Progression of Dental Decay

Patients who fail to maintain proper oral hygiene will begin to experience tooth decay. The degree of tooth decay will depend on the length of time that the tooth decay has remained undiagnosed and untreated.

The stages of tooth decay are:

  1. Initial decay affecting a small area of the enamel
  2. Medium-sized decay affecting the enamel and dentin of the tooth
  3. Large decay affecting also the pulp and nerve tissue

Gross decay affecting the entire tooth, often associated with abscess, tooth fractures and a poor prognosis for saving the tooth


At this early stage, a small cavity will begin to break down the tooth’s enamel. While enamel is the strongest substance in the human body, once compromised, it will begin to decay fairly quickly.  At this stage, depending on the tooth area affected, patients may experience tooth sensitivity to hot and / or cold foods and drinks, sweets, or may show no symptoms at all. Dental decay at this stage is often ignored by the patients but easily diagnosed during a routine cleaning and checkup visit with x-rays.

Initial decay is quickly and easily treated with a dental filling in a single office visit.


If left untreated, a small cavity progresses to a medium sized cavity, which has now reached the tooth’s dentin. It now affects the patient’s ability to chew properly and it more often than not will cause pain and sensitivity. A medium-sized cavity also compromises the tooth integrity and depending on size and position of the tooth, will make the tooth prone to fracturing.

Depending on the extent of decay, the treatment options at this stage include an inlay, onlay or crown. All three of these options are permanent, lab-fabricated, custom made porcelain restorations. They typically require two visits to the dental office and take about 2-3 weeks to complete.


If left untreated, a medium sized cavity will quickly progress to a large cavity involving the pulp and nerve tissue of the tooth. The rate of decay at this stage accelerates sharply. Once the cavity enters the tooth’s dentin, it no longer needs to face the strong resistance from the tooth’s enamel. In other words, the dentin is a much softer substance than the enamel, and quite literally “melts away” when invaded by the bacteria in the mouth.

Once the bacteria penetrates into the pulp and nerve tissue of the tooth, sharp – often extreme – pain occurs. An abscess is also common at this stage. The only treatment option available at this point is a root canal treatment, followed by a crown. A root canal treatment followed by a crown requires two to four visits to the dental office, spanning up to 3 months in treatment.

This is the last stage at which the tooth could still be saved with timely treatment. Unfortunately,


If left untreated, a large cavity progresses to a non-restorable condition known as gross decay. At this stage, an abscess is nearly certain to exist as well. The patient is highly likely to experience unbearable pain that no longer responds well to pain medications. The tooth can no longer be saved and must be extracted.

Once extracted, the tooth may or may not be replaced, depending upon the patient’s choice. The options for replacement include an implant or a 3-unit bridge. The time in treatment will be 3 to 12 months depending on the treatment option and the rate at which the patient heals following each treatment step.

If the tooth is not replaced, a number of adverse conditions occur in the patient’s health. In the mouth, neighboring teeth will begin to drift, leading to food lodgment, tooth decay and periodontal disease. Bone loss continues in the area of the missing tooth, leading to gum recession. Elsewhere in the body, particularly in patients with multiple missing teeth, stomach and other digestive system issues will begin to develop as the missing teeth have impacted the patients proper chewing function.