How decay actually begins
Your mouth contains natural bacteria living in a sticky film called plaque. When sugars reach them, they produce acids that dissolve minerals from the enamel. This dissolving happens several times a day, and your saliva rebuilds what was lost in between.
Trouble starts when the balance tips. If sugar arrives often, saliva never gets long enough to repair the damage. The loss accumulates day after day until a hole appears.
The five stages
- White spot — the first sign, and a stage that can still be halted and even reversed with fluoride and better cleaning. Completely painless.
- Decay in enamel — a small cavity has formed. Still no pain, but there is no going back now.
- Decay in dentine — the layer beneath enamel is softer, so decay advances faster. Sensitivity to cold and sweet begins.
- Reaching the pulp — the living tissue becomes inflamed. This is where real pain appears: throbbing, and worse at night.
- Abscess — infection escapes from the root tip into the bone. Swelling, sometimes fever.
Notice that pain arrives at stage four. That is precisely why regular check-ups matter: the first three stages are entirely silent.
Treatment, stage by stage
- White spot — professional fluoride and a change of habits. No drilling.
- Enamel or dentine decay — the affected part is cleaned away and a filling placed. Modern fillings match the tooth colour.
- Extensive decay — the tooth may need a larger restoration or a crown to protect it from fracture.
- Pulp involvement — root canal treatment: the inflamed tissue is removed, the canals cleaned and sealed. The tooth is kept.
- Abscess — drainage, then treatment of the cause. Extraction stays the last resort, when the tooth cannot be saved.
The rule is simple: the earlier it is caught, the lighter, cheaper and shorter the treatment.
Why X-rays are sometimes necessary
Decay between two teeth cannot be seen by eye, however careful the examination, because it hides at the contact point. Only an X-ray reveals it. This is why films are not taken routinely or at random, but when the clinical examination justifies them and when they will genuinely inform your care — at the lowest reasonable dose.
Prevention that works
- Fluoride — toothpaste at 1450 ppm, twice a day. This is the single strongest proven measure.
- Do not rinse with water afterwards — spit only. Rinsing washes the fluoride away before it can act.
- Clean between the teeth daily — floss or interdental brushes. Most decay starts where a brush cannot reach.
- Cut the frequency of sugar, not only the quantity. Watch fizzy drinks and juices, including natural ones.
- Fissure sealants for children — a protective layer placed on the chewing surfaces of permanent molars, before any decay appears.
- Regular check-ups — at an interval set by your dentist according to your risk, not a fixed calendar for everyone.