Symptoms and Diagnosis of Tooth Decay

One of the most prominent symptoms of tooth decay is toothache. This, however, occurs only when the decay has progressed to an advanced stage and eaten away at the hard tooth enamel and into the inner pulp of the tooth where the blood vessels and nerves are contained.

Early tooth decay is often symptom free and detectable only on routine dental checkups. Early stages of tooth decay are also easier to treat than later stages. Ideally, adults should have a check-up at least once every two years and people aged under 18 years should attend a check-up annually. Younger children, who are more prone to tooth decay, benefit from routine dental checkups every 4 to 6 months.


Some of the symptoms of tooth decay include:

  • Tooth ache - This may be severe and radiate to the jaw, ears or head. The pain is sharp and may often disrupt sleep. Toothache may or may not be triggered by food intake.
  • Increased sensitivity of the tooth - The tooth may become more sensitive on eating or drinking. Pain can be intense when food or drink is cold, hot or sweet.
  • Halitosis - Bad breath is a sign that tooth decay has progressed to an advanced stage. This is usually caused by the reduced cleaning mechanism seen with dry mouth and by the gases given off by colonizing bacteria in the mouth.
  • People with tooth decay often complain of a bitter or unpleasant taste in the mouth as well as a frequently dry mouth.
  • The affected tooth may appear discoloured with brown, grey or black spots at the site of decay.

Diagnosis of tooth decay

  • Tooth decay can be diagnosed early on by way of routine dental examinations. The teeth are examined in detail for the early stages of tooth decay and plaque formation. The examination also includes a thorough check-up of the gums for evidence of gum involvement.
  • A detailed history of oral hygiene routines, previous history of any tooth decay or teeth problems and dietary habits is obtained.
  • A bitewing radiograph or X-ray may also be used to detect tooth decay. Such X-rays can help detect small lesions of tooth decay that have not yet caused cavities or holes. Bitewing X-rays, however, are not recommended as a screening tool for caries in all children presenting for dental examination.
  • An X-ray may be used to identify the type of cavity which include pit cavities that occur in the molars and may quickly affect the whole tooth; the smooth surface cavity that occurs over the flat side-surface of the teeth; and the root cavity which occurs in the root of tooth below the gum line.
  • Other less commonly used diagnostic techniques include temporary tooth separation, laser fluorescence and the use of electric caries meters.

Further Reading

Last Updated: Jan 20, 2023

Dr. Ananya Mandal

Written by

Dr. Ananya Mandal

Dr. Ananya Mandal is a doctor by profession, lecturer by vocation and a medical writer by passion. She specialized in Clinical Pharmacology after her bachelor's (MBBS). For her, health communication is not just writing complicated reviews for professionals but making medical knowledge understandable and available to the general public as well.


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