How do you know if you have tooth decay? Signs, stages and treatment at each stage
Tooth decay does not hurt at first: the earliest sign is a chalky white spot on the enamel, and at this stage it can be stopped with fluoride and good oral care. Once decay reaches the dentine, sensitivity to cold and sweet and darkening begin, and a filling is needed. When it reaches the nerve, spontaneous pain that is worse at night appears and root canal treatment is needed.
How does tooth decay form?
Bacteria in plaque on the teeth turn the sugars and starches we eat into acid, which dissolves minerals from the enamel. Saliva neutralises the acid and repairs the enamel. When you snack on sugar often through the day, there is no time for repair and decay begins.
Stages of tooth decay and their treatment
| Stage | Signs | Treatment |
|---|---|---|
| 1. White spot (mineral loss in enamel) | No symptoms; dull, chalky white spot | Fluoride varnish, fluoride toothpaste, monitoring; reversible |
| 2. Enamel decay | Brown-black discolouration, slight roughness | A small white filling |
| 3. Dentine decay | Sensitivity to cold and sweet, a hole, food trapping | Filling; onlay or crown if a lot of tooth is lost |
| 4. Decay reaching the nerve | Spontaneous, throbbing pain, worse at night | Root canal treatment, usually followed by a crown |
| 5. Abscess | Swelling, pain on biting, a pimple-like spot on the gum, fever | Root canal treatment or extraction; antibiotics if needed |
What are the signs of tooth decay?
- A white, brown or black spot on a tooth
- A twinge with cold, heat or sweet food
- A hole you can feel, or food always catching in the same place
- Floss shredding at the same spot
- A bad taste or bad breath from one area
- Pain on biting, spontaneous pain or swelling (advanced stage)
Hidden decay: between teeth and under fillings
Much decay starts where two teeth touch or at the edges of old fillings and crowns. You cannot see these areas in a mirror and they give no symptoms for a long time. Bitewing X-rays show this decay before it hurts, while it can still be treated with a small filling.
A check-up once a year is recommended if your decay risk is low, and every six months if it is high.
Can tooth decay go away on its own?
Only the first stage, the white spot, can be stopped and reversed. Once a hole has formed in the enamel, decay does not heal; only its speed changes.
When a tooth that has hurt for a while suddenly stops hurting, that is not good news; it often means the nerve has died. Infection can then spread silently to the tip of the root.
How can you prevent tooth decay?
- Brushing properly twice a day with fluoride toothpaste, especially at night
- Cleaning between the teeth once a day
- Keeping sugary food and drinks to mealtimes and drinking water between meals
- Sugar-free (xylitol) gum after meals
- Fissure sealants and regular fluoride for children's back teeth; see our children's dentistry guide
- Regular check-ups and X-rays
At Dent32 in Beylikdüzü we treat decay early, removing as little tooth as possible. For a check-up, book an examination.
Frequently asked questions
Does decay need treating if it doesn't hurt?
Yes. Decay usually does not hurt until it nears the nerve. A filling done at the painless stage avoids the need for root canal treatment and a crown.
How do you know whether you need a filling or a root canal?
The decision is based on the examination, X-rays and how the tooth responds to cold. Spontaneous pain that comes on at night usually means root canal treatment is needed.
Can tooth decay cause bad breath?
Yes. Food and bacteria collecting in decayed cavities can cause a bad smell and taste.
Should decay in baby teeth be treated?
Yes. Untreated decay in baby teeth causes pain and infection, and can harm the permanent tooth underneath and the space it needs.
