The Five Stages of Tooth Decay & How to Treat Each
Tooth decay is the destruction of your tooth enamel, the hard, outer layer of your teeth. It can be a problem for children, teens and adults. Plaque, a sticky film of bacteria, constantly forms on your teeth. When you eat or drink foods containing sugars, the bacteria in plaque produce acids that attack tooth enamel. There are five stages of tooth decay. The earliest stage is often reversible, but later stages can cause permanent damage to an affected tooth.

Stage 1: Initial demineralization
The outer layer of your teeth is composed of a type of tissue called enamel. Enamel is the hardest tissue in your body and is mostly made up of minerals.
However, as a tooth is exposed to acids produced by plaque bacteria, the enamel begins to lose these minerals. When this occurs, you may see a white spot appear on one of your teeth. This area of mineral loss is an initial sign of tooth decay. This earliest stage of tooth decay can be reversed before more permanent damage occurs. This can be achieved by treating the teeth with fluoride.
Stage 2: Enamel decay
If the process of tooth decay is allowed to continue, enamel will break down further. You may notice that a white spot on a tooth darkens to a brownish color. As enamel is weakened, small holes in your teeth called cavities, or dental caries, can form. Cavities will need to be filled by your dentist.
Stage 3: Dentin decay
Dentin is the tissue that lies under the enamel. It’s softer than enamel, which makes it more sensitive to damage from acid. Because of this, tooth decay proceeds at a faster rate when it reaches the dentin.
Dentin also contains tubes that lead to the nerves of the tooth. Because of this, when dentin is affected by tooth decay, you may begin experiencing sensitivity. You may notice this particularly when having hot or cold foods or drinks. If identified early, dentin decay may be treated with a filling. In more advanced cases, placement of a crown may be required.
Stage 4: Pulp damage
The pulp is the innermost layer of your tooth. It contains the nerves and blood vessels that help to keep the tooth healthy. The nerves present in the pulp also provide sensation to the tooth. When damage to the pulp happens, it may become irritated and start to swell. Because the surrounding tissues in the tooth can’t expand to accommodate this swelling, pressure may be placed on the nerves. This can lead to pain. When tooth decay has reached the pulp, you’ll often need a root canal. In a root canal, the damaged pulp is removed. The tooth cavity is then cleaned and filled in. A crown is placed on the affected tooth.
Stage 5: Abscess
As tooth decay advances into the pulp, bacteria can invade and cause an infection. Increased inflammation in the tooth can lead to a pocket of pus forming at the bottom of your tooth, called an abscess. Tooth abscesses can cause severe pain that may radiate into the jaw. Other symptoms that may be present include swelling of the gums, face or jaw, fever, and swollen lymph nodes in your neck.
A tooth abscess requires prompt treatment, as the infection can spread into the bones of your jaw as well as other areas of your head and neck. If an abscess has formed in your tooth, your dentist will likely perform a root canal to remove the infection and seal the tooth. In severe cases, the affected tooth may need to be removed completely.
There are steps that you can take to help prevent tooth decay. These include things like brushing your teeth at least twice a day, avoiding sweet foods, and making sure to visit your dentist regularly.
If you have a periodontal/dental implant condition, it’s important to receive treatment before it becomes a dental emergency. At the Havrilla Center for Periodontics & Dental Implants located in Broomall, PA, attending to your comfort and concerns is our first priority. Our mission is to provide you with the highest quality of periodontal and dental implant care in a warm and friendly environment.