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Tooth Decay

Tooth decay is the destruction of tooth material, which includes:

  • Enamel — the hard outer surface of the tooth
  • Dentin — the second softer layer beneath the enamel
  • Pulp — the inside of the tooth containing the nerve and blood supply
  • Root — the area of the tooth anchoring it in the bone


Bacteria eat sugars left on your teeth, which then creates acid. The acid and the bacteria form plaque and holds the acid to the teeth. Acid wears away teeth and can eventually lead to tooth decay.

Risk Factors

Anyone can develop tooth decay. Factors that may increase your risk of cavities include:

  • Having poor dental hygiene
  • Having high numbers of bacteria in your mouth
  • Having an insufficient amount of fluoride 
  • Taking medicine that contains sugar or causes dry mouth
  • Eating a diet high in sugar
  • Enamel erosion from gastroesophageal reflux disease or bulimia 
  • Being malnourished 
  • Having certain conditions that decrease the flow of saliva in the mouth, such as Sjogren syndrome or heartburn

Symptoms of Tooth Decay

Symptoms include:

  • Tooth sensitivity to hot or cold
  • Tooth discomfort after eating
  • Darkening of the tooth surface
  • Bad breath or a foul taste in the mouth
  • Throbbing, lingering pain in tooth

Diagnosis & Treatment

A dentist checks for tooth decay by:

  • Asking about pain in the teeth
  • Visually inspecting the surface of the teeth
  • Probing teeth with dental instruments to check for:
    • Sensitivity
    • Pain
    • Softness
    • Surface defects
  • Taking X-rays of teeth

Sometimes tooth decay repairs itself. This is most likely if it's caught early.


When decay reaches the dentin, your dentist will remove the decay and use dental filling to repair the hole.

Root Canal

Root canals treat tooth decay that reaches the pulp and/or root of the tooth. Your dentist removes pus and dead tissue from the tooth and cleans the inside of the tooth and the root canals. Your dentist then seals the root canal with a permanent filling and places a crown to protect the tooth.

Tooth Extraction (Removal)

Your dentist may need to remove your tooth if:

  • Tooth decay and/or tooth infection is too extensive for filling or root canal
  • A break or crack in the tooth that has allowed for decay is too severe for repair
  • An extensive infection exists between the tooth and gum
Once removed, your dentist will replace the tooth with either a partial bride, dentures or a tooth implant.

How to Prevent Tooth Decay

Measures that help prevent and stop tooth decay include:

  • Proper dental hygiene, including:
    • Brushing teeth with fluoride toothpaste after meals or at least twice per day
    • Daily flossing between teeth and gums
    • Getting regular dental check-ups and teeth cleaning
  • Limiting the amount of sugar and carbohydrates you eat and drink
  • Rinsing your mouth with water after eating sugars
  • Replacing your toothbrush every 3 to 4 months
  • Avoiding sugar-containing drinks
  • Chewing gum with xylitol or sorbitol

Talk to your dentist about the use of a sealant, a protective plastic covering for teeth. Sealants usually last anywhere from 5-15 years.

Prevention is particularly important for children. Supplemental fluoride can prevent early decay. Most local water supplies have fluoride, but it can also be applied to permanent teeth as a long acting varnish. Re-varnishing is usually necessary at least twice yearly. 

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Content was created using EBSCO’s Health Library. Edits to original content made by Rector and Visitors of the University of Virginia. This information is not a substitute for professional medical advice.

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