Understanding the 5 Stages of Tooth Decay

Did you know there are five distinct stages of tooth decay? And, that in the first stage of decay, you can actually take steps to reverse the progression of the disease? Indeed, it’s true. In the first stage of decay, whether you’re a child or an adult, the application of fluoride via fluoride treatments, your toothpaste and even the local water supply can stop a cavity from penetrating through the enamel and reaching its second stage. Even the saliva in your mouth and the foods you eat help to re-mineralize a tooth in jeopardy. But that’s just the first stage! What about the rest? Understanding how a cavity progresses can assist you in preventing each successive stage from occurring in your own mouth and in your child’s mouth.

Stage One: White Spots

In stage one, the tooth begins to show signs of strain from the attack of sugars and acids, and white spots will begin to materialize just below the surface of the enamel. These white spots are representative of the demineralization of the tooth and can be easy to miss because they’re likely to occur on your back molars. A dental exam, of course, is designed to catch such cavities! Can you see why regular visits to the dentist are recommended? As mentioned previously, at this stage, the cavity can be repaired without the need to excavate the tooth.  The dentist and the hygienist are trained to spot these areas and will notify and educate you about how to prevent the weak spot from progressing.

Stage Two: Enamel Decay

Stage two marks the beginning of the end for the surface enamel that is being attacked. Initially, the tooth erodes from the underside outward, so the outer enamel will still be intact for the first half of this second stage. Once the cavity breaks through the surface of the enamel, there is no turning back, and you will need to have the cavity corrected with a filling. This is why it is critical to have regular exams.  When the tooth is at this stage you still may not notice the break in enamel.  The filling will be small at this point if detected early.

Stage Three: Dentin Decay

If a cavity in your mouth were to progress beyond stage two without you knowing, you’d tend become aware of it when it started to hit stage three because it would probably start to cause some pain. At this level, the cavity begins to eat away at the second level of tooth material that lies beneath the enamel: the dentin. A filling can still be used to stop the onslaught of bacteria assaulting the tooth in order to prevent the cavity from reaching the tooth’s most critical component: the pulp.

Stage Four: Involvement of the Pulp

Once the cavity reaches the pulp, it’s going to hurt- A lot.  Or, the tooth may be so weakened, it fractures or breaks. So if you’ve unfortunately missed all the signs to this point, instead of a small filling or a reversible spot, your tooth may become an emergency situation for you. Stage four is serious, and a root canal is the only option of treatment at this stage, save for a complete extraction.  Fortunately, due to advances in dentistry, both of these procedures can be done comfortably for you, but at a much greater expense than preventive measures.

Stage Five: Abscess Formation

In the fifth and final stage of a cavity, the infection has reached the tip of the root and exited the tip of the tooth’s structure. This in turn infects the surrounding tissues and possibly the bone structure. Swelling would be commonplace and pain severe.  An abscess can be fatal if not dealt with immediately. Root canal or extraction would be the order of the day should decay reach this stage.  You need to call the office right away if this happens so you can be evaluated and most likely prescribed antibiotics.

As you can see, cavities don’t happen overnight. In the early stages, regular visits can stall and reverse the progression of these dastardly little devils, so it really does pay to visit the dentist at pre-selected intervals. You and your children can stay away from stage five their whole lives, and if a little bit of prodding to get them to the dentist accomplishes that, you can rest easy despite the griping.  And don’t think cavities are just for kids.  Older adults often end up with recurrent decay around old fillings or crowns due to inadequate oral hygiene, dry mouth due to medications, or other health factors. So remember the old adage you have often heard:  Prevention is the Best Medicine.