Tooth Decay

A cavity is a hole in the tooth that develops from tooth decay. Cavities form when acids in your mouth wear down (erode) your tooth’s hard outer layer (enamel). Anyone can get a cavity.

More than 80% of Americans have at least one cavity by the time they enter their mid-30s. Cavities are one of the most common chronic diseases affecting people of all ages.


Tooth decay on the outer enamel surface does not usually cause pain or symptoms. You are more likely to experience symptoms as decay reaches beyond the enamel into the dentin and pulp. There are five main tooth decay stages:

  1. Demineralization: During this first stage, you may notice small, white, chalky spots on your tooth. This is due to the breakdown of minerals in your tooth enamel.
  2. Enamel decay: Left untreated, tooth decay progresses and continues to break down your enamel. At this point, cavities (holes) may become noticeable. White spots may turn to a light brownish color.
  3. Dentin decay: Dentin is the layer just beneath your tooth enamel. It is much softer than your enamel. So, once plaque and bacteria reach this layer, cavities form faster. At this stage, you may notice teeth sensitivity. The spots on your teeth may also turn to a darker brown.
  4. Pulp damage: Your tooth pulp is the innermost layer of your tooth. It contains nerves and blood vessels that transport nutrients and keep your tooth alive. When cavities reach your pulp, you may feel pain. You may also start to notice redness and swelling in the gums around your tooth. The spots on your tooth may turn darker brown or black.
  5. Abscessed tooth: Left untreated, a deep cavity can cause infection. This results in a pocket of pus that forms at the tip of your tooth root. Symptoms may include pain that radiates into your jaw or face. You may also develop facial swelling and swollen lymph nodes in your neck. At this point, a tooth abscess can spread to surrounding tissues and other areas of your body. In rare cases, infection can even spread to your brain or to your bloodstream (sepsis).


Bacteria in your mouth feed on sugar, starchy foods and drinks (fruit, candy, bread, sodas, juice and milk). The bacteria convert these carbohydrates into acids.

Bacteria, acid, food and saliva mix to form dental plaque. This sticky substance coats your teeth.

Without proper brushing and flossing, acids in plaque dissolve tooth enamel, creating cavities, or holes, in the enamel surface.

Certain factors increase your risk of cavities, including:

  • Dry mouth (xerostomia). Certain conditions (like Sjögren’s syndrome), or medications (like antidepressants) can make you more likely to develop dry mouth.
  • Consuming sugary, starchy foods or drinks.
  • Gum recession.
  • Previous radiation therapy to treat head and neck cancer.


Twice-a-year dental check-ups are the best way to catch cavities early, before they worsen or grow larger. Dr. DiDonato will use a number of instruments to examine your teeth. A tooth with a cavity will feel softer when probed.

Digital x-rays will need to be taken. These images show decay before the cavity is visible.


A cavity gets worse every single day so the sooner you treat a cavity, the better your chance for a predictable outcome.Treatment depends on the severity of your condition and treatments include:

  • Fluoride

In the very early stages of tooth decay, fluoride treatments can repair damaged enamel — a process called remineralization. This can reverse the early signs of cavities. You may need prescription toothpaste and mouthwash, as well as fluoride treatments.

  • Fillings or crowns

Once a hole forms in your tooth, the decay is drilled out and the hole is filled with a composite resin, a tooth-colored material. If the cavity has advanced and too much of the tooth has been affected, a crown is placed and covers what is left of the tooth. This is necessary to strengthen the affected tooth.

  • Root canal therapy

Root canal therapy relieves pain from advanced tooth decay. During root canal treatment the tooth pulp, or nerve, is removed and those canals are filled. The remaining tooth structure is built up and a dental crown is placed to strengthen the affected tooth.

  • Tooth extraction

If root canal therapy isn’t possible, tooth extraction may be recommended. You may need a dental bridge or dental implant to replace a pulled permanent tooth.


Proper oral hygiene, including regular brushing and flossing, can get rid of plaque, acids and cavity-causing bacteria. Good teeth and gum care includes:

  • Brushing your teeth with a soft-bristled brush and fluoride toothpaste at least twice a day, and preferably after every meal.
  • Cutting back on sugary, starchy foods and drinks.
  • Daily flossing to get rid of food and plaque stuck between your teeth.
  • Dental check-ups twice a year with x-rays. You will need more frequent visits if you are prone to tooth decay, gum disease or other oral health issues.
  • Dental sealants to protect the top chewing surfaces of your teeth.


When tooth decay goes untreated for too long, you can lose a large portion of your tooth and need an extraction. Advanced tooth decay can lead to a severe infection inside your tooth and under your gums (tooth abscess). This infection can spread throughout your body. Rarely, infection from a tooth abscess can be fatal.


What does a cavity look like?

Though cavities are hard to see in the early stages, you might notice a small, white, chalky area on your tooth enamel. As the cavity worsens, you may see brown or black spots on your tooth.

What does a cavity feel like?

It depends on the severity of tooth decay. For instance, if you have a very small cavity that only affects your enamel, you won’t feel it. But when decay reaches the inner layers of your tooth, you may experience pain or sensitivity to heat, cold or sweets. Teeth sensitivity doesn’t always mean you have a cavity. But it’s a good idea to get it checked out, just in case.

What happens if you have a cavity for a long time?

Small tooth cavities turn into large cavities over time. As decay worsens, it affects the deeper layers of your tooth. This can lead to pain, infection and ultimately, tooth loss. Early treatment is essential for long-term oral health.

If a cavity hurts, is it too late?

If a cavity is painful, it means the decay has spread to the deeper layers of your tooth. At this stage, you’ll need a dentist to repair the cavity. When treated quickly, Dr. DiDonato may be able to save your tooth. She prefers to save your natural teeth but if a cavity results in an abscessed tooth, or the damage is too significant, you may need a tooth extraction.

If you think you have a cavity, call our office right away to schedule an appointment with Dr. DiDonato. (614).885.1215

Prompt, timely treatment is key.

Connect with us

New patient?

Contact us today to set up an appointment.

request an appointment
Referring doctor?

We’d love to help you serve your patients.

contact us