At What Stage Of Decay Do Teeth Begin To Fall Out?

Unfortunate Fading - At What Stage Of Decay Do Teeth Begin To Fall Out?

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Tooth decay is one of the main disorders related to teeth, which, if not controlled, can not only cause the loss of teeth but also the origin of many diseases.

Understanding the progression of caries and the critical points at which teeth become vulnerable to loss is essential for effective dental care and the prevention of unwanted and unpleasant consequences.

In this article, from drhealthandbeauty by Dr.Sanaz, we will dive into the stages of tooth decay, the symptoms associated with each stage, and the available treatment options. We will also address the important question: when and why do teeth become vulnerable to loss?

Stages of tooth decay

Plaques play an important role in tooth decay. Plaque is a sticky and colorless layer that covers the surface of the teeth. 

Plaque is create by  food particles, bacteria, and saliva. If you do not brush and floss regularly, the accumulation of plaque on the teeth will increase. 

Related: “What Is The Cause Of Tooth Decay Despite Brushing?”

The increase in plaque over time leads to the formation of a solid structure called tartar. tartar is harder to remove than plaque.

In the continuation of this article, we will review the stages of decay and the symptoms and treatments of each stage, and we will also provide criteria for how to diagnose each stage at home.

Before starting, you should note that it is challenging to diagnose the different stages of tooth decay at home because it requires a detailed examination by a dental specialist using specialized tools and techniques. 

However, there are signs and symptoms that you can look out for that may indicate the presence of tooth decay in different stages.

  • Stage 1: Demineralization (primary decay):

    The outer layer of your teeth is made up of a tissue called enamel. Enamel is the hardest tissue in the body and is mostly composed of minerals. However, when the tooth is exposed to acids produced by plaque bacteria, the enamel begins to lose these minerals.

When this happens, a white spot may appear on one of your teeth. This loss of minerals is the first stage of tooth decay.

    • Symptoms

      In this early stage, there may be no noticeable symptoms. However, when tooth enamel begins to demineralize, tooth sensitivity to hot or cold foods may increase.

    • Diagnosis at home:

      The high level of sensitivity to hot or cold foods and drinks may be an early symptom. You may also notice white spots on the enamel.

    • Treatment in stage 1

      If the tooth is in this stage of decay, using fluoride can prevent the progress of decay. Fluoride therapy can be done in the dentist’s office. In this situation, fluoride is usually applied in the form of gel or varnish on the teeth.

Fluoride strengthens tooth enamel and increases its resistance.

  • Stage 2: enamel decay:

    If the process of tooth decay is not stopped in the first stage and continues, the tooth enamel will break down further. Moreover, it causes the white spot on the tooth to turn dark brown. As tooth enamel weakens, small holes called cavities form in your teeth. Cavities should be filled by your dentist.

    • Symptoms

      As the caries progresses, the erosion of tooth enamel becomes more noticeable. People may experience toothache, especially when consuming sweet, hot, or cold foods.

    • Diagnosis at home:

      The appearance of brown or black spots on the tooth surface may indicate more advanced decay. Toothache, especially when consuming sweet, hot, or cold foods, can also be a symptom.

    • Treatment in stage 2

      When decay reaches this stage, it usually creates a cavity in the tooth, which must be filled with restorative materials. For restoration, the dentist first shaves off the decayed section of the tooth and then fills the tooth using dental filling materials such as resin, ceramic, or amalgam.

  • Stage 3: Dentin decay:

    Another stage of tooth decay is dentin decay. Dentin is the tissue that is under the tooth enamel and is softer than the tooth enamel, which makes it more sensitive to acid damage. For this reason, tooth decay progresses faster when it reaches dentin.

Dentin also contains tubules that lead to the nerves of the tooth. For this reason, when the dentin is affected by tooth decay, you may experience tooth sensitivity.

    • Symptoms

When decay reaches the dentine layer, tooth sensitivity intensifies. Pain may become more persistent and have an impact on daily activities.

Related: “Tooth Pain, No Cavities, Treatment, And Remedies

    • Diagnosis at home:

      Increased tooth sensitivity, especially to temperature changes, is a common indicator. You may experience more persistent pain or discomfort.

    • Treatment in stage 3

      If stage 3 decay, which is related to dentin or dentin, is detected early, it can be treated using restorative materials. But if the decay has progressed, it is necessary to put a crown or veneer on the tooth.

A crown is a covering that is placed on the upper part of the tooth. Before placing the crown on the tooth, the decayed areas of the tooth are shaved. Sometimes, to place the crown on the tooth, parts of the healthy tissue of the tooth must be removed.

  • Stage 4: Pulp involvement (pulpitis):

    The pulp is the first layer of the tooth from the inside. It consists of blood vessels and nerves that help tooth health. The nerves in the pulp also create a sensation for the tooth. When the pulp is damaged, it may become irritated and start to swell. Since the tissues around the tooth cannot expand to accommodate this swelling, it may put pressure on the nerves and lead to pain. Related: “Treatment Of Tooth Infection Swelling

    • Symptoms

      In this advanced stage, decay reaches the pulp of the tooth, leading to severe pain, swelling, and possible infection. Pulpitis may lead to abscess formation.

    • Diagnosis at home:

      Severe toothache, swelling, and increased sensitivity are possible. The pain may be more constant and intense.

    • Treatment in stage 4

      Stage 4 caries occurs when the pulp of the tooth is damaged. In this situation, denervation or root canal treatment is needed for treatment. In root canal treatment, the damaged pulp is removed from the tooth. Then, they clean the tooth cavity and fill it with restorative materials. Finally, they cover the tooth.

  • Step 5: Abscess formation:

    As tooth decay progresses to the pulp, bacteria can penetrate and cause infection. Expanded inflammation in the tooth can lead to the formation of a pus bag at the end of the tooth, which is named an abscess.

Related: “How To Cure Swollen Gums / Home Remedies

An abscess of dental can lead to extreme pain and is usually accompanied by symptoms such as swelling of the gums, face, or jawfever, and swelling of the lymph nodes in the neck. A dental abscess requires immediate treatment because the infection can spread to the jawbones as well as other areas of the head and neck. In some cases, treatment may include removing the affected tooth.

    • Symptoms

      Abscess formation is characterized by swelling, pus formation, and severe pain. Systemic symptoms such as fever may also be present.

    • Diagnosis at home:

      Swelling, pus formation, and a bad breath and taste in the mouth may be noticeable. Severe pain and fever are also possible.

    • Treatment in stage 5

      If an abscess has formed inside the tooth, in addition to draining the abscess, they perform nerve extraction or root canal treatment. In cases where the amount of decay is very high and deep, they have to pull the tooth. In this situation, antibiotics may be prescribed for the patient.

At what stage of decay do teeth begin to fall out? Why?

The stage at which tooth decay is no longer salvageable and the decay inevitably leads to tooth loss usually occurs in advanced stages of decay when the damage is extensive and affects the structural integrity of the tooth.

Decay in stages 4 and 5, especially when it involves the dental pulp (pulpitis) and leads to abscess formation, often presents significant challenges for preservation. Here are some reasons why tooth loss is more common in these advanced stages of decay:

  • Pulp involvement (stage 4 – pulpitis)

At this stage, the dental pulp, which includes nerves, connective tissues, and blood vessels, becomes infected due to the progress of caries. Pulpitis causes severe pain, and infection will lead to inflammation and damage to the pulp.

Treatment at this stage is usually a root canal method where the infected pulp is removed, and the root canal is cleaned, sanitized, and sealed.

While this treatment can save the tooth in many cases, it is not always successful, and there may be cases where the damage is too extensive or the tooth does not respond well to treatment.

If the tooth cannot be treated effectively, extraction may be the only opportunity to prevent the spread of infection and reduce pain.

  • Abscess formation (stage 5):

Abscess formation occurs when the infection spreads from the pulp to the surrounding tissues, resulting in a pocket of pus. This situation can lead to pain, swelling, and potentially systemic symptoms such as fever.

Related: “How Do I Know What Kind Of Toothache I Have?

The presence of an abscess indicates a severe and often advanced infection. While root canal treatment may still be performed at this stage, the success rate can be lower, especially if the infection has spread widely.

In cases where the infection is not controlled, or if the tooth does not respond to treatment, tooth extraction may be necessary to prevent the infection from spreading to other areas of the body.

In summary, the challenges of stages 4 and 5 lie in the severity of the infection and the potential limitations of treatment options. 

While modern dentistry has come a long way, there are cases where the extent of damage and infection may render a tooth unsalvageable. In such cases, the priority is to treat the infection and prevent its spread to ensure the overall health of the person. 

Tooth extraction, while a last resort, may be necessary to achieve this goal and reduce pain and possible systemic complications. 

Regular dental checkups and early intervention in the early stages of decay are important to prevent progression to these advanced stages and reduce the risk of tooth loss.

Tooth decay and the risk of irreversible diseases

Tooth decay, if left untreated and allowed to progress, can contribute to various health issues and may increase the risk of certain diseases. 

The relationship between oral health, particularly dental issues such as tooth decay, and systemic health is an area of active research. Here are some conditions associated with untreated tooth decay and poor oral health:

  • Gum disease (periodontitis):

    Untreated tooth decay can cause gum disease, which is also called periodontitis. This condition includes inflammation and infection of the gums and the holding structures of the teeth.


  • Cardiovascular disease:

    Some studies show a potential relationship between poor oral health and a high risk of cardiovascular diseases such as heart attacks and strokes. While the exact relation is not fully understood, it is believed that the inflammation rooted in gum disease may lead to cardiovascular problems.


  • Diabetes:

    People with diabetes are at high risk of developing gum disease. Conversely, untreated gum illness can make it more difficult to balance blood sugar levels in people with diabetes.


  • Respiratory infections:

    Poor oral hygiene, including untreated tooth decay, can lead to the increase of harmful bacteria in the mouth. Harmful oral bacteria can lead to respiratory infections, especially in individuals with a weak immune system.


  • Premature birth and low birth weight:

    Based on new studies that look at the complex relationship between oral health and pregnancy, it has been confirmed that pregnant people with untreated gum illness may be at a higher risk for untimely birth or low birth weight babies.


  • Rheumatoid Arthritis:

    Some research recommends a potential link between gum disease and rheumatoid arthritis. Chronic inflammation is a justification for this connection.


  • Alzheimer’s disease:

    While research is ongoing, some studies have explored the potential link between oral health issues, including gum disease, and high risk of cognitive decline and Alzheimer’s disease. Although the exact reason for it has not been discovered, studies emphasize the existence of a connection between the two.

How to prevent tooth decay?

Maintaining proper oral and dental hygiene plays an important role in preventing tooth decay. To prevent harm to your teeth due to decay, remember these tips:

Be sure to visit your dentist regularly for routine teeth cleaning and oral examinations. A dentist can help identify and treat tooth decay before it gets worse.

Brush and floss your teeth regularly. It is suggested to brush teeth twice a day after meals and try to use fluoride toothpaste to boost tooth enamel.

Prodentin Silver Complete Toothpaste, containing colloidal silver and fluoride particles, is a safe way to prevent tooth decay. This toothpaste, with new and unique compounds and antibacterial properties, prevents the growth of bacteria that cause caries in the mouth.

Limit the consumption of sugar and sweets. Try to avoid foods or drinks that have a lot of sugar, like candy, cookies, and soft drinks.

Drink water from the tap. Most tap water has fluoride, which can help keep tooth enamel strong and protect it from decay. If possible, drink tap water.

Limit snacks. This can give the bacteria in the mouth more sugar to turn into acid.


There are five stages of tooth decay. The first stage is often reversible, but the later stages can cause permanent injury to the affected tooth. Damage occurs due to the activity of bacteria in dental plaque on your teeth and damage to tooth tissue. These bacteria convert sugar in food into acid, which can damage teeth.

The treatment of tooth decay depends on its stage. Some of the treatments include fluoride treatments, fillings, and root canal treatments. These include actions like brushing your teeth at least twice a day, avoiding sugary foods, and making sure to visit the dentist regularly.

Have you had sudden caries, and have you lost a tooth due to caries? Share your business with us.

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Author and specialist

Dr. Majid Zahrabi,


  • Board Certified Neurosurgeon
  • DHA certificate holder
  • Plantation certificate holder, France
  • Certified holder of Discogol, France
  • A pioneer in the non-surgical treatment of disc herniation in the Middle East and CIS countries.
  • Under the training and coaching of Professor Jacques Theron (founder of Discogel Therapy) since 2008
  • More than 400 successful cervical and 1300 lumbar discogel injections
  • Trained and certified several neurosurgeons and spine surgeons in the Middle East and CIS countries for the treatment of Discogel
  • Strong belief in patient-centered care planning and participation
  • Neurosurgeon and spine surgeon at Imam Khomeini and Amir Mazandarani Hospital, Sari, Iran, with more than 430 surgeries annually, 2000-2011
  • Neurosurgeon and spine surgeon at Farmaniyeh, Nikan and Yas Sepid Hospital, Tehran, Iran, with more than 400 surgeries annually, 2011-2012
  • Neurosurgeon at Iranian Hospital, Dubai, 2022-2023
  • Since 2015, he has been working as a reference doctor for the treatment of intervertebral disc herniation with Discogel and has trained many doctors of spine-related specialties in various countries of the Middle East and CIS in person/practically and online.



  • Individual training sessions under the direct supervision of Professor Jacques Theron in Discogel treatment, 2008-2020
  • Training sessions under the supervision of Professor Thierry Boye on spinal implants, 2007
  • Participation and presentation in several national and international medical and neuro-spinal conferences
  • Board certificate by Iran Neurosurgery Board, 2001
  • Neurosurgery assistant training course, Isfahan University of Medical Sciences, Isfahan, Iran, 1996-2001 (In 2001, he graduated from Isfahan University of Medical Sciences with the first rank in the country.
  • His thesis the titled:The Application of human amniotic membrane in repair of dura matter in dogs.” ( It was happening for the first time in the world. )
  • General medical education, Tabriz University of Medical Sciences, Tabriz, Iran, 1984-1993


Published books:

  • CT scan of the brain for doctors
  • Etiology and treatment of painful spine disorders
  • Atlas of diagnosis, prevention, and treatment of spine disorders
  • The most common mistakes in the treatment of spinal disorders
  • Reading brain CT scan in simple language (3rd place in the book of the year)
  • Treatment of head and spine injuries

Publications and articles:

  • Bacteriostatic and bactericidal effects of DISCOGEL® (https://www.researchgate.net/)
  • Muscle recovery, reduction of pain, and improvement of movement strategies in patients with lumbar discopathy after injection of Discogel.
  • The article on the initial results of the treatment of intervertebral disc herniation with discogel injection, which won the second-best poster rank at the Pan Arab International Congress of Interventional Radiology (March 14-16, 2015) and was accepted for presentation at the Chicago Pain Congress.
  • The use of human amniotic membrane in dura mater repair in dogs, a study for the first time in the world.



  • Annual Congress of Physiotherapists of Iran, 2019
  • Chicago International Pain Congress, 2019
  • Iran International Pain Management Congress, 2018
  • Annual Congress of Physiotherapists of Iran, 2018
  • Presentation of Discogel as an innovative solution for the treatment of spinal disc herniation in Armenia for orthopedic specialists and neurosurgeons, 2017
  • First Live Workshop and Seminar on Minimally Invasive Disc Therapy (DISCON), 2017
  • Presentation of Discogel as an innovative solution for the treatment of spinal disc herniation in Azerbaijan for orthopedic specialists and neurosurgeons, 2016
  • Seminar of Iranian official managers, 2016
  • Presentation of Discogel as an innovative solution for the treatment of spinal disc herniation in Tajikistan for orthopedic specialists and neurosurgeons, 2016
  • International Neurological Intervention Congress in Iran, 2014
  • Educational seminar for nurses on treatment approaches for head and spine trauma, 2014
  • Educational seminar for general practitioners on treatment approaches for head and spine trauma, 2014
  • Speech at the Retraining Seminar for General Practitioners and Specialists in Dubai (Discon) in 2017
  • Speech in the internal retraining courses of Irani Hospital, Dubai
  • Holding lecture sessions and practical workshops on the treatment of intervertebral disc herniation with discogel injection in Azerbaijan, Tajikistan, Ukraine, Oman, and Armenia during the years 2015 to 2021.
  • Giving a lecture and holding a practical workshop for neurosurgeons in Vietnam at Ho Chi Minh City University in 2023

Dr. Majid Zohrabi started treating his patients in Dubai in 2022 and continues his activities in private medical centers in the UAE.