5 Stages of Tooth Decay

5 stages of decay text

Did you know there are five distinct stages of tooth decay? And, that in the first stage of decay, you can actually take steps to reverse the progression of the disease? Indeed, it’s true.

In the first stage of decay, whether you’re a child or an adult, the application of fluoride via fluoride treatments, your toothpaste, and even the local water supply can stop a cavity from penetrating through the enamel and reaching its second stage. Even the saliva in your mouth and the foods you eat help to re-mineralize a tooth in jeopardy. But that’s just the first stage! What about the rest? Understanding how a cavity progresses can assist you in preventing each successive stage from occurring in your children. There’s always a lot going on in that little mouth!

Stage One: White Spots

In stage one, the tooth begins to show signs of strain from the attack of sugars and acids, and white spots will begin to materialize just below the surface of the enamel. These white spots are representative of the demineralization of the tooth and can be easy to miss because they’re likely to occur on your child’s molars. A dental exam, of course, is designed to catch such cavities! Can you see why regular visits to the dentist are recommended? As mentioned previously, at this stage, the cavity can be repaired without the need to excavate the tooth. This is why we highly recommend keeping up with your six-month check-ups so Dr. Engle can spot these little spots before they turn into anything more serious. We may recommend a prescription-strength fluoride tooth-paste to help remineralize the teeth. 

Stage Two: Enamel Decay

Stage two marks the beginning of the end for the surface enamel that is being attacked. Initially, the tooth erodes from the underside outward, so the outer enamel will still be intact for the first half of this second stage. Once the cavity breaks through the surface of the enamel, there is no turning back, and your child will need to have the cavity corrected with a filling. 

Stage Three: Dentin Decay

If a cavity in your child’s mouth were to progress beyond stage two without you knowing, you’d tend to become aware of it when it started to hit stage three because it would probably start to cause some pain. At this level, the cavity begins to eat away at the second level of tooth material that lies beneath the enamel: the dentin. A filling can still be used to stop the onslaught of bacteria assaulting the tooth in order to prevent the cavity from reaching the tooth’s most critical component: the pulp.

Stage Four: Involvement of The Pulp

Once the cavity reaches the pulp, it’s going to hurt. A lot. So if you’ve unfortunately missed all the signs to this point, a screaming child or moaning teenager will certainly let you know there is a big problem. Stage four is serious, and a root canal is the only option of treatment at this stage, short of a complete extraction. We will typically refer patients who need root canals out to an endodontist. 


Stage Five: Abscess Formation

In the fifth and final stage of a cavity, the infection has reached the tip of the root and exited the tip of the tooth’s structure. This in turn infects the surrounding tissues and possibly the bone structure. Swelling would be commonplace and pain severe. In children (as well as adults) an abscess can be fatal if not dealt with immediately. Root canal or extraction would be the order of the day should decay reach this stage. If this is the case, please call us immediately at 520-744-7388, or call the endodontist who we refer to: Southern Arizona Endodontics 520-322-0800.


As you can see, cavities don’t happen overnight. In the early stages, regular visits can stall and reverse the progression of these dastardly little devils, so it really does pay to visit the dentist at pre-selected intervals. You can keep you and your kids far from stage five their whole lives, and if a little bit of prodding to get them to the dentist accomplishes that, you can rest easy despite the griping.

Author
Dr. Engle riding in the desert Dr. Engle Dentist and owner of Presidio Dental

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