When tooth decay begins it doesn’t mean you have a cavity right away. Tooth decay happens in stages and progresses when your teeth are continually exposed to acids produced by oral bacteria. Over time, frequent exposure to these acidic byproducts erodes the minerals in your teeth which leads to decay and cavities. There are five stages of tooth decay that contribute to the development of a cavity:

1. Enamel Lesion: The first stage of tooth decay occurs when spots or lesions (typically white or light brown) appear on the tooth’s surface or enamel. This discoloration is a sign of demineralization. It is possible to remineralize the teeth and stop the decay from progressing into a cavity.

2. Enamel Decay: The second stage of decay happens when the enamel continues to break down. At this stage, holes (cavities) can form in your teeth.

3. Dentin Decay: The third stage of tooth decay is when it reaches the layer beneath the enamel known as dentin. The cavity will likely be painful as it is closer to the nerves or root of the tooth.

4. Pulp Decay: This major stage of decay is when the cavity has reached the pulp, the innermost layer of your tooth beneath the dentin. It contains the nerves and blood vessels that provide nutrients to the tooth. Once the pulp has been reached, it can cause a tooth ache and tooth is at risk.  

5. Tooth Abscess: The final stage of decay occurs when the bacteria inside the cavity spreads beneath the pulp and forms a pocket of pus. Most times, the infection is extremely painful. Symptoms of tooth abscess vary according to the Mayo Clinic and may result in fever and facial swelling.

Not all tooth decay is created equal, according to The Journal of the American Dental Association (JADA). If you’re hoping to avoid a filling there are a few less invasive options your dentist can use if the decay is caught early in its development. When tooth decay first begins it can look brown or white where the enamel is softening. Topical fluoride treatments and sealants may be your best tool to prevent the cavity from forming and avoid a filling.

• Fluoride varnish: This is a liquid that is painted onto the teeth, quickly hardening into a thin layer as the fluoride is absorbed by the enamel.
• Fluoride gel: A gel treatment is put in a specially designed tray and placed in your mouth. The tray is left in your mouth for a period of time as the enamel absorbs the fluoride before the tray is removed.
• High-fluoride toothpaste: Hopefully you’re already using a toothpaste containing fluoride, but some toothpaste has a higher concentration of fluoride and is available with a prescription. This type of toothpaste is prescribed when the decay leaves the root exposed. Daily use of high-fluoride toothpaste is used to prevent further decay from occurring.
• Silver diamine fluoride (SDF): If tooth decay has advanced to form a cavity, there may be another option your dentist will consider besides a filling, especially for young patients. SDF is a treatment that is applied directly to the area of decay, stopping the decay from continuing without filling the cavity in. This means your tooth structure is still compromised and unfortunately the treated area will also turn black. So why should you consider this option? This type of treatment is best used when the cavity is occurring in primary (baby teeth). The aesthetic issue of the black spot is less of a concern since those teeth will fall out, and this quick and inexpensive option may be preferable for younger patients that aren’t comfortable with a drill.
• Dental sealants: The back of your teeth are decay targets since they have deep pits and grooves that trap plaque and food particles. Dental sealants provide extra protection by forming a smooth surface over the back teeth. Dental sealants should be administered to healthy teeth with no decay, but can also be used over areas of early decay to prevent further damage to your tooth. Your dentist would monitor this tooth to make sure the sealant is doing its job. The quick and painless process is a great way to start kids off with extra protection against cavities.

Cavities need to be filled. Luckily, there are more types of fillings for teeth than ever before. They vary in complexity and material, from amalgam to composites, or gold and porcelain. There are benefits and drawbacks to each type, such as changing color, longevity, durability and expense. If you’re not able to catch the tooth decay early enough, your dentist will help you determine the best filling type or treatment plan for your cavity.

Regular dental checkups are your best defense to spot tooth decay as early as possible so that non-drilling options are still in your scope of treatment. Remember to brush with fluoride toothpaste after eating or drinking. If your dentist believes you’re at a high risk for decay or cavities, a mouth rinse may also be recommended. Just be aware that being proactive is always best. Use good oral hygiene and keep an open conversation going with your dentist, and hopefully you can keep those cavities at bay.

This article is intended to promote understanding of and knowledge about general oral health topics. It is not intended to be a substitute for professional advice, diagnosis or treatment. Always seek the advice of your dentist or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.