Rotten Teeth and Tooth Decay: Stages and Treatment

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You may develop rotten teeth if you let your dental care lapse, but the good news is rotten teeth are usually treatable.

Tooth decay is a common problem among people of all ages, especially children and older adults¹. It’s usually easily treated by a dentist, and often easily prevented by good oral hygiene. However, if left unchecked, tooth decay can lead to painful and unsightly rotten teeth. 

If you suspect you or your child has a rotten tooth, it’s likely difficult to undo the damage already done – but it isn't too late to help improve the condition of teeth that have begun to fall into disrepair. Failing to act quickly can likely lead to even more dental pain, expensive treatment, and even permanent tooth loss. It can likely negatively affect your health, your appearance, and even your finances – especially if you don’t have dental insurance. Learn the most common stages of rotten teeth, how to help prevent rotten teeth, and how to treat rotten teeth.

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What is tooth decay?

Tooth decay, or a rotten tooth, is a permanently damaged area on the tooth’s surface². It occurs when decay-causing bacteria in your mouth generate acids that attack the tooth’s surface or enamel³. People of all ages can get tooth decay once they have teeth.

Typically when caught during the early stages, tooth decay is relatively easy for a dentist to identify, treat, and reverse. However, if left unchecked, an untreated cavity or rotten tooth can become larger, gradually affecting deeper and deeper layers of the tooth.
Stages of rotten teeth and tooth decay to watch out for

Typically, teeth decay and rot gradually, not all at once. There are various stages⁴ of rotting teeth and tooth decay to watch out for. It’s a good idea to check for these signs in your own mouth as well as for your children, especially if they’re experiencing tooth pain. Look for these common signs of tooth decay to know whether you need to go to the dentist about rotten teeth: 

  • Stage 1: White spots on teeth - If you notice white spots starting to form on your teeth, this may be one of the first signs of the presence of tooth decay. White spots on teeth typically occur when calcium is lost, and plaque starts to build up on the teeth and gums. The plaque begins to form an acid that eats away at tooth enamel, causing the spots. By visiting the dentist regularly for routine cleanings and brushing with fluoride toothpaste, you may be able to undo the damage of tooth decay and help prevent it before it gets any worse.

  • Stage 2: Decaying enamel - If tooth decay hasn’t been prevented after white spots start to appear on teeth, the next stage of rotting teeth that occurs is typically the erosion of dental enamel. Once enamel wears away from a tooth, there is no natural way to replenish it. However, you can still help stop this tooth decay from getting any worse. Make sure you’re practicing good oral hygiene at home and regularly visiting the dentist for routine cleanings. 

  • Stage 3: Decaying dentin - At this stage, tooth decay becomes more severe. Tooth rot typically moves from the enamel, or surface layer of the teeth, to the dentin, the layer between the enamel and the pulp. Once the tooth’s dentin begins to decay, you may experience more intense pain since the next layer, the pulp is the tooth’s center and contains the living tissue of the tooth. A cavity can form at this stage. If so, a dental filling will likely be needed to restore the tooth and prevent further rot.

  • Stage 4: Pulp damage and infection - If left untreated, tooth decay can continue beyond the dentin to the pulp of the tooth. If the pulp of the tooth is infected, pus can build up, which may likely kill off the tooth’s nerves and blood vessels. Your dentist may need to take more drastic measures such as performing a root canal to save the tooth and make sure you don’t lose it altogether.  

  • Stage 5: Abscess forms - If your tooth reaches this stage, it is likely that serious damage has occurred and a tooth abscess may form. A tooth abscess is formed when pus builds up at the root-tip in the jawbone. Tooth abscesses can be very painful. They can also cause fever, swelling, redness in the gums, and a bad taste in the mouth. If severe enough, an abscess can even cause an infection to occur in the adjoining bones. If your rotten tooth gets to this stage, oral surgery will likely be necessary to treat the abscess and underlying infection and relieve tooth pain.

  • Stage 6: Tooth loss occurs - Without treatment, the rotten tooth may die off and become blackened because of the infection and decay. If this happens, a tooth extraction will be necessary to remove the dead tooth. Your dentist may recommend a bridge or a crown to restore the appearance of your smile, once the area has fully healed.

Common symptoms of rotten teeth

The rotten teeth symptoms you experience might vary depending on what stage of tooth decay your tooth is in and what the underlying cause is. If you’re experiencing any or multiple of the following symptoms, consider setting up an appointment with your dentist⁵.

  • Tooth pain

  • Tooth sensitivity

  • Grey, brown, or black spots appearing on your teeth

  • Bad breath

  • An unpleasant taste in your mouth

It’s important to note that some cavities and tooth decay can go undetected, with no symptoms or changes to the tooth’s appearance. That's one reason it’s so important to schedule regular dental visits – a professional can identify and treat cavities early to stop teeth from rotting and requiring more serious treatment. Even if you don’t think you have any rotten teeth, make sure you still visit your dentist twice a year for routine care.

How to prevent rotten baby teeth

About one in five children aged 5 to 11 years old have at least one untreated decayed tooth – and children aged five to 19 years from low-income families are twice as likely to have cavities than children from higher-income households⁶. The good news is that cavities are typically preventable. Studies show that fluoride varnish can prevent 33% of rotten baby teeth⁷. 

Though baby teeth eventually fall out, they’re important to a child’s health and development. They help your little one chew, speak, and smile. If a baby tooth is lost too early due to a rotten tooth, the permanent teeth can drift into empty space and cause teeth to be crooked or crowded. It’s important to help your children practice good oral hygiene starting from a very young age, both to help prevent rotten baby teeth and to help them develop good oral hygiene habits going forward.

How to help prevent rotten baby teeth for babies

Good oral hygiene starts early – sometimes even before your little one has any teeth at all. Wipe your baby’s gums twice a day with a soft, clean cloth in the morning after the first feeding and right before bed. This can wipe away bacteria and sugars that can cause cavities. As teeth start to come in, brush twice a day with a soft, small-bristled toothbrush and water⁸. Visit the dentist after your baby’s first tooth appears but no later than the first birthday so you can spot any signs of problems early⁹.

How to help prevent rotten baby teeth for kids

Young children can’t adequately care for their teeth and gums on their own. For children under three, it is recommended to start brushing their teeth twice a day with fluoride toothpaste¹⁰. Have them drink tap water that contains fluoride when possible and ask your child’s dentist to apply dental sealants whenever appropriate¹¹. For children aged three to six, it is recommended to use a pea-sized amount of toothpaste and watch them brush until they have good brushing skills¹². Make sure they don’t swallow their toothpaste.

How to treat rotten teeth

If you or your child is just beginning to experience tooth decay, the time to start practicing better oral hygiene is now. If you start to see early signs of decay, such as white spots on the teeth or worn-away enamel, evaluate your home oral care habits. Improving daily oral care can help stop the process of tooth decay and prevent larger, more painful, and more expensive problems later.

Some stages of tooth decay require treatment from a dentist. If you suspect you or your child might have rotten teeth, set up an appointment with your dentist. They may have a good idea of what stage of tooth decay you have and what actions you can take to treat it. 

Depending on the stage of tooth decay you have, your dentist might recommend one of the following procedures:

  • Dental filling

  • Root canal 

  • Oral surgery

  • Tooth extraction

Even if you have rotten teeth, it’s still possible to help relieve your pain and restore your smile to its former brilliance. Your dentist can help you figure out what option is best for you.

How to help prevent rotten teeth and tooth decay

Preventing tooth decay generally comes down to simple habits that typically only take a few minutes of your time each day.

If you have concerns about rotten teeth, you can begin to improve existing habits and start new ones to help improve your oral health. Practice the following common habits to help prevent rotten teeth and other dental disease¹³:

  • Brush your teeth twice each day with a fluoride toothpaste

  • Clean between your teeth daily, using floss or another interdental cleaner

  • Eat a healthy diet that limits sugary foods and drinks

  • See your dentist regularly for the prevention and treatment of oral disease

  • Drink fluoridated water

Use dental insurance to help with the cost to treat rotten teeth

Dental insurance can help you reduce the cost of both preventing and treating rotten teeth. Most dental insurance cover preventive treatments such as checkups and routine cleanings, allowing you to visit the dentist and catch tooth decay before it develops into rotten teeth.

If you’ve already developed rotten teeth, dental insurance can help reduce the cost of treating and restoring them as well. Procedures such as dental fillings, root canals, extractions, and oral surgery can be expensive without dental insurance, typically costing hundreds or even thousands of dollars. Dental insurance can help cover these costs.


This is not dental care advice and should not be substituted for regular consultation with your dentist. If you have any concerns about your dental health, please contact your dentist's office.

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