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Cavities 101: The Ins And Outs Of Tooth Decay In Houston, TX

Learn the basics of dental decay and cavities...

By Jennifer
Photography by Pete

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We all know the importance of flossing and brushing our teeth once and twice daily, respectively. These habits are vital for fighting off tooth decay and dental cavities. However, skipping your dental hygiene, snacking throughout the day, eating sweets and junk food, and even dry mouth lead to toothaches and cavities. Nearly everyone will get at least one cavity in their lifetime. By the time they’re 64, the average American will have had four to ten decayed or missing teeth.

At Nu Dentistry Houston, our dentists have seen our fair share of patients with tooth decay and dental caries. Let’s take a look at how these dental problems impact your smile…

The Stages of Tooth Decay

While “tooth decay” and “cavities” are often used interchangeably to describe the same thing, they are different. What is tooth decay? Dental decay is a dental disease caused by dental plaque and oral bacteria attacking your tooth. So what is a cavity? A cavity is a hole in your tooth that forms once tooth decay wears down the enamel enough. Cavities form partway through the tooth decay process. Your tooth decay treatment will depend on what stage your tooth is in.

Stage 1: Demineralization

In its earliest stage, tooth decay first appears as white and chalky patches on your teeth. The acids found in plaque and bacteria initially strip the enamel of crucial minerals like calcium that help strengthen and protect the tooth. You can reverse this demineralization with good at-home care since the enamel is only weakened but not injured.

Stage 2: Enamel Decay

As demineralization weakens the tooth, dental decay can gradually break down the enamel (and later the inner tooth). As decay burrows a small hole into your tooth, the first cavity forms. White tooth spots may also begin darkening. At this stage, the damage to your tooth is permanent and will need professional treatment.

Stage 3: Dentin Decay

Tooth decay eventually breaks through the hard outer enamel to attack the more vulnerable dentin layer below. Dentin is more sensitive than enamel, so you may notice twinges of discomfort or pain in your tooth that you didn’t before. Tooth decay will also pick up more speed as it wears down this softer layer of the tooth.

Stage 4: Pulp Decay

Below the dentin is the dental pulp. This is the most sensitive and vulnerable part of the tooth because it contains its nerves and blood vessels. Damage to this central dental layer will not only be painful but also put your tooth’s health at serious risk. The pulp runs down the tooth’s roots, and tooth decay can cause infection in these critical structures.

Stage 5: Tooth Abscess Formation

In the last stage, decay and oral bacteria may spill from the infected tooth’s roots into the surrounding gum tissues. This can create a pocket of pus called a tooth abscess. Abscesses are incredibly painful and potentially dangerous when left untreated. If the abscess bursts, the infection can spread to the rest of the mouth or even throughout your body.

What Does A Decayed Tooth Look Like?

As we’ve already mentioned, first-stage tooth decay shows itself as white spots on the enamel from demineralization. As dental decay starts breaking down the tooth’s surface, these spots can gradually darken to a brown, gray, or black, depending on the cavity’s severity. After a cavity forms, it can be seen as a visible pit, deepening as the cavity worsens. If an abscess forms, you may notice a white pimple on your gums as pus fills up the pocket below.

However, some of the signs of tooth decay aren’t so noticeable to the naked eye. They can still be difficult to ignore, especially as your cavity worsens and puts your tooth’s health at further risk. Other cavity symptoms include:

  • Persistent toothache
  • Sharp pain in your tooth when biting down
  • Halitosis (bad breath that won’t go away)
  • Intense tooth sensitivity to hot and cold
  • Lingering sensitivity to sweets
  • Tooth becoming numb

When a cavity becomes severe enough, your tooth pain may suddenly disappear. This is a blaring warning sign to see your dentist immediately. A numb tooth is often a sign that it is on the brink of death. In the last tooth decay stages, enough of the tooth’s dental pulp can be damaged or destroyed that the tooth’s nerve can no longer warn you about your cavity. Waiting too long for treatment may mean that a dentist can no longer save your tooth. It may need to be removed.

How To Get Rid Of Cavities

How is tooth decay treated? This depends on the stage of tooth decay.


If tooth decay hasn’t formed a cavity yet, you can reverse the damage with great dental hygiene habits. This doesn’t just mean brushing and flossing your teeth—though those are certainly important parts too. Instead, you need to start adding fluoride to your routine. Fluoride is a naturally occurring mineral that enriches tooth enamel and makes it more resistant to demineralization. While it is often used to strengthen teeth and prevent cavities, it can also remineralize teeth.

Fluoride is often added to drinking water, but we recommend using fluoridated toothpaste and mouthwash instead for more effective treatment. Dentists can also apply fluoride to your teeth with sealants after dental cleanings. If you use fluoride, do not eat or drink anything (including water) for at least 30 minutes. Otherwise, you will wash the fluoride away and keep your teeth from fully absorbing the mineral.

Dental Filling

Once dental decay causes a cavity, your tooth will need professional treatment. The first and most common way to repair dental damage is with a cavity filling. Dental fillings are typically used for smaller cavities. They can also reinforce the tooth and protect it from further deterioration. Dental composite is the most common material used for this tooth decay treatment. This tooth-colored resin is designed to match the rest of your tooth so that no one can tell your enamel from your filling.

To fill a tooth, your dentist will first numb your mouth with a local anesthetic. From there, we can get to work removing the cavity with a dental drill. Once the tooth is decay-free, it will be disinfected and filled with composite. The composite is cured and hardened with UV light, with minor adjustments made to ensure the filling fits and feels just like your tooth did pre-cavity. Depending on the cavity’s size, the entire tooth filling process takes 20 minutes to an hour.

Dental Crown

More extensive cavities may require a dental crown instead. While a cavity filling can fix a specific area of your tooth, dental crowns restore the entire tooth’s surface. This custom dental cap provides greater protection and reinforcement to your decayed tooth. Crowns can be made from different materials, each with its strengths and weaknesses:

  • All-Porcelain. All-porcelain crowns are often patients’ and dentists’ first choice for dental crowns. They offer the most natural appearance and can be made to match the rest of your smile. They are also very durable and can last more than 20 years.
  • Metal. Metal crowns are the strongest option, rarely cracking or breaking under pressure. However, their unnatural appearance means they are typically only placed on less visible back teeth. Metal crowns can last more than 30 years on average. Gold crowns are even more durable than base metals and can last more than 50 years—possibly even a lifetime.
  • Porcelain-Fused-To-Metal (PFM). PFM crowns are a combination of a metal base and a porcelain surface. This strikes a balance between aesthetics and durability. These crowns can last as long as all-porcelain while better preventing chips and cracks.

Root Canal

Once tooth decay reaches the pulp, you will need a root canal. Since the pulp is much more sensitive and complex than enamel or dentin, a specialist called an endodontist often performs this procedure. Like with a cavity filling or crown, all of the decay is removed via a drill. Especially deep cavities may require an entire tooth root or canal cleared out. A root canal can also help safely drain a dental abscess that might have formed.

With only healthy dental tissues remaining, your tooth will be disinfected and filled with a toothpaste-like substance called gutta-percha. Gutta-percha is rubbery to help hold the root structure together now that the tooth is much more brittle. It also acts as a seal to keep bacteria out. Finally, the tooth will need to be reinforced and strengthened to protect the hollowed-out and weakened tooth from future damage. This reinforcement is often a dental crown since it offers the best long-term and comprehensive protection. However, a dental filling may be used instead in some instances.

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