If you ask ten patients what a cavity is, you’ll hear ten different versions:
“It’s a hole,” “It’s something I did wrong,” “It’s sugar,” “It’s just a stain,” “It’s a spot that the dentist wants to drill.”
I’ve heard every possible definition in the chair. Some are close. Some are guesses. Most capture only one part of the story.
A cavity is a process — not an event.
And because it moves slowly, almost quietly, many people discover it only when it reaches a point where the tooth finally starts to protest.
At Gamma Dental Clinic, both Dr Olga Gelfand and Dr Zoren Ratner see cavities every day. Some are tiny, some are deep, and many surprise the patient because they had no pain at all. When you look at enough teeth over enough years, you start recognising the same patterns that repeat from one person to another.
Let me explain it the way we explain it in the operatory, without the textbook tone, and without simplifying it so much that it stops being accurate.
How a Cavity Actually Starts
People imagine cavities as holes that appear suddenly. Teeth don’t behave that dramatically. Most cavities begin on enamel — the outer shell — and enamel is quiet when it’s weakened. It doesn’t throb. It doesn’t react. It just loses minerals.
Every time you eat or drink something with sugar or refined starches, the bacteria in your mouth use it as fuel. They release acids. Those acids soften enamel. Then your saliva repairs it if it has enough time, enough minerals, and enough protective factors.
If the repair doesn’t keep up, the softened zone deepens.
That’s where a cavity begins.
This early stage is still reversible, but almost no one knows it’s happening because there’s no symptom. No pain. No visible mark in most cases. When we catch it early — usually by accident on an X-ray — we talk about prevention and remineralisation.
But if the process continues, the enamel finally gives way and breaks.
Once the surface collapses, the cavity is a cavity.
You can’t “grow enamel back.” You can only treat the tooth.
The Different Ways Cavities Announce Themselves
Patients often assume they’ll feel something dramatic. They expect a sudden jab or constant ache. Most cavities don’t behave that way.
Here are the signs we see most often:
Brief cold sensitivity
It comes and goes. A sip of water irritates the tooth for a moment, then everything settles. Many patients ignore this stage.
Sweet sensitivity
If one particular tooth reacts to chocolate or juice, it almost always means the enamel has lost integrity.
Food getting stuck
This is usually the first sign for cavities between teeth. Patients say, “I keep getting something caught right here,” and that spot is often exactly where the decay has softened the wall.
A dark shadow in the mirror
Not all shadows are cavities, but most cavities do darken as they trap stain and lose minerals.
A dull ache when chewing
Once the cavity reaches dentin — the softer tissue under enamel — pressure becomes noticeable.
No symptoms at all
This is the most surprising category, and more common than people expect. Large cavities can stay quiet until they reach the nerve.
When a patient says, “But nothing hurt,” it doesn’t mean the tooth is healthy. It means the nerve hasn’t been affected yet.
How Dentists Diagnose a Cavity
Diagnosis isn’t guesswork. We use a combination of:
- visual examination
- gentle probing (to feel softened tooth structure)
- bite-wing X-rays
- sometimes a 3D scan for complex cases
When Dr Ratner looks at a radiograph, he’s not just checking for dark spots. He’s checking shape, depth, spread patterns, proximity to the nerve, and whether the decay has undermined the enamel. Years of doing this mean he often identifies cavities before the patient suspects anything.
Sometimes the tooth looks perfect from the outside but the X-ray shows a triangular shadow between teeth — the classic sign of interproximal decay.
This is why “I don’t feel anything” and “there is no cavity” are not the same statement.
When a Cavity Needs Treatment
The moment the enamel collapses, treatment is required.
Enamel cannot heal once it has developed an actual opening.
The goal of treatment is simple:
remove the decayed part → restore the tooth → prevent further spread.
But how we restore depends on how deep the decay runs.
Treatment Options for Cavities
Let me walk through these the way we explain to patients — plainly, without jargon.
Small Cavities
These are the easiest to manage and the most predictable.
Composite fillings
We remove the softened enamel and dentin, shape the area, and place a tooth-colored material. Modern composites bond well and restore strength efficiently.
Small cavities are almost always handled in one appointment. Patients rarely feel anything once numbness fades.
Moderate Cavities
Still manageable with fillings, but they require more attention.
These cases involve removing a larger amount of decay and sometimes rebuilding a wall of the tooth. The filling is shaped carefully to protect the contact point between teeth and maintain bite function.
Patients often ask whether they will “feel” the filling afterward. Usually no — but if the cavity was close to the nerve, there may be some temporary sensitivity.
Deep Cavities
Once decay is near the nerve, the tooth may show signs of inflammation.
When the nerve is irritated but not infected
We sometimes use liners or protective materials to keep the nerve calm. The tooth is then restored with composite or sometimes a crown.
When the nerve is infected
This is where root canal therapy comes in.
It is not as dramatic as people fear. The goal is to remove the inflamed tissue, disinfect the canals, and seal the root. After this, the tooth is restored with a crown to protect it long-term.
Patients often walk in with severe pain and walk out relieved because the pressure has been addressed.
When the Tooth Structure Is Too Weak for a Filling
If a cavity has consumed a large portion of the tooth, placing a filling would leave the tooth vulnerable.
Crowns
A crown reinforces the tooth by covering it entirely. This is common for teeth that:
- have cracks
- had large old fillings
- underwent root canal therapy
- lost multiple walls to decay
It’s not a failure to need a crown. It’s simply the next appropriate step for preserving function.
When Extraction Is the Only Option
Extraction is not a first choice. It’s a last resort.
This happens when decay extends below the gumline, or the tooth cannot be rebuilt in a predictable, stable way. If extraction becomes necessary, we always discuss replacement options — implants, bridges, or removable prosthetics — so the patient understands the long-term picture.
Cavity Prevention That Actually Works
People often hear the same generic advice everywhere, but effective prevention is more about consistency and technique than expensive products.
Here are the things that make the most difference:
Brush well, not just often
Technique matters. Angle the brush at the gumline. This is where plaque tends to start the demineralisation process.
Floss regularly
Most cavities we treat between teeth would not exist with regular flossing. It’s simple but impactful.
Limit grazing
It’s frequency, not quantity, that matters. Constant snacking keeps acids active.
Use fluoride
Fluoride strengthens enamel. Toothpaste is often enough, but some patients benefit from professional fluoride varnishes.
Rinse with water after meals
This clears sugars and neutralises acidity naturally.
Keep regular checkups
Cavities caught early are straightforward to treat. Cavities caught late are not.
Cavities in Children
Baby teeth decay faster because their enamel is thinner.
Children’s diets also tend to be higher in carbohydrates. We often see the first cavities in molars that didn’t fully erupt evenly, creating tiny traps where food sits.
Treatment for children follows the same principles as for adults but with an even greater emphasis on prevention. Early habits shape long-term health.
FAQ — Dental Cavities and Treatment
Do cavities always hurt?
No. Pain is a late symptom.
Can a cavity stop growing on its own?
Not once there is a physical opening in the enamel.
How long does a filling last?
Several years, sometimes longer with good hygiene.
Can mouthwash replace flossing?
No — they are not interchangeable.
Why do some teeth get cavities while others don’t?
Anatomy, diet, saliva composition, and hygiene all play roles.
Is a cavity always visible?
No. Many are hidden between teeth or under old fillings.
How quickly can decay spread?
That varies widely — weeks in some cases, years in others.
Cavity Treatment at Gamma Dental Clinic
Cavities are common, but treating them well requires accuracy and restraint — remove only what is necessary, preserve what is healthy, and protect the tooth long-term. At Gamma Dental Clinic, Dr Olga Gelfand and Dr Zoren Ratnerapproach each case this way, explaining the reasoning behind every recommendation so patients understand what is happening in their mouth.
Whether the cavity is new, deep, or discovered unexpectedly during a routine exam, early treatment always leads to better outcomes.
A tooth restored at the right moment is a tooth saved.