Tooth Decay Treatment: Signs, Stages and What Each One Needs

Tooth decay is treated according to how far it has gone. A white spot can still be remineralised with fluoride. A cavity in enamel or dentine needs a filling. Decay that has reached the nerve needs a root canal, and an abscess needs urgent care. Only the first stage is reversible.

What tooth decay actually is

Bacteria in plaque feed on sugar and produce acid. That acid dissolves minerals out of the enamel. Saliva puts minerals back. Decay happens when the dissolving outpaces the repairing, day after day.

Which is why how often you eat sugar matters more than how much. One dessert does less damage than sipping a sweet tea across an afternoon, because the second keeps the acid attack running for hours.

The signs, in the order they appear

A chalky white spot. No pain. This is the only stage that can still be reversed.
Sensitivity to cold, or a twinge with something sweet.
A visible hole, or brown or black staining in a groove.
Food packing into the same spot every meal.
Pain that lingers after the hot or cold has gone. This is the turning point. It usually means the nerve is inflamed.
Pain at night, or pain that wakes you. The nerve is involved.
Swelling of the gum or face. An abscess has formed.

Decay is painless for most of its life. By the time it hurts, the cheap fix has usually passed.

The stages, and what each one needs

White spot. Fluoride, better cleaning, and cutting snacking frequency. No drilling. The enamel can remineralise.
Enamel cavity. A small filling. Often no anaesthetic needed.
Into the dentine. A larger filling. Dentine is softer than enamel, so decay spreads faster once it gets through.
Reaching the pulp. A root canal, then a crown. A filling alone will fail.
Abscess. Root canal, or removal if the tooth cannot be saved. If there is facial swelling, this is urgent, see what to do today.

What goes into the hole

Composite. Tooth coloured, bonded to the tooth, shade matched to your enamel. It is what is used here for almost everything. No silver amalgam.

Glass ionomer. Releases fluoride, bonds well in a damp field. Useful in children and in cavities that sit at or below the gum line.

Bonded fillings need less healthy tooth removed than the old silver ones did, because they hold on chemically rather than by being wedged into an undercut. Less drilling, more tooth left.

When a filling is no longer the answer

A filling replaces missing tooth. It does not strengthen what is left. Past a certain size the remaining walls are too thin to survive chewing, and the honest answer is a crown or an inlay, not an ever larger filling.

A very large filling in a back tooth is often just a slow route to a fractured tooth. If you are told a filling has been redone twice in the same tooth, that is the conversation to have.

Does it hurt

Small early cavities are often filled with no anaesthetic at all. Anything deeper is numbed first, and you should feel pressure, not sharpness. Say something if you do, because more anaesthetic is not a problem.

The toothpaste question

People search for the best toothpaste for decay and the honest answer is dull: any toothpaste with fluoride at 1450 ppm, which covers most standard adult brands. What actually changes outcomes is not the tube.

Brush a full two minutes, twice a day. Most people manage about forty seconds.
Spit, do not rinse. Rinsing washes away the fluoride you just paid for. This one change does more than switching brands ever will.
Clean between the teeth. Most adult decay starts where a brush cannot reach.
Attack the frequency of sugar, not the quantity.

Children

Deep grooves in new adult molars trap food that no brush reaches. Pit and fissure sealants flow into those grooves and seal them, and fluoride varnish hardens the surface. Both are quick, painless and cost a fraction of the filling they prevent. See children’s dentistry.

Getting it looked at

An examination with digital X-rays finds decay between teeth, where it hides until it is large. You will be told what needs doing, what can wait, and what it costs, in writing. If a tooth can be saved rather than replaced, you will be told that too, even though saving it earns less.

The clinic is on RB Mehta Marg in Ghatkopar East, open until 9 pm Monday to Saturday.

Common questions

What are the first signs of tooth decay?

A chalky white spot on the enamel comes first and causes no pain. Then sensitivity to cold or sweet things, then a visible hole, then pain that lingers after the trigger is removed. Pain that wakes you at night usually means the nerve is involved.

Can tooth decay be reversed without a filling?

Only at the white spot stage, before a hole forms. Fluoride, better cleaning and cutting the frequency of sugar can remineralise enamel at that point. Once the surface has broken, the tooth cannot repair itself and needs a filling.

What is used to fill a cavity?

Tooth coloured composite bonded to the tooth, matched to your enamel shade. Glass ionomer is used where it suits better, such as in children or below the gum line. No silver amalgam.

Does getting a filling hurt?

The tooth is numbed first and most people feel pressure rather than pain. Small early cavities can often be filled without any anaesthetic at all.

When is a filling no longer enough?

When too little tooth structure is left to hold one, a crown or inlay is needed. When decay has reached the nerve, a root canal is needed before the tooth can be restored.

Which toothpaste actually helps against decay?

Any toothpaste with fluoride at 1450 ppm, which is most standard adult toothpastes. The brand matters far less than two things people get wrong: brushing for a full two minutes, and spitting without rinsing afterwards so the fluoride stays on the teeth.