Options for dealing with tooth decay

Not all tooth decay is created equal. Although some decay may require invasive drilling, in its early stages it may be addressed through less invasive means. In fact, there are a variety of minimally invasive interventions that can be used to tackle decay early. To help you partner with our office in this fight against decay, here is a rundown of what tooth decay is and how it can be addressed in its infancy.


Teeth are covered with a thin film called plaque that contains bacteria. When you eat foods or drink beverages that have sugar in them, the bacteria produces acid. This acid causes tooth decay.

Tooth decay starts by softening the hard outer layer of your tooth called enamel. If it is not treated, it could become a cavity.

When tooth decay first begins, it can look brown or white. These are areas where the hard surface of your tooth, the enamel, is softening. At this point, we may have some choices about how to manage this decay—to make sure it doesn’t get worse.

Topical fluoride treatments

Fluoride is a mineral found in nature that makes enamel stronger. You may already know that drinking fluoridated water helps prevent tooth decay. But there are also products that can be put right on teeth to help strengthen tooth enamel. Research shows that these products can help stop or even reverse early tooth decay.

Fluoride varnish

Fluoride varnish is a gel that is painted onto the teeth. It hardens quickly into a thin sticky layer, allowing the fluoride to be absorbed by the enamel. Fluoride varnish is quick and easy to apply. It can be a good option for patients who have difficulty sitting through treatments. On the downside, it can make your teeth look a little yellow. Although this yellowish color only lasts for a few hours, the protection offered by fluoride varnish lasts months. You will need to have it reapplied in about 3 to 6 months, depending on the schedule you and our office works out.

Prescription-level fluoride toothpaste

Everyone over the age of two should use toothpaste that contains fluoride. You can buy over-the-counter fluoride toothpaste in the store without a prescription, but some patients need toothpaste that is higher in fluoride, which requires a prescription. For instance, patients who have developed decay or early signs of decay can benefit from higher fluoride toothpaste. Also, patients who are at higher risk for decay such as those patients who are under orthodontic treatment may also benefit from prescription-level toothpaste.


Sealants are a thin white coating applied to the chewing surfaces of your back teeth. These teeth have natural deep pits and grooves that trap plaque and food particles, increasing the risk of developing tooth decay. The sealant hardens and covers the pits and grooves, helping keep the plaque and food out and protecting your teeth. Sealants have been shown to stop some early tooth decay.

Sealants can be used alone or with a fluoride varnish. Sealants can last for years, but our office regularly examines sealed teeth to check that the sealant is still covering the surface well.


Once a tooth has a cavity, it may not be possible to reverse the tooth decay. But it is possible to stop more damage to the tooth. In some cases, we may decide to remove the decay with a small drill (which will involve the loss of some enamel) and then fill that area of the tooth or cover it with a crown. Or we may be able to consider an option that does not involve drilling into the tooth.

Silver diamine fluoride

Silver diamine fluoride (SDF) may be used in some cases to stop decay when a cavity has formed. With SDF, we apply it directly to the area of decay without first having to drill the tooth. SDF is simple to apply and while it stops the decay from progressing, it does not fill the cavity. The tooth structure will remain weak if not eventually restored with a filling or a crown. Another drawback of SDF is that the color of the treated area will become black. This may be less of a problem in primary teeth, which will be lost as the child ages, than for permanent teeth. Even so, because applying SDF is quick, it may be especially helpful for patients who have trouble sitting still during dental treatments. SDF needs to be reapplied at least twice a year.