How should I manage a dental caries that has progressed to a visible cavity (hole) in the tooth?

Treatment of Dental Caries with a Visible Cavity

A tooth with a visible cavity (hole) from dental caries requires professional dental restoration—typically a filling—to remove decayed tissue and restore tooth structure; this cannot be managed at home and requires urgent dental referral within 24-48 hours. 1

Immediate Assessment and Triage

Before arranging dental care, assess for signs of spreading infection that would require emergency intervention rather than routine dental referral 1:

• Facial swelling extending beyond the immediate tooth area
• Lymphadenopathy (swollen lymph nodes in the neck)
• Fever suggesting systemic infection
• Trismus (difficulty opening the mouth)

If any of these signs are present, antibiotics may be indicated and immediate emergency dental or medical evaluation is necessary. 1 However, antibiotics alone do not treat the underlying cavity and are only appropriate when infection has spread beyond the tooth. 1

Definitive Treatment: Professional Dental Restoration

Once a cavity (hole) has formed in the tooth, the disease has progressed beyond the reversible stage of demineralization. 2 The standard of care is:

• Surgical removal of decayed tooth structure followed by placement of a restoration (filling) to seal the tooth 3, 4
• This must be performed by a dentist—there is no home remedy or medical treatment that can repair a cavitated tooth 3
• Arrange dental follow-up within 24-48 hours for definitive restoration 1

The cavity represents irreversible structural damage where bacteria have dissolved enamel and dentin through acid production. 3, 4 Without professional intervention, the decay will continue to progress deeper into the tooth, potentially reaching the pulp and causing more severe complications including abscess formation. 3

Interim Measures While Awaiting Dental Care

While waiting for dental treatment, implement these measures to prevent further progression and maintain oral health:

Fluoride Application

• Use fluoride toothpaste (1,000-1,100 ppm fluoride) twice daily to help arrest progression of any surrounding demineralization 1
• For adults, rinse briefly with a small amount of water or not at all after brushing to retain more fluoride 1
• High-risk patients may benefit from additional fluoride measures beyond standard toothpaste 1

Oral Hygiene

• Brush within 30 minutes after eating and before bed using an ultra-soft bristle toothbrush 5
• Floss at least once daily to remove plaque and food debris 5
• Rinse vigorously several times daily with a bland rinse (1 teaspoon salt, 1 teaspoon baking soda in 4 cups of water) 5

Dietary Modification

• Reduce frequency of refined carbohydrate consumption, as dietary sugars are the main cause of dental caries 4
• Without sugar, caries progression would be negligible 4

Patient Education

Provide clear counseling about the nature of the problem 1:

• Explain that the cavity represents permanent structural damage requiring professional repair
• Emphasize that delaying treatment will lead to deeper decay, potential pulp involvement, and possible tooth loss 3
• Discuss proper oral hygiene practices to prevent future cavities 1
• Address risk factors including high sugar consumption, inadequate fluoride exposure, and poor oral hygiene 3

Critical Pitfalls to Avoid

• Do not attempt to manage a cavitated tooth with fluoride or oral hygiene alone—once a hole has formed, remineralization cannot restore the lost tooth structure and professional restoration is mandatory 3, 2
• Do not prescribe antibiotics unless there are clear signs of spreading infection (facial swelling, fever, lymphadenopathy, trismus)—antibiotics do not treat the cavity itself 1
• Do not delay dental referral—progression of untreated caries can lead to pulpal necrosis, abscess formation, and eventual tooth loss 5, 3
• For children under 6 years, use only a pea-sized amount of fluoride toothpaste to reduce risk of enamel fluorosis from swallowing 1