Short answer: Tooth decay is a disease that develops when acids produced by mouth bacteria from sugary and starchy foods gradually dissolve tooth enamel. At first, chalky white spots appear on the enamel; as it progresses, brown-black discoloration, cavities, sensitivity and pain develop. In the early stage it can be stopped with fluoride and good oral care; once a cavity forms a filling is needed, and when decay reaches the nerve a root canal treatment is required. Regular brushing, eating sugar less often and regular check-ups are the foundation of prevention.
Tooth decay is one of the most common chronic diseases in the world and can affect people of all ages. The good news is that it is largely preventable and, when caught early, can be stopped with simple methods. In this article we cover how decay develops, the stages it goes through and the symptoms it causes, treatment options by stage, ways to prevent decay, and the points that people using clear aligners should pay special attention to.
How does tooth decay develop?
Tooth decay develops when acids, produced as the bacterial plaque on the tooth surface ferments sugars, cause the enamel to lose minerals. There are always bacteria in our mouths. These bacteria form a sticky layer on the tooth surface called plaque. When we eat something sugary or starchy, the bacteria in plaque use it to produce acid, and the mouth becomes more acidic. This causes the enamel to lose minerals for roughly half an hour to an hour.
Saliva tries to repair this loss by neutralizing the acid and returning calcium and phosphate to the enamel. Decay begins when mineral loss happens faster and more often than repair. That is why one of the most important factors in decay risk is not so much the total amount of sugar eaten as how often it is consumed during the day. Constant snacking or sipping sugary drinks for hours leaves the teeth no chance to recover.
Other factors that increase the risk of decay include poor oral care, lack of fluoride, reduced saliva flow (due to some medications, radiotherapy or chronic diseases), deep grooves in the teeth, root surfaces exposed by gum recession, and orthodontic appliances such as braces that make cleaning harder.
What are the stages and symptoms of tooth decay?
Tooth decay passes through stages that start in the enamel and progress toward the dentin and finally the nerve; the symptoms change as it advances.
- Early (white spot) stage: Dull, chalky white spots appear on the enamel. There is usually no pain at this stage. The enamel surface is still intact and the process is reversible.
- Enamel decay: Mineral loss progresses, the spot may turn brown and a small break may begin on the surface. There may still be very few symptoms.
- Dentin decay: Once decay reaches the softer dentin beneath the enamel, it progresses faster. Sensitivity to sweet, cold or hot, a visible hole in the tooth and food getting stuck are common at this stage.
- Decay reaching the pulp: When decay reaches the nerve, pain that starts on its own, lasts a long time and gets worse at night may develop.
- Abscess: Untreated infection can spread to the root tip; swelling of the gum, discharge, a bad taste in the mouth and sometimes facial swelling may occur.
Decay that starts between the teeth may remain invisible for a long time and only be detected on an X-ray. So the absence of pain does not mean there is no decay; this is why regular check-ups matter.
How is tooth decay treated at each stage?
Treatment of tooth decay depends on how far it has progressed; preventive approaches may be enough in the early stage, while more extensive treatment is needed in later stages.
- Early spots: With professional fluoride applications, regular brushing with fluoride toothpaste, changes in eating habits and close monitoring, the lesion can be stopped and remineralize. In some cases, minimally invasive procedures such as resin infiltration can be used.
- Decay with a cavity: The decayed tissue is removed and the tooth is repaired, usually with a tooth-colored composite filling. For large losses of tooth structure, lab-made inlay or onlay restorations may be preferred.
- Deep decay: If decay is very close to the nerve, a protective base material can be placed while preserving the nerve. If the nerve is affected, root canal treatment is needed.
- Very advanced cases: If the tooth is too damaged to be restored, extraction may be needed; the gap is then filled with an implant, bridge or denture.
- Baby teeth: Decay in children's baby teeth should also be treated, because infection can affect the permanent tooth developing underneath and early tooth loss can disrupt the alignment of the permanent teeth.
Mild sensitivity to cold for a few days after a filling is normal and usually eases on its own. If the filling feels high when you bite or sensitivity keeps increasing, you should see your dentist for a simple adjustment. Keep in mind that a filling repairs the damage caused by decay but does not change the habits that caused it; preventive steps are essential so that new decay does not form in the same tooth or neighboring teeth.
How can tooth decay be prevented?
The basic principles of preventing decay are removing plaque regularly, making use of fluoride, eating sugar less often and having regular dental check-ups. Here are steps you can apply in daily life:
- Brush twice a day with fluoride toothpaste: In particular, do not skip brushing before bed.
- Clean between your teeth: Clean between your teeth once a day with floss, interdental brushes or a water flosser.
- Keep sugar to mealtimes: Have sweets with meals rather than as snacks; avoid snacking throughout the day.
- Limit sugary and acidic drinks: Water is the safest drink. Try having tea and coffee without sugar.
- Support your saliva: Drink enough water; if you have a dry mouth, talk to your dentist.
- Make use of preventive treatments: Fissure sealants and fluoride varnish for children, and professional fluoride applications for high-risk adults, may be recommended.
- Go for regular check-ups: Depending on your level of risk, check-ups are usually recommended every six months to once a year.
Does using clear aligners increase the risk of decay?
Clear aligners do not cause decay on their own, but they can increase the risk of decay when the rules of use are not followed. Because aligners fit tightly around the teeth, they limit saliva's access to the tooth surface. If you drink a sugary drink with your aligners in, or put your aligners back in after eating without brushing, sugar and acid get trapped between the teeth and the aligner and stay in contact with the enamel for a long time. This can cause white spots, especially at the necks of the teeth and around the attachments.
The basic rules for preventing decay while using clear aligners are:
- Drinking nothing but water while your aligners are in
- Not putting your aligners back in after a meal without brushing and cleaning between your teeth; if brushing is not possible, at least rinsing your mouth thoroughly with water
- Cleaning the aligners themselves every day
- Avoiding frequent snacking throughout the day; this both shortens your aligner wear time and increases the risk of decay
- Keeping up with the fluoride applications and check-ups your dentist recommends
Cleaning your aligners correctly is also important for the health of your teeth; for details, you can read our article how to clean clear aligners.
When should you get an exam in Ankara if you suspect tooth decay?
If you have noticed white or brown spots on your teeth, sensitivity to sweets or cold, or a hole where food gets stuck, or if it has been a long time since your last check-up, it is a good idea to have an examination. At our clinic in Park Oran Ofis in Oran, Çankaya, we assess your risk of decay, examine areas that are not visible to the eye with X-rays if needed, and share a treatment plan suited to the stage with you.
Frequently asked questions
Does tooth decay go away on its own?
Decay that has formed a cavity does not go away on its own and gets worse over time. Only early decay in the white spot stage can be stopped and remineralize with fluoride and good oral care.
Does a decayed tooth need treatment if it does not hurt?
Yes. Many cavities progress without pain; by the time pain starts, the decay has usually come close to the nerve. A small filling done early can prevent the root canal treatment that might be needed later.
Should decay in baby teeth be treated?
Yes. Decay in baby teeth can cause pain and infection, can affect the permanent tooth developing underneath, and early tooth loss can disrupt the alignment of the permanent teeth. For this reason, decay in baby teeth should also be treated.
Is tooth decay contagious?
The bacteria that cause decay can pass from parent to baby through saliva, for example by sharing a spoon or a pacifier. For this reason, parents are advised to look after their own oral health and not to put the baby's spoon in their own mouth.
