, in some instances, even longer. Considering the numbness ad sharp pain that may occur with a tooth nerve, you have to do what you can to get rid of the pain as soon as possible.

What are the signs of a dead tooth? ›

Signs of a dead tooth can include:
  • Pain, which can range from almost unnoticeable to excruciating.
  • A bad taste or bad smell resulting from an infection.
  • Swelling.
  • A change in the tooth's color; a dead tooth will often darken.

What does it feel like when a tooth is dying? ›

A tooth that is dead or dying can lead to a varying level of pain, from almost non-existent to extremely painful. The dying nerve or an infection usually causes an increase in pain. Some people wonder why they experience pain if the nerve is dead.

Can tooth decay spread to another tooth? ›

If you have this decay-causing bacteria on one tooth, it's possible it could also settle in nearby teeth if the conditions are right. This bacteria can also be spread from person to person in a number of ways, including through sharing food, using the same eating utensils, kissing, sneezing, and coughing.

Is it too late if a cavity hurts? ›

It is never too late to have a cavity treated even if it is hurting you. However it may be too late to do a cavity filling on it if the decay is excessively large. Although other treatment options are available for varying sizes of tooth decay.

Why do I get cavities even though I brush? ›

Brushing alone is not enough

Brushing helps remove bits of food and plaque from your teeth, but it doesn't always get the food and bacteria from between them. Most adult cavities form between the teeth. These are called interproximal cavities.

Can you stop tooth decay from getting worse? ›

Brushing is essential to preventing your cavity from worsening. Brushing will also help prevent the formation of even more cavities. Zero in on the cavity as you brush to eliminate any remaining food particles from your snack or meal. This thorough brushing can help hinder the cavity's progression.

Why is my tooth turning black? ›

Tooth decay: One of the leading causes of teeth turning black is tooth decay, which can result from the build-up of plaque and tartar. Poor oral hygiene can result in tooth decay, although this is reversible in the early stages. However, when teeth turn black further treatment is necessary.

When do you need a root canal? ›

Root canals are needed for a cracked tooth from injury or genetics, a deep cavity, or issues from a previous filling. Patients generally need a root canal when they notice their teeth are sensitive, particularly to hot and cold sensations.

What drugs cause rapid tooth decay? ›

Methamphetamine – also called ice, crystal meth, glass, shards or puff. This drug causes severe tooth decay in a very short time. The term 'meth mouth' is used to describe the extensive damage typically caused by this drug. Methamphetamine is highly acidic and attacks tooth enamel.

What bacteria causes tooth decay? ›

Streptococcus mutans is the main cause of dental decay. Various lactobacilli are associated with progression of the lesion.

What are 5 causes of tooth decay? ›

The Top 5 Things That Cause Cavities
  • Bacteria. Both gum disease and tooth decay are caused by bacteria. ...
  • Sugars. Sugars are bacteria's most preferred food choice and the bacteria in your mouth feed predominantly on sugars from food and beverages. ...
  • Plaque. ...
  • Parafunction. ...
  • Certain Medical Conditions.

Is a black tooth an emergency? ›

A broken tooth is considered a dental emergency and requires prompt attention from a dentist. If your tooth is black on the inside and your tooth is sensitive, it's likely a sign of tooth decay. A dentist will be able to tell you the exact cause after an examination, and can recommend the best treatment option.

Do you have to pull a rotten tooth? ›

If a tooth dies or becomes rotten with decay, you should visit your dentist ASAP. The sooner a patient sees a dentist, the chances increase that a root canal can save a rotten tooth. So, yes a rotten tooth will eventually fall out, but a patient should not wait until it does.

Is a decaying tooth an emergency? ›

Dental pain, especially shooting pain that often accompanies dental decay, can signify other more advanced dental concerns beyond decay, such as an abscessed tooth or infected roots. The short answer to the title question is that, in the truest sense, a cavity is not a dental emergency.

Is it better to do a root canal or extraction? ›

In most cases, root canal therapy is a better way to treat an infected tooth than an extraction. However, there are exceptions, such as if the tooth has suffered extreme damage. Your dentist will carefully analyze your oral health before making a treatment recommendation.

What happens when a cavity is too close to the nerve? ›

If the filling is too close to the nerve, it may get infected slowly. Dentists can't predict the time frame for the tooth to become infected. If infected, you may experience a throbbing pain or a dental abscess.

Does drilling a cavity hurt? ›

Once the site is numb, your dentist uses a dental drill to remove the decay. You may feel a slight vibration from the drill, but no discomfort.

How can I remove black tooth decay at home? ›

High-fluoride toothpaste or direct fluoride application helps remineralize the tooth enamel and prevent cavities.
Here are some home remedies to prevent tooth cavities.
  1. Oil pulling. ...
  2. Aloe vera. ...
  3. Avoid phytic acid. ...
  4. Vitamins and minerals. ...
  5. Avoid sugary foods and drinks. ...
  6. Eat licorice root. ...
  7. Sugar-free gum. ...
  8. Eggshell.

What happens if tooth decay is left untreated? ›

An untreated cavity can lead to an infection in the tooth called a tooth abscess. Untreated tooth decay also destroys the inside of the tooth (pulp). This requires more extensive treatment, or possibly removal of the tooth. Carbohydrates (sugars and starches) increase the risk of tooth decay.

Can a decayed tooth be crowned? ›

Crowns can be used for a severely decayed tooth that can no longer be saved. Drilling the badly decayed section can often lead to cracks. Thus, protecting it with a crown can stop the decay from getting worse. When you misplaced any tooth in your mouth, the perfect treatment for proper restoration would be an implant.

Can tooth decay spread to another tooth? ›

If you have this decay-causing bacteria on one tooth, it's possible it could also settle in nearby teeth if the conditions are right. This bacteria can also be spread from person to person in a number of ways, including through sharing food, using the same eating utensils, kissing, sneezing, and coughing.

How long does it take for a cavity to destroy a tooth? ›

There's no specific timeline for how quickly a cavity can destroy a tooth. In most cases, severe damage to the tooth occurs because of years of unaddressed tooth decay. Fortunately, proper dental hygiene and regular dental checkups can save a tooth before it ever gets this bad.

Can garlic treat tooth decay? ›

Allicin prevents the bad bacteria that cause tooth decay from proliferating in the mouth. Several studies concluded that the use of garlic extract could help combat periodontitis (gum disease) by controlling the population of the bad bacteria and letting the good bacteria thrive.

What essential oil is good for tooth decay? ›

Research has found that peppermint oil is exceptionally powerful for fighting oral pathogens and killing common bacteria that can lead to cavities and gum disease.

What is the black stuff in between teeth? ›

Tartar is a hard deposit of plaque that can build up on the teeth and usually appears below the gum line. Some forms of tartar are black.

What happens when tooth decay reaches nerve? ›

If you have a cavity that has reached the nerve tissue, you may experience some or all of the following symptoms: Toothache when pressure (such as chewing) is applied to the tooth. Tooth sensitivity to heat or cold. Discoloration of the tooth.

What health problems can cavities cause? ›

Poor oral health can impair your general health and well-being by creating or exacerbating health conditions such as heart and lung disease, stroke, or social anxiety and depression. Lesser but still serious side effects include difficulty swallowing and speaking, chronic pain, and loss of sleep.

How long is too long to have a cavity? ›

On average, as a broad timeline, it can take anywhere from six months to four or five years before a cavity needs treatment. The conditions of your mouth change daily. Conclusion: a cavity can start to form, then not have the right conditions to develop.

What happens when a tooth Cannot be saved? ›

When a tooth is missing the surrounding teeth will shift and drift into spaces that make it difficult to eat, cause damage to the jaw bone, and potentially damage other teeth. Bone loss, uncommon cavities, and TMJ problems are all associated with tooth loss without replacement.

How much tooth is required for a crown? ›

In most cases, at least two millimeters of tooth structure is required in order to place a crown. Generally, this means that at least one-quarter of the visible portion of the tooth must be present and healthy enough to support a dental crown.

How long can a tooth go without a crown? ›

A tooth can survive for several weeks without a crown. However, this is not advisable as your teeth remain exposed. This could make your teeth sensitive to hot or cold temperatures and cause further damage.


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