Do you know that according to the World Health Organization, nearly 3.5 billion individuals are believed to be affected by oral diseases globally? The Global Burden of Disease 2019 considers untreated dental caries (tooth decay) in permanent teeth the most prevalent medical condition.¹

Tooth decay is a widespread dental issue that impacts everyone worldwide, regardless of age. But did you know that brushing your teeth for only 2 minutes with fluoride toothpaste in a day can ensure that your mouth is cleaned adequately?² But a question arises: How is tooth decay connected to maintaining oral hygiene? So, to find the answer, let's first understand what is tooth decay.

Dental decay, a process that harms teeth structure, can result in cavities, dental abscesses, or even tooth loss.

It occurs due to a particular species of bacteria that can live in the biofilm, dental plaque. This bacteria can convert the sugars in your food into acid. 

If you don't brush your teeth regularly, plaque builds up on your teeth, and the acids in the plaque start to damage them. This is why good oral hygiene is vital for healthy teeth.

Tooth decay occurs in various stages. Now, we will discuss each stage in detail so that you can easily recognize your stage if you have tooth decay. We will also discuss treatment options that may help stop the decay and save you from tooth loss.

Stages of tooth decay

Tooth Decay is generally divided into five stages, which are

• Stage 1: the white spots
• Stage 2: Enamel Decay
• Stage 3: Dentin decay
• Stage 4: Pulp damage
• Stage 5: Tooth Abscess

Stage 1: The white spots

This stage is also called initial demineralization. It is because the outer layer of your tooth is made up of a tissue called "enamel." Serving as a protective outer covering for the tooth crown, enamel, the hardest tissue in the body, plays a crucial role in maintaining dental health.³

However, a tooth's enamel starts to lose these minerals when exposed to the acids that the plaque bacteria create.

When this happens, a white spot appears on your tooth. This demineralized spot indicates the initial stage of tooth decay, i.e., demineralization. As this stage progresses, the enamel weakens due to demineralization. If it continues to lose minerals, your tooth becomes weaker, softer, and eventually decayed if left untreated and unchecked.

This stage can also be called pre-cavity because the cavity has yet to form. It is completely reversible and curable if you maintain good oral hygiene.

Presentation

The white spots resemble a patch of powdery white enamel on the tooth's surface. Because they contrast sharply with enamel and are more opaque than transparent, the colour is easily distinguishable.

Symptoms

As this is the first stage and is only marked by the appearance of white spots, it usually has no pain or sensitivity. You can only recognize this stage by seeing spots on your tooth.

Treatment

Thankfully, tooth decay can still be reversed at this point, so seeing your dentist is not always necessary. At this stage of caries development, preventive treatment at home is sufficient; dental operations or drilling are unnecessary. Several actions can be taken to prevent your teeth from further damage.

Maintain good oral hygiene

To maintain good oral hygiene, brush your teeth twice daily for two minutes.⁴ After dinner, floss and use mouthwash to remove any remaining food particles.

Fluoride toothpaste and fluoride treatment 

A toothpaste containing fluoride may help prevent and stop tooth decay progression.⁵ It works very well for lesions with white spots. Fluoride strengthens enamel by changing the structure of the crystal and creating an additional layer over the enamel, which serves as protection. 

You can also get a fluoride treatment from the dentist. Fluoride is frequently administered to your teeth as a varnish or gel. It strengthens enamel, increasing its resistance to the acids that plaque bacteria create.

Minimize sugar intake

Sugar in your diet plays a crucial role in providing bacteria with the fuel they need to produce acid, which ultimately leads to the demineralization of your enamel. Therefore, reducing your sugar consumption can be an effective strategy to slow down this progression.

Stage 2: Enamel decay

If the white spots are left untreated, stage 1 progresses to enamel decay. It is when stage 2 starts. You may observe the white spots turning brownish. The cavity has begun to penetrate further into the tooth, affecting more of the enamel than simply the surface. 

When the cavity is between the outer layer of enamel and before it reaches the dentin layer, it can still be referred to as enamel decay. 

Presentation

This stage presents as black spots or brownish dots on the tooth, whether on the top, sides or even between.

Symptoms

Besides its appearance, a cavity in this stage generally does not result in any sensitivity. It means you won't feel any pain and may not know that the cavity is progressing unless you look in your mouth. However, some people may be sensitive to sweets at this stage.

Treatment

Enamel decay is best treated by having a dental filling placed by a dentist. The damaged tooth portion will be removed during the process and replaced with a dental amalgam, ceramic, or resin filling that will match the colour of your natural teeth.

Stage 3: Dentin decay

If decay in the enamel is not treated, it will ultimately go to the dentin, the layer beneath the enamel. Since this layer is considerably weaker than enamel, acid damage will occur rapidly at this point. 

Extreme tooth sensitivity to hot, cold, and sugary foods is a common symptom often associated with dentin decay. If you discover your teeth are more sensitive, see your dentist immediately.

Presentation

The cavity's colour is usually some shade of brown as it penetrates the dentin. If the deterioration is severe and extensive, it may seem nearly black.

Symptoms

Dentin has tubes that connect to the tooth's nerves. You may start feeling sensitive when tooth decay affects the dentin. It could be especially noticeable while consuming hot or cold meals or beverages.

Treatment

When decay reaches this stage, it proceeds more quickly because dentin is weaker than enamel. If discovered early, dentin decay can be treated with a filling. In more severe cases, the dentist may place a dental crown. 

A dental crown is a cap shaped like a tooth. The decayed area is removed before the crown is placed. Some healthy tooth tissue may also be extracted to guarantee that the crown fits properly.

Stage 4: Pulp damage

The innermost layer of the tooth is the 'pulp.' It contains the nerves and blood vessels that help keep the tooth healthy. The nerves in the pulp also provide sensation to the tooth. 

When decay progresses to the tooth's pulp, it may become irritated and swell. Since the surrounding tissues in the tooth cannot expand to accommodate the swelling, pressure may be placed on the nerves, which may cause pain and restlessness.

Presentation

When a cavity reaches the pulp, it is a large lesion that is usually dark brown or black. Because there is frequently a visible cavitation or hole in the tooth, it is a massive food trap. Food will continually become lodged in the cavity, forcing you to keep trying to remove it by digging. You may even touch and sense the cavity with your tongue.

Symptoms

Since the pulp connects the tooth to the rest of the body and has nerve endings, the first symptom is the constant dull pain. Other symptoms are

• The colour of the tooth becomes black
• Bad smell of the tooth and mouth
• Swelling
• Unpleasant taste

Treatment

The decayed pulp in your tooth may require a root canal. The dentist will perform a series of steps during the procedure, which includes clearing out the damaged pulp, filling in the resulting cavity, and finally placing a protective crown on the tooth.

Stage 5: Tooth abscess

Untreated pulp decay will eventually lead to a tooth abscess, the next stage of tooth decay. It occurs when the cavity destroys the dental nerve and continues to the tip of the root, where it begins to cause a bone abscess. 

A tooth abscess can cause excruciating pain that radiates throughout the rest of your mouth, gums, cheek, and jaw.

Presentation

You can't see the abscesses in your mouth because the infection has penetrated deep down to the bone. Therefore, tooth abscesses can only be seen on an X-ray.

Symptoms

Tooth abscesses have more severe symptoms than the previous stages. Some of them are

• Severe excruciating pain
• Swelling
• Fever
• Tenderness of neck and jaw

Treatment

The first line of treatment for tooth abscesses is the root canal. After clearing out all the decay, the dentist cleans the cavity and seals it.

However, in more severe cases, the dentist may suggest tooth extraction.

Antibiotics are also prescribed at this stage to eradicate all the infections from the tooth.

Summary

Tooth decay is damage to your teeth due to poor oral hygiene. It may lead to the development of cavities. It has five stages. First is the appearance of white spots, which is called Initial demineralization. This stage progresses to enamel decay. In this stage, the decay damages the enamel, and the white spots turn brownish. This stage advances to the dentin, which is the next layer of the tooth. You may observe sensitivity to hot and cold food in this stage.

Then, the decay progresses to the pulp. The pulp is the next layer of the tooth, which contains nerve endings. So, the decay causes pain and swelling. This stage finally progresses to the last stage, which is the tooth abscesses. This stage is excruciating. The dentist may opt for a root canal, and severe cases may result in tooth extraction.