A “rotten tooth” is a common term for advanced dental caries, a disease process where bacteria produce acid that progressively destroys the hard tissues of the tooth. This decay begins with the breakdown of the enamel, the tooth’s outer layer, and can eventually penetrate the softer dentin and reach the innermost pulp chamber. Fortunately, in the majority of cases, a dentist can intervene to stop the disease and restore the tooth’s structure and function. The specific treatment depends entirely on how far the bacterial infection has progressed through the layers of the tooth.
Determining the Extent of Decay
The first step in addressing any decayed tooth is a thorough diagnosis to determine the precise depth and location of the damage. A dental professional uses a combination of visual inspection and tactile examination to assess the tooth surface. They will look for obvious cavities, discoloration, or areas of enamel that appear chalky or opaque, which can indicate demineralization.
The dentist may use a blunt probe to gently check the grooves on the chewing surfaces for any areas of softness or stickiness, which suggests a defect in the enamel. To confirm the diagnosis and determine the extent of internal damage, dental X-rays are essential. These images reveal decay that is hidden between teeth or under existing restorations, appearing as radiolucent (darker) areas because the mineral content of the tooth structure has been lost. Assessing the proximity of the decay to the pulp, which contains the tooth’s nerve and blood vessels, is paramount, as this dictates the complexity of the required treatment.
Restorative Options for Early and Moderate Damage
When decay is caught relatively early, before it has compromised the pulp, restoration focuses on removing the infected tissue and sealing the tooth. The most common procedure for small to moderate lesions is a direct restoration, or filling, where the decayed material is excavated and the space is immediately filled with materials like tooth-colored composite resin or silver amalgam. This process effectively halts the progression of the decay and restores the tooth’s contour in a single visit.
For larger areas of damage that involve more than one tooth surface but do not yet require a full crown, an indirect restoration such as an inlay or onlay is often recommended. These restorations are custom-fabricated in a dental laboratory, usually from porcelain or composite resin, to perfectly fit the prepared cavity. An inlay fits within the cusps on the chewing surface, while an onlay covers one or more of the cusps, providing more structural support. Because they are bonded to the tooth, inlays and onlays are stronger and more durable than traditional fillings in these larger defects, preserving more natural tooth structure than a full-coverage crown would require.
Addressing Deep Infection and Structural Loss
When the bacterial infection has breached the dentin and reached the pulp chamber, the tooth develops an irreversible condition requiring root canal therapy. This treatment is necessary to save the tooth by eliminating the infection that resides deep within the root canal system. The dentist or a specialist carefully accesses the pulp chamber, removes the inflamed or necrotic (dead) pulp tissue, and meticulously cleans and disinfects the entire interior canal space.
After the canal system is cleaned and shaped, it is filled and sealed with a biocompatible, rubber-like material called gutta-percha to prevent future bacterial re-entry. A tooth that has undergone a root canal procedure, or one that has lost significant structure to decay, is often weakened and brittle. To protect the repaired tooth from fracturing under the forces of chewing, a dental crown, or “cap,” is typically placed over the entire remaining structure. The crown provides full coverage and necessary reinforcement, restoring the tooth’s original shape, strength, and function for long-term survival.
The Outcome: When Extraction is the Only Option
Despite the many advanced techniques available, there are situations where a tooth is deemed non-restorable, making extraction the only viable treatment. This determination is usually made when the decay has progressed so far below the gum line that a seal for a restoration cannot be achieved, or when there is irreparable damage such as a vertical root fracture. Severe bone loss due to advanced periodontal disease or an infection that has destroyed too much supporting bone mass can also disqualify a tooth from being saved.
Removing the tooth stops the infection from spreading to adjacent teeth and the jawbone. When an extraction is performed, the dentist will immediately discuss options for replacing the missing tooth to prevent neighboring teeth from shifting and to maintain proper bite function. The most common and effective replacements include dental implants, which replace the tooth root and the crown, a fixed bridge that spans the gap, or a removable partial denture.