Tooth Decay Stages: 5 Stages & Best Treatments

‘Don’t each so much sweets!’ ‘Brush before bed!’ ‘Floss!’ How many of these warnings did you miss and progressed on tooth decay stages1, huh?

Each tooth is composed of three layers: enamel, dentin, and pulp. The damage to teeth can be seen in any of these layers as cavities, dental abscesses, or tooth loss.

It happens when certain types of food or bacteria in the mouth build up as dental plaque and cause damage to the tooth. These damages start from the enamel and move through five tooth decay stages.

If left untreated, tooth decay can cause considerable damage to the gums and also tooth loss. Let’s understand the different stages, treatment options, and ways to prevent tooth decay.

But First, What is Tooth Decay?

Our mouth is filled with both good and bad bacteria. The harmful bacteria combine with the food we eat to form a soft and sticky layer on the tooth called plaque.2

The bad bacteria use the sugar and starch in the food we eat to make acids, these acids erode the minerals of the enamel. If left untreated, the plaque hardens into tartar, and the enamel demineralization deepens, causing permanent damage to the tooth.

White spots on the teeth are the first sign of enamel damage. At this point, it is easier to help treat and prevent further tooth decay. The enamel can repair itself if proper care is taken. But, if left untreated, it can eventually lead to the formation of holes called ‘cavities.’

The fluoride in toothpaste, water, and other sources helps the enamel repair and regain the damaged spots on the teeth. Limiting the consumption of sugars and starch contain food also helps in preventing tooth decay.

Symptoms of Tooth Decay

Several red flags indicate tooth decay. Identifying the symptoms is the first step toward prevention and treatment, these symptoms also lead us to determine the tooth decay stages. Signs of tooth decay are:

1. Hot and Cold Sensitivity

This is the sudden tooth pain or sensitivity experienced after eating or drinking anything hot or cold. When the enamel is damaged, it exposes the inner layers of the tooth.

The layer below the enamel is called dentin.3 With the enamel gone, the dentin is exposed to the feeling of all the food; hot, cold, sticky, sugary, acidic, etc. This leads to sensitivity or pain feeling.

tooth decay stages
Image by Sammy-Williams from Pixabay

2. Toothache

An ache begins suddenly because of something you eat or occurs without any apparent cause.

It may occasionally occur for a short duration of time or may also last long enough to keep you awake during the night. Such pain may indicate a cavity, pain is a common symptom of a cavity.4

3. Stains on Teeth

There are many causes for teeth staining. Certain food and drinks like coffee, tea, and wine can also cause stains on the teeth, but stains can also occur due to poor oral hygiene.

Inadequate brushing or flossing can cause discoloration, it starts as white spots and darkens to brown over time as the damage deepens. The stains may also appear black or grey colour on the surface of the tooth.

4. Hole or Pit on the Tooth

A white or brown spot can progress into a hole or a pit on the tooth. This hole is called a cavity. A cavity can be visible and felt on the surface of the tooth.

But if it is located between two teeth or in crevices, it may not be visible or felt. In such cases, pain while biting or having food stuck in the teeth can indicate tooth decay.

Tooth Decay Stages

The tooth decay process starts with dental plaque. If teeth are not regularly cleaned, plaque can build up. Eventually, the soft, sticky layer of plaque hardens to form tartar.

This layer of tartar acts as a protection against bacteria, making it difficult to clean. This leads to decay of the tooth and may be damaging enough to lose the tooth.

Let’s examine the five tooth decay stages and possible treatment options to understand its severity and the importance of oral health5.

Stage 1: Demineralization

The outermost part of a tooth is called enamel. It is composed of minerals and is the hardest tissue in the body.

However, when the tooth is repeatedly exposed to acids from food and bacteria build-up, it can cause the enamel to lose the minerals.

Spots, where the minerals are lost, are white. These white spots are initial signs of tooth decay. The damage can be reversed with simple care, like frequently using fluoride toothpaste and mouthwash or getting a fluoride treatment from a dentist.

Stage 2: Enamel Decay

When the demineralization progresses further, the white spots start to darken to a shade of brown. The enamel breaks down completely in the space of white spots to form dental caries or cavities.

These holes need to be filled by a qualified dentist to prevent further stages of decay. The dentist cleans the decayed part of the tooth and fills it with ceramic, silver amalgam, resin, or gold.

tooth decay stages
Image by Gerd Altmann from Pixabay

Stage 3: Dentin Decay

If you are experiencing extreme tooth sensitivity when drinking hot or cold beverages and when eating, you are experiencing the third stage of tooth decay stages.

Below the enamel is the dentin layer. Unlike the outer layer enamel, dentin is softer and more sensitive to damage from acids. Dentin contains tubes leading to the nerves of the teeth. Therefore, any damage to the dentin layer causes sensitivity to hot or cold food. The decay progresses faster in this stage of tooth decay.

A filling can be used to restore dentin decay that is detected early. If the decay is severe, your dentist may remove the decayed portion of your tooth and place a crown over the remaining tooth structure.

Stage 4: Pulp Damage

The innermost part of the tooth is called the pulp. It contains the nerves and blood vessels, which help keep the tooth healthy and provide sensation.

In this stage of tooth decay, the pulp damage causes the tooth to be irritated and may result in swelling. As the tooth cannot swell along with the pulp, it causes pain. The last stage of pulp damage is called pulp necrosis6, where the pulp dies.

In such cases, the treatment includes a root canal, the dentist clears the damaged pulp and fills the cavity. Then, the filled tooth is covered with a crown.

Stage 5: Abscess

This is the final stage of tooth decay, where the bacteria invading the pulp can cause an abscess infection. This infection forms a pus pocket under the tooth causing severe pain and may spread into the gums, jaw, and face.

Other symptoms of this tooth decay stage include fever, swelling of the jaw, face, gums, and swollen lymph nodes in the neck. Prompt treatment is required for this stage to control the infection from spreading further into the jaw, head, or neck.

Root canals may be performed, or in severe cases, the entire tooth may be removed. Antibiotics may also be prescribed to remove the infection.


After understanding the different tooth decay stages, it is also important to understand the various treatment options to prevent damage.

In the first stage of tooth decay, fluoride treatments can help reverse the damage and prevent any permanent damage.

A dentist may apply a gel or varnish containing fluoride to strengthen the enamel from plaque acids. A toothpaste or mouthwash coating fluoride can also be used in the daily care of teeth.

dental treatments
Image by MARCIO GUIMARAES from Pixabay

As tooth decay progresses, dental treatments like tooth fillings, the crown of the tooth, and root canal treatments are used. These are treatments performed by qualified dental professionals only.

In severe cases, like the final stage of decay, antibiotics are also prescribed to kill the bacteria causing infection.

Prevention of Decay

dental hygiene

Preventing the build-up of dental plaque is the first step to the prevention of tooth decay. Here are a few steps to take for prevention:

  • Brush teeth at least twice a day with toothpaste containing fluoride.
  • Flossing after every meal is important to remove any particles stuck between teeth.
  • Rinsing the mouth with a fluoride mouthwash at least once a day or after every meal.
  • Making regular visits to a dentist for routine oral checkups and teeth cleaning.
  • Ask a dentist about sealant – a thin plastic coating- for the protection of molars.
  • Limiting intake of sugar-containing food like caramels, carbonated drinks, cookies, etc.

Frequently Asked Questions

1. Can tooth decay be fixed?

Enamel can heal itself by utilizing minerals found in saliva as well as fluorine from mouthwash or toothpaste. However, as the deterioration process proceeds, additional minerals are lost.

2. How do I get rid of decay on my teeth?

Fluoride medications, such as mouthwash or varnish, can be prescribed by a dentist to prevent early tooth decay.

3. What causes tooth decay?

Cavities are caused by several reasons, including germs in your mouth, a habit of frequently drinking sugary drinks, and failing to properly brush your teeth.


There are several symptoms to identify tooth decay, these may include sensitivity to hot or cold drinks, toothache, stains on teeth, and cavities. These symptoms lead us to the five tooth decay stages, which help in choosing the best treatment option for the problem.

Many treatment options are available when decay occurs, like root canals, fillings, cleanings, and crowns. A qualified dentist performs dental treatments.

There are also various steps you can take to prevent tooth decay and maintain good oral health. In the initial stage of decay, there may be no symptoms.

In such a case, a regular visit to the dentist will help identify the problem before it progresses further. Other preventive methods include regular brushing of teeth, fluoride-containing mouthwash and toothpaste, and limiting sugar intake.

Whatever happens, keep smiling big, beautiful!

Things You Should Know About Receding Gums
Icy Health
  1. Ramezani, Seddigheh, et al. “Stages of change for Tooth decay preventive behaviors and related factors among sample of elementary school students.” J Health Sci Technol 1 (2017): 93-99. ↩︎
  2. Rosan, Burton, and Richard J. Lamont. “Dental plaque formation.” Microbes and infection 2.13 (2000): 1599-1607. ↩︎
  3. Pashley, David H. “Dentin: a dynamic substrate-a review.” Scanning microscopy 3.1 (1989): 19. ↩︎
  4. Alt-Epping, Bernd, et al. “Symptoms of the oral cavity and their association with local microbiological and clinical findings—a prospective survey in palliative care.” Supportive Care in Cancer 20 (2012): 531-537. ↩︎
  5. Haumschild, Mary S., and Ryan J. Haumschild. “The importance of oral health in long-term care.” Journal of the American Medical Directors Association 10.9 (2009): 667-671. ↩︎
  6. Golstein, Pierre, and Guido Kroemer. “Cell death by necrosis: towards a molecular definition.” Trends in biochemical sciences 32.1 (2007): 37-43. ↩︎

Last Updated on by ayeshayusuf



Leave a Reply

Your email address will not be published. Required fields are marked *