Stages of Tooth Decay

One of the most common reasons for tooth pain, tooth decay starts when enamel begins to wear away creating pockets of decay on the tooth surface.  Acidic plaque forms a sticky layer on the tooth surface that if not properly cleaned away, can cause decay.  Because tooth decay can be stopped and potentially reverse when addressed early, understanding the various stages of decay can help patients better understand their prognosis.

Six States of Tooth Decay

Stage One: Formation of White Spots

The initial stage of decay starts when white spots appear on the tooth surface.  These spots present due to plaque build up and calcium loss.  Plaque bacteria metabolize sugars from consumed food and drink releasing acids that begin to erode the tooth enamel.  If addressed at this stage, decay could be reversable through professional dental treatment, cleaning, and using fluoride toothpastes and topical applications.

Stage Two: Enamel Decay

The second stage of tooth decay is characterized by the enamel breaking down underneath the surface of the tooth.  At this point, the natural remineralization process can no longer restore the minerals and enamel creating a lesion to form in the tooth.  As the tooth decay progresses, the tooth surface is at risk irreversible damage and risks breaking.

Stage Three: Dentin Decay

Located between the enamel and pulp, the dentin is the next tooth layer that is impacted when decay is left untreated and progresses past the enamel.  At this stage, pain begins to increase and the infected tooth may be particularly painful.  Once enough of the dentin is weakened from loss of minerals, the enamel collapses forming a cavity.  A dental filling will likely be needed to restore the tooth.

Stage Four: Pulp Affected

Considered the center of the tooth, the pulp consists of living cells and tissue known as odontoblasts.  The pulp produces dentin which connects to the enamel.  If tooth pulp gets infected by bacteria, pus forms which kills the tooth nerves and blood vessels.  Commonly referred to as a toothache, this stage will result in constant pain and likely require a root canal treatment.

Stage Five: Formation of Abscess:

The final and most painful stage of decay is the formation of an abscess.  If the infection penetrates to the tooth root, the surrounding bones are at risk of infection.  The tongue and gums typically swell affecting speech and putting the patient at risk of other diseases.  Oral surgery may be needed in addition to other procedures.

Stage Six: Tooth Loss:

Tooth loss and extraction can result if any stage of the tooth decay is left untreated.

Seeing a Dentist

Because tooth decay is a manageable condition that can be stopped and possibly reversed if treated early, routinely seeing a dentist is an important prevention strategy.  Decay is far easier and less costly to treat in the early stages and dentists can often identify decay or other issues with an X-ray or exam.  While dental checkups should be part of an oral hygiene practice, any suspected decay, cavities, or discomfort warrant a special visit to the dentist.

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