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Tooth decay begins with the Streptococcus mutans bacteria. These bacteria join with food particles and fluids in the mouth to create plaque, a constantly forming biofilm which sticks to the surface of tooth enamel.
The bacteria in plaque convert the sugars in our foods into lactic acid. When plaque remains on the tooth, these acids erode the calcium phosphate minerals which make enamel the hardest substance in the body. This process, called demineralization, creates weak spots in the tooth surface.
Over time, a weak spot will become larger and deeper until a hole, or cavity, forms in the enamel.
Because tooth enamel isn’t living tissue, it can’t regenerate or grow back. Once bacteria and acids have created a deep enough cavity, only a dentist can repair it by removing the decayed area of the tooth and restoring the tooth’s structure.
Without treatment, a cavity will continue to grow until it erodes the enamel and spreads into the interior of the tooth. Treatment for tooth decay will depend on how far the decay has progressed.
Early signs of demineralization can show up as white spots where minerals have been stripped from the enamel. Demineralization is sometimes reversible with a professional fluoride treatment that remineralizes and strengthens tooth enamel.
For small cavities in the enamel, a filling is generally recommended. The dentist will remove any decay, clean the area, and fill the tooth. Filling options include color-matched composite, silver dental amalgam, and gold fillings.
Dentin lies just below tooth enamel. When decay reaches the dentin, it spreads more quickly because dentin is much softer than enamel. More extensive decay might require a larger filling or a crown.
Left untreated, a cavity can grow until it reaches the living pulp inside the dentin. The pulp contains blood vessels and nerves, and, once damaged or infected, will require a root canal procedure and a crown to save the tooth.
When decay is so extensive that a tooth cannot be saved, extraction becomes necessary. A dental implant is often the best choice to replace a lost tooth because it prevents shifting in the remaining teeth and helps maintain jawbone density.
While there are many options for treating cavities, prevention is always best. Working together with your dental team, you can help prevent cavities with healthy dental habits and proactive treatments:
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