Tooth Decay and Toothache

Cavities · Dental Caries · Toothache

Symptoms and Complications

In the early stages, tooth decay rarely causes symptoms. But when tooth decay has been present for a long time, the most common symptom is a toothache or sensitivity to hot, cold, sweet, or pressure. Another symptom may be a bad taste in your mouth.

The most common complication occurs when tooth decay reaches the nerve, the root, and the area at the base of the tooth. When this happens, the tooth nerve may die and, if left untreated, an abscess can develop.

Making the Diagnosis

A dentist can identify tooth decay with an oral examination. Cracks and small holes can be detected by your dentist, and decay causes these areas of the tooth to soften.

Dental X-rays are sometimes needed to detect tooth decay that has not yet caused symptoms or is in between teeth.

Treatment and Prevention

The treatment for tooth decay depends on its severity. But once tooth decay has destroyed part of a tooth, the tooth cannot regenerate. Dentists will recommend a treatment that preserves the tooth or teeth and also prevents complications.

If the decay has just started, it may be possible for you to stop the process with a professional cleaning followed by fluoride treatments. Fluoride helps tooth enamel to recalcify, which repairs the enamel.

If you have a cavity, the standard treatment is a filling. With a filling, the decayed tooth material is removed and replaced with a hard material such as amalgam (a mixture of several metals), gold, porcelain, or composite resin. Crowns, or "caps," are used if the decay is extensive and removing the damaged parts leaves the tooth structurally weak. Crowns are made of gold, zirconia, porcelain, or a combination of porcelain and metal, or porcelain and zirconia. You may need a root canal if the nerve of your tooth becomes infected or dies.

If teeth are so badly decayed that they have to be removed, they may need to be replaced with artificial teeth. This may mean a bridge, implants, or dentures. Bridges are typically composed of three or more artificial teeth joined together. These are cemented in place and do not come out. With implants, a titanium pin is inserted into the supporting bone, which fuses with the bone to grip it firmly and make it stable. Once it's secure, a single artificial tooth can be attached to it. Multiple teeth can also be replaced with implants. Dentures are a form of removable full or partial set of teeth. They are usually fixed to adjacent teeth by clasps or various chemical fixatives. Implants can also be used to hold the dentures in place, these can be screw-in or snap-in type.

Good oral hygiene is the most important way to prevent tooth decay. Take care of your teeth and gums by brushing your teeth, flossing, and visiting your dentist regularly.

Tips for brushing your teeth:

  • Brush at least twice a day with fluoride-containing toothpaste.
  • Use a soft toothbrush and ensure that you brush gently for at least 2 minutes a day (most people do not brush long enough).
  • An electric toothbrush cleans better than a manual toothbrush.
  • Place the toothbrush at a 45-degree angle where the teeth meet the gums.
  • Brush gently in a sweeping movement. Vigorous brushing can damage gums and teeth.
  • Make sure that all tooth surfaces are brushed.
  • Remember to brush your tongue.

To clean babies' teeth, use a gauze square to wipe the teeth clean until a toothbrush can be used.

Tips for flossing:

  • Floss at least once a day.
  • Floss gently, because harsh flossing can damage your gums.
  • Remember that if your gums bleed, you may be flossing too hard, or your gums may not be healthy. See your dentist for advice.
  • A water flosser (e.g., Waterpik®) may replace flossing and control bacterial growth at the gum line.

These other tips may also help prevent cavities:

  • Eat nutritious meals and limit snacking. If you must eat sweet foods, do so during regular meals, when your mouth contains more protective saliva.
  • If you chew gum, switch to a sugarless brand. Chewing gum that contains xylitol also has decay preventative properties.
  • If your water supply does not contain fluoride, talk to your dentist about fluoride supplements.


Paul Fotek, DMD, MS, Diplomate of the American Board of Periodontology, Florida Institute for Periodontics & Dental Implants, West Palm Beach, FL. Review provided by VeriMed Healthcare Network.

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The contents of this health site are for informational purposes only. Always seek the advice of your physician or other qualified healthcare provider regarding any questions you may have about a medical condition.

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