What Happens When a Cavity Is Left Untreated

What Happens When a Cavity Is Left Untreated?

When you visit the dentist for your routine checkup, the last thing you want to hear is that you have cavities—a sure sign of tooth decay gone wild. You might be tempted to do nothing with early warning signs, but cavity progression due to non-action is real trouble. That’s what we’re going to look at today because tooth decay is a process of degeneration resulting in various stages of damage to a tooth.

The good news is, severe tooth damage doesn’t happen overnight, it actually takes some effort for tooth decay to turn into a full fledge cavity, or worse a root canal. In fact, if you catch it early enough then you may even be able to reverse the cavity.

But repeated exposure to sugars and acids will break down tooth enamel. And if you don’t address the decay, well, you’re looking at varying degrees of damage to a tooth (not to mention varying degrees of pain).

Know Your Tooth’s Anatomy to Understand Cavities

What Can You Do About Painful Sensitive Teeth

The part of the tooth that you can see is known as the crown, and it sits above the gums. Tooth enamel is a hard outer covering of the crown that is actually harder than bone! Tooth enamel can be thought of as the protection for the softer tissues & nerves inside of your tooth.

Dentin is the softer tissue right below the enamel that envelopes the pulp. If you looked at it under a microscope you’d see that it has small hollow canals. So when this layer of the tooth is exposed, then things like heat, cold, or acid are able to reach your nerves (aka sensitivity and/or pain sensors).

The root is the part of the tooth that lies underneath the gums. And it’s outer covering is called cementum which is a calcified, bonelike substance protecting the tooth root.

The pulp is the heart of the tooth, and it houses the blood vessels and nerves which nourish the tooth and keep it alive.

What Causes Tooth Decay?

It’s really pretty simple. It’s the acid by-product of bacteria (biofilm) that causes tooth decay—and gum disease but that’s another topic for a different day.

Knowing how to keep the bacteria at bay can help you prevent cavities in the first place.

First, take a look at your diet. Regularly consuming foods (and drinks) high in sugars feed oral bacteria and produce plaque and tartar.

How? When you eat or drink sugary things and then forget to brush your teeth or accidentally miss a spot, the debris sticks to your teeth. The longer this sits in your mouth, the more of a chance the oral bacteria gets to turn those sugars /carbs into acids.

Acid attacks the enamel and starts to break down the tooth. Sugary habits, coupled with poor oral hygiene actively court tooth decay.

This is why you brush your teeth at least twice a day, floss at least once daily to remove plaque. And is why you need to see our hygienists at regular intervals for professional cleanings to remove tartar, & examine your gums. As well as annual exams by Dr. Powell so he can look for any signs of problems so they can be caught early.

If these precautions are not taken consistently, you’re going to invite decay and cavities into your smile. Now let’s take a look at what it looks like when decay is allowed to stay.

The 5 Stages of Cavity Progression

When it comes to cavity progression, there are five main stages. This is your body’s way of trying to let you know that something not-so-great is going on.

Not only are we’re going to dive into the progression of decay, but also into some general solutions at each stage.

Which is why we have to preface (yes, again) that good home-care with proper tools, and regular dental visits are not only preventative in nature but imperative in making sure that the condition does not get worse.

5 Stages of Cavity Progression

Stage One: Demineralization

This is where you start to see the handiwork done by sugars and acids attacking the tooth enamel. The hardness of the tooth is essentially being compromised. You’ll notice chalky white spots forming and often times they will darken as they are more prone to stains. These spots are letting you know that the enamel is demineralizing because calcium is being lost.

The steps you need to take at this point: 

At this stage of cavity progression, the tooth can be naturally restored and the damage reversed with the help of diligent oral hygiene, office fluoride treatments, prescription toothpastes, and the minerals that are present in your saliva. Make changes to your diet and eat foods that promote remineralization (like cheese & milk), and avoid the foods that cause demineralization.

Stage Two: Enamel Decay

This is where the surface enamel continues its march to erosion. Once the decay breaks through the surface enamel, it’s likely you will need a dental filling to halt the bacterial progression and restore a protective layer. You may experience some sensitivity/pain at this point or you might not feel anything at all.

Waiting for pain is a bad game to play, because that means more damage has been done. It’s more cost-effective to fix things when they are small not to mention who really likes to have tooth pain?! (Not us!)

The steps you need to take at this point: 

If your dentist says you need to have a filling done. Get the filling. Don’t wait and let the decay increase the area of damage and move deeper into the tooth. At this point the lesion isn’t very large and a composite filling will usually solve the problem.

Stage Three: Dentin Decay

At this level of cavity progression, tooth decay starts to hurt. This is because the decay has gained access to the nerves (remember those little canals we mentioned before? They’re like slip-n-slides right to the heart of your tooth). While the decay is going deeper into that tooth it’s also rapidly destroying the softer dentin layer below the enamel.

The steps you need to take at this point: 

To stop the bacterial progression at this stage a larger restoration will typically be needed. This will keep the decay from getting to the vital part of the tooth, the pulp. The type of restoration you need at this point can vary. Again, depending on how long the bacteria has gone unchecked & how much damage it has done.

A dentist may use a larger composite filling, or an inlay (although these aren’t too common since insurances typically try to down-grade & pay for fillings. But cash patients can typically reap the benefits of an inlay).

If your cavity is too large for those types of restorations (aka more tooth structure needed to be removed and repaired), then it will require a major restoration. Such as an onlay which conserves more natural tooth structure than a crown,  or a dental crown which is basically a rebuild of the entire tooth structure above the gums.

Stage Four: Pulpal Decay

At this stage, we’re not going to lie, you’re probably going to be hurting. You’ll know something’s wrong, and if it’s gotten this far, you’re going to need a root canal to clean out the bacterial infection. This is because pus is irritating the tissues, making the nerves, blood vessels, and connective tissue in the pulp die.

The steps you need to take at this point: 

Obviously, you’ll need to see a dentist. Depending on the severity of the pulp damage your dentist may even refer you to a root canal specialist (aka an endodontist). The endodontist will clear out the infection that is in the tooth root. After the root canal treatment is preformed, in a week or so you’ll return for a follow-up. If the tooth is healing fine then you’ll be cleared to return to the dentist.

Seeing your dentist after a root canal is a must, as they will permanently seal the canal and restore the part of your crown that was damaged.

We see this happen all too often where a patient no longer feels pain so they don’t finish treatment, but then end up needing another root canal!

Stage Five: Abscess Formation

This is the final stage in cavity progression. At this stage, the pulp is damaged. Bacteria and decaying pulp remnants cause an infection at the tip of the tooth’s root. Thus, a pus-filled pocket forms.

The infection impacts the rest of the tissues surrounding the pulp and bone material. There’s typically going to be swelling and lots of pain. The side of your face by the abscess may even be swollen.

What’s scary is you might not feel any pain until things get really really bad and then the pain is intense. However, regular trips to the dentist should catch the abscess in radiographs which means you can take action before you experience any real pain.

The steps you need to take at this point: 

You’ll pretty much need a root canal (in order to try and save the tooth), and/or you might need have surgery to open the abscess and drain it. Both typically require antibiotics. If the tooth cannot be saved, then you might have to have the tooth extracted.

Missing teeth come with their own set of progressive problems so this should try to be avoided if possible. However, if the tooth is lost, then a dental implant could be a great option to replace it.


As you can see, severe cavities don’t crop up overnight and catching a cavity early saves you time, money and pain. The smaller the problem, the quicker, the least costly, and least invasive the treatment. Of course, the very best protection is prevention, and that’s why we want you to make your daily oral hygiene care a priority! Clean your mouth daily, see Dr. Powell every six months, and eat a well-balanced diet that’s rich in vitamins and minerals (and low on sugar).

At Exceptional Dentistry, we are your advocates for preventative health. That’s why, when you come in for your dental exam and cleaning, Dr. James Powell uses the SOPROLIFE intraoral camera. This intraoral camera lets him view the inside of your mouth to find tooth decay before it even has the opportunity to damage the tooth surface. This early cavity detection is just what the doctor ordered!

No matter which stage your decay is in, we’re here for you!

Please call us at (661) 349-7725 today to book your reservation or stop by our state-of-the-art dental office in Palmdale, CA. You can also schedule your visit online.

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