Tooth decay: symptoms, treatment and prevention

Tooth decay can begin without pain. By the time marked sensitivity or a visible cavity appears, the lesion may already have progressed. Early diagnosis helps distinguish changes that can be managed from those that need a filling.

What is tooth decay?

Bacterial plaque forms continually on teeth. When bacteria metabolise sugars from food and drink, they produce acids that remove minerals from the enamel. If these episodes occur frequently and natural repair is insufficient, the lesion progresses.

Risk depends on how often sugar is consumed, hygiene, fluoride exposure, the quantity and quality of saliva, tooth anatomy and health factors. Two people with similar habits can therefore have different levels of risk.

What are the early signs?

An early lesion may appear as a chalky white spot without causing symptoms. As it progresses, brown or dark discolouration, a cavity, food trapping, sensitivity to cold, heat or sweet foods, and pain may develop. Decay between teeth may not be visible without an X-ray.

Not all staining or pain is caused by tooth decay. Discolouration, wear, gum recession, fractures, erosion and problems with the pulp can produce similar signs.

Can tooth decay be stopped without a filling?

Some early lesions that have not yet formed a cavity can be stabilised through plaque control, fluoride toothpaste, less frequent sugar intake and professional fluoride treatment or sealing where indicated. These areas need monitoring.

When there is a cavity that can no longer be cleaned or significant structural loss, a filling is usually needed. Delaying allows the lesion to get closer to the pulp, making treatment more complex.

How is it diagnosed?

The dentist combines the symptom history, examination under good lighting, surface assessment and, where needed, X-rays. Treatment decisions consider lesion activity, depth, whether the area can be cleaned and individual risk; an image alone does not replace an examination.

What does having a filling involve?

1. Managing discomfort: local anaesthesia is used where indicated.
2. Selective removal: affected tissue is removed according to the depth of the lesion, preserving healthy structure wherever possible.
3. Rebuilding the tooth: the tooth is restored with a material suited to the location, size and chewing forces.
4. Adjustment: the contacts between teeth, bite, shape and polish are checked.

A deep filling may cause temporary sensitivity. Report increasing pain, spontaneous pain, pain at night, swelling or a feeling that the filling is too high when you bite.

What happens if decay reaches the pulp?

If bacteria and inflammation reach the tissue inside the tooth, a simple filling may not be enough. Root canal treatment and a stronger restoration may be needed. When the tooth cannot be saved, extraction may be considered after discussing the alternatives.

How to reduce the risk of further tooth decay

• Brush twice a day with fluoride toothpaste, including before bed.
• Clean between your teeth daily with floss or suitable interdental brushes.
• Reduce how often you have sugary foods and drinks between meals.
• Avoid repeatedly sipping acidic or sugary drinks throughout the day.
• Attend check-ups at intervals based on your risk rather than waiting for pain.

Frequently asked questions

Does tooth decay spread from one tooth to another?

It does not travel between teeth like an infection, but the same risk factors affect several surfaces. Finding a lesion is a reason to assess the whole mouth and associated habits.

Does a filling last forever?

No. Longevity depends on size, material, bite, hygiene, diet and habits. A filling should be monitored and replaced only when clinically indicated.

Does brushing hard prevent tooth decay?

No. Technique, reaching all surfaces and fluoride toothpaste are more important than excessive force, which can injure the gums and wear down tooth surfaces.

Visit the page on restorative dentistry at Clínica Prisma to learn how dental lesions are assessed and restored.