Decay is a bacterial process that begins in the enamel of the tooth and, left untreated, advances into the dentine, the pulp and the surrounding bone. Caught early, a filling may be enough; in more advanced cases root canal treatment or extraction can become necessary.
From the moment decay starts to the point it runs deep, it passes through four stages.
01 · Enamel decay
A white or brown mark on the surface. It is painless. It can be reversed with fluoride application and good oral care.
02 · Dentine decay
The enamel has been breached and the dentine reached. Sensitivity to cold and heat may begin. A composite filling is required.
03 · Pulpal decay
The decay has reached the nerve of the tooth (the pulp). There is throbbing pain. Root canal treatment is necessary.
04 · Abscess and loss
The infection has spread to the root tip, an abscess has formed or the tooth has lost its structural integrity. Extraction and an implant may be considered.
What is done according to the depth of decay?
Discoloured mark, no pain
A change in colour visible on the surface. Fluoride application, good care and regular check-ups may be enough. A routine appointment is recommended.
Sensitivity, visible cavity
There is sensitivity to cold and heat, and the decay is found by eye or on an X-ray. A composite filling is placed. An appointment within a week is appropriate.
Throbbing pain, large cavity
The pulp is affected; root canal treatment is required. Where there is a risk of abscess, same-day emergency assessment is recommended.
Decay is diagnosed in four steps.
Visual examination
Assessment of the tooth surfaces and the spaces between the teeth under light and magnification. Early decay can be identified by a change in colour.
Periapical X-ray
This is critical for finding approximal decay (between the teeth) that is not visible on the tooth surface, and secondary decay beneath existing fillings.
Laser fluorescence or fibre-optic tests
Supplementary diagnostic methods that can detect early demineralisation of the enamel surface before it is visible to the clinical eye.
A written treatment plan
Depending on the depth of decay, the options of a filling, an inlay, a crown or root canal treatment are set out in writing along with the alternatives.
