Tooth cavity treatment involves dental caries removal while avoiding the dental pulp, nerve or root canal.

The treatment of tooth decay can become quite complex in some patients. For example a large fixed bridge connected to many teeth could have cavities in one or more abutment teeth. It can also involve a group of teeth wherein the patient desires to avoid the need for root canal therapy. Above all patients should understand Indications for crowns and fillings. They should also learn that tooth decay, cavities and dental caries all mean the same thing. The Center for Special Dentistry® in midtown Manhattan focuses on the treatment of complex cases. Our cosmetic dentists provide white cosmetic fillings, Bondings in NY that are nearly invisible. Incidentally these photos on how to remove tooth decay or cavities in teeth were created in our NYC General Dentistry office.

The cause of tooth decay is simple to understand

Cavities are caused by not keeping your teeth clean and having a high sugar diet.

We offer tooth decay treatment for complex problems – read reviews

Our team includes 16 cosmetic dentists, specialists and lab ceramists in one high-end midtown Manhattan office. In addition an MD-anesthesiologist offers several options for dental sedation. Nitrous oxide laughing gas is also available. As a result we are able to offer quick and comfortable general dentistry. We offer intelligent and honest diagnosis based upon 31+ years of experience. We use the finest materials and top labs.

Our dental patients also have access to top medical care

Moreover our patients have access to our affiliated team of 12 medical doctors in our building. We hope to help improve your overall health one step at a time.

How to remove tooth decay, teeth cavity removal, drilling a tooth, dental pulp, tooth nerve

How to remove tooth decay

View these nine photos from left to right and then top to bottom. Generally the dentin looks smooth and intact until touching it with an explorer shows it to exhibit a diseased, oatmeal-like consistency.

Finally in the last photo the dental pulp, i.e. tooth nerve or root canal, appears in the last photo in the middle of the preparation through a thin layer of dentin.

tooth decay teeth cavity dental caries bonding composite silver amalgam filling how to pictures

How to remove tooth decay pictures

1) Dental bonding an upper premolar tooth where the buccal cusp has failed adjacent to a large old silver filling amalgam. 2) Silver filling removed. Don’t try to bond to this amalgam since its foundation is not very strong and decay is frequently beneath it. 3) Decay removal. 4) Final tooth bonding.

More information on treatment for fractured teeth.

tooth decay cavities cavity between teeth dental caries interproximal lesion bonding composite

How to remove tooth decay from two upper front teeth

Dental caries or cavity removal from behind the front teeth. Then teeth bonding from the palatal side of these two upper central incisors.

1) Pre-op palatal photo of #’s 8 & 9. 2) Interproximal decay. 3) Decay removed. 4) Final bonding.
tooth decay cavity teeth cavities dental caries interproximal lesion carious gingivectomy

Pictures show how to remove recurrent tooth decay

1) Old white filling composite.
2) Next composite removed, exposing recurrent tooth decay.
3) Pulp chamber with decay present.
4) The old composite was not bonded or glued to the tooth. Therefore it came out in one piece. This is not ideal dentistry.
5) Then decay removal and tooth drilling into the root canal orifices for the dental bonding retention.
6) Depth of preparation into pulp chamber.
7) Bonding is in place before tooth preparation.
8) Finally tooth preparation and gingivectomy; note the occlusal retention groove.

recurrent tooth cavity cavities dental caries teeth buccal decay sensitive sensitivity pain oral

Photos of recurrent tooth decay

There is recurrent decay under this silver dental filling. Drilling on the buccal – cheek side – of a tooth is frequently more sensitive after a dental visit than removal of occlusal – biting surface – decay. Decay is still present. Accordingly root canal and crown is most predictable.
indirect pulp cap capping tooth decay cavity teeth cavities dental caries nerve interproximal

Removal of tooth decay avoids exposing the nerve or root canal

In brief treatment choices: 1) Dental bond only; 2) Dental bond and porcelain crown; 3) Root canal and a porcelain crown.

tooth decay teeth cavity dental caries third molars wisdom teeth second molar impaction 3rd

Retaining a wisdom tooth in the mouth longer than recommended causes tooth decay in the adjacent second molar

In this case this wisdom tooth is growing at an angle directly into the adjacent tooth causing a big cavity.

tooth decay cavity teeth cavities dental caries small amalgam silver filling carious lesions

Deep tooth decay under a small silver dental filling

Incidentally apparently small cavities can grow much larger inside a tooth where the bacteria colonize.

indirect pulp cap capping tooth decay cavity teeth cavities dental caries nerve exposure

Dental bonding technique shows tooth decay removal using a dental drill to avoid exposing the root canal

As a rule an indirect pulp cap procedure removes tooth decay and avoids nerve exposure.

dental crown buildup build-up tooth decay teeth cavity caries root canal orifices

Tooth decay removal and crown buildup technique after root canal therapy

Bonding placement into root canal orifices after drilling away a little gutta percha. Notice the crown margin finish line ends on tooth structure and not the buildup.

impacted wisdom tooth impaction decay cavity third 3rd molar teeth cavities dental caries carious

A large cavity created in the adjacent second molar by the wisdom tooth or third molar growing into it

The patient did not feel oral pain. Treatment: Root canal and dental crown – notice the crown covers the decay removal site.

broken silver filling, tooth decay cavity teeth cavities, dental caries, root canal therapy

A big dental cavity extends into the nerve – red blood vessel – after removal of a broken silver tooth filling

This tooth needs root canal therapy. In particular bleeding is visible from the nerve or root canal.

extensive tooth decay cavity, teeth cavities, dental caries, carious lesions mouth oral pain

Treatment of two lower premolar teeth that had large dental caries into the nerve (#28 & 29) following root canal therapy

Initial preparation into the pulp chamber reveals extensive teeth decay. Lastly following teeth decay removal.

tooth decay and stain removal technique, dental filling bonding composite teeth restoration

Tooth decay under a filling

Cavity and dental stain removal following removal of a silver dental filling.

tooth decay cavity under fractured silver filling teeth cavities dental caries carious lesions

Tooth decay seen under a fractured silver amalgam dental filling

Dental bonding seen in the final photo.
decay, cavity, caries, extract tooth extraction teeth hopeless carious pulp chamber

Extensive tooth decay that needs extraction

Extract this tooth. Tooth decay extends through the pulp chamber into the furcation. In this case the prognosis is much less predictable than replacement with a dental implant.

silver filling tooth decay cavity, teeth cavities, dental caries, carious lesions, recurring

Diagnose a cavity under a silver dental filling

The initial crown preparation has a supragingival shoulder to later help retain the endodontic clamp. Finally the final crown margin finish line should have a chamfer or a bevel.
silver filling, dental bonding, teeth composite restoration tooth decay stain removal how to

Tooth decay and stain under and old silver filling

Tooth cavity and stain removal under the silver filling or amalgam.
tooth decay cavity teeth caries dental cement leakage washout dental bridge tooth caps

Tooth decay under a fixed porcelain bridge

Teeth decay shown under an old dental bridge that had dental cement failure or leakage.
decay, cavity, caries, replace remove silver amalgam filling, teeth tooth mouth oral pain

Silver dental filling and tooth decay removal

Replacement of the silver amalgam filling with a white filling.

tooth decay cavity, teeth cavities, dental caries, interproximal lesion, cracks, craze lines mouth

Tooth decay diagnosis

Arrows point to a horizontal black line which represents tooth decay entering through the distal contact (dotted black lines). In this case you must prepare a distal box and remove this black line at its source.
decay, cavity, caries, fracture crack craze lines, diagnosis, clinical examination oral mouth pain

This is a cavity!

This is a lingual photo of a lower molar tooth. Generally this tooth decay is seen as a black crack line with white tooth decalcification around it. It goes deeper under the silver dental filling.
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Diagnosis of tooth decay

In brief be suspicious of “little” cavities … they can become quite deep. If ignored they may soon need root canal therapy!
decay, cavity, caries, diagnosis, clinical oral examination, intraoral exam teeth tooth smile

A dental drill removes tooth decay.

The hole that results filled with a tooth-colored bonding material.

dental decay bonding tooth filling restoration cavity teeth decalcification oral mouth

These pictures show dental decay drilled away in a tooth that has a large cavity

Then white tooth filling, dental bonding, placement. The last sentence reads: 4. Bonding. By the way behind the copyright it reads “The white in photo #2 is decalcification.”

cavity caries teeth preparation drill tooth how to dental crown cap root canal technique

Tooth decay and tooth pain

This patient presented with severe mouth pain. Tooth decay – cavity – removal is shown. This tooth is being prepared for root canal therapy and a dental crown – teeth cap. Before and after pictures are shown.

dental cavity teeth caries lesion drill drilling how to preparation technique crown cap root canal

Tooth pain and tooth decay

This patient presented with oral pain. These pictures show the initial tooth cavity after drilling it away. Soon this tooth will receive root canal therapy and a dental crown.

dental cavity caries drill teeth drilling preparation how to technique crown cap gum surgery

Dental caries, tooth decay, in a molar tooth

Cavity removal before referring the patient for crown lengthening periodontal gum surgery. Therefore the periodontist knows how much gum tissue removal is necessary.
dentistry decay cavity caries tooth teeth decalcification interproximal diagnosis clinical exam

Interproximal tooth decay is a cavity between teeth

The cavity after removal of the adjacent dental crown.
Preparation into this stain clearly shows the teeth decalcification and  tooth decay present.
decay cavity removal tooth drilling teeth caries bonding central incisor composite oral mouth pain

Tooth decay or dental cavity removal between two front teeth

1) Teeth decay is in this photo. 2) Decay removal. 3) Tooth decay removed. 4) The white fillings blend in with the teeth.
tooth pain emergency decay teeth cavities cavity caries periapical radiolucency x-rays

Emergency oral pain in the lower right jaw caused by tooth decay

1) X-rays showing big teeth cavities in the second premolar and first molar and smaller cavities in both the second and third molars. 2) There was also a large periapical radiolucency around the apex of the second premolar tooth. 3) Photo of the second premolar and first molar teeth. 4) Radiograph – xray – of the second premolar and first molar following root canal therapy. The patient felt better immediately following this. In summary treatment followed a careful differential diagnosis. It would not be surprising, if in another patient, the mouth pain came from a tooth with a less apparently severe problem.
decay cavity caries cavities teeth tooth dental dentistry dentist silver filling fracture broken

How to pictures show the removal of a large silver amalgam filling and tooth bonding

Photo 1) Fractured disto-lingual cusp. Photo 2) Amalgam filling removal. Photo 3) Tooth decay removed. Photo 4) Bonded restoration, a white tooth filling.
teeth decay tooth cavity dentistry caries dental cavities amalgam silver filling fracture crack

Pictures show tooth decay removal and how to drill out a crack

A fracture or crack line during removal of tooth decay from under a large silver filling. 1) Large silver filling showing a mesial interproximal crack line. 2) Amalgam removal still shows the presence of the crack line. 3) This mesial crack line is now seen to be continuous through the middle of the tooth and out towards the buccal. 4) The crack line has been removed as much as possible without invading the pulp chamber. Root canal therapy and a crown would be the most predictable method to keep the mesio-buccal cusp from further fracture and the patient was informed. Dental bonding would be a good second choice because the bonding actually glues the cusps together to help prevent further cracking – particularly if the mesio-buccal cusp was reduced occlusally and the bonding overlayed. Incidentally a non-bonded silver filling would probably exacerbate the fracture over time.
teeth pain mouth jaw oral painful, root canal, cavity decay cavities dental caries endodontics tooth

Tooth decay, tooth pain and need for root canal therapy

This patient presented with mouth pain in the lower right jaw. Both teeth had cavities in them. Root canal therapy, crown buildup and dental crown preparation were performed for both the molar and premolar. In particular the premolar is the focus in this series of photos.
tooth pain jaw mouth oral root canal cavity decay caries dental teeth crown cap buildup core

Tooth decay, tooth pain and need for root canal therapy

Patient presented with severe oral pain in her lower jaw focused on two teeth. Both teeth had dental caries extending into the pulp chamber. Root canal therapy, crown buildup and dental crown preparation were  performed on both the molar and premolar. In particular the molar is the focus in this series of photos.
Tooth Fracture amalgam silver dental filling Decay teeth cavity fractured broken cusp oral mouth

How to treat a tooth fracture

1) The entire lingual cusp of this upper premolar fractured and is  separated from the tooth decay around the silver filling. 2) The lingual cusp is lifted away from the tooth. 3) The fractured cusp of the tooth. Next 4) The tooth after the removal of the fractured cusp. The black line indicates the anticipated extent of crown lengthening periodontal gum surgery that will be needed.

More information on treatment for fractured teeth.

silver amalgam filling decay leakage cavity recurrent caries teeth dental oral mouth tooth pain

Tooth cavity preparation – how to remove tooth decay

Photos 1 – 3) Note how big the tooth cavity is even though the silver filling initially appears clinically intact. Photo 4) The black line indicated by the arrow is a crack extending from the mesial box that probably was the source of a lot of the cavity. Particularly this crack must be completely removed.
Cavity Decay Fracture Cracks Broken Broke Decalcification Preparation Dental Emergency Pain Teeth

Proper tooth cavity preparation requires the removal of crack lines that could contribute to recurrent tooth decay

1. The arrow points to a crack line extending interproximally. This crack line can be either white or black. 2. In this case preparation of a mesial box still shows the presence of the crack surrounded by white decalcification. 3. Next appropriate removal of the crack. 4. The arrow points to a crack line adjacent to visible decalcification in the adjacent tooth. Reevaluate your bite-wing radiographs; this tooth should probably also be treated. Note: sometimes it might be necessary to prepare a narrow channel with a 169 carbide steel bur to just remove a crack without unnecessary tooth preparation. Incidentally this tiny channel could be filled with flowable composite resin.
Tooth Cavity Teeth Decay Silver Filling Composite Bonding Balls Drill Drilling Preparation Dental

Final tooth preparation – dental caries removal – before placement of direct-bonding material in a lower molar

1) – 2) Final tooth preparation. 3) Placement of chemically-cured flowable bonding material. Note the presence of several spheres of slightly different-colored bonding material within the flowable bonding material. These are spheres of light cured dental bonding material – bonding balls – that are used to condense against. 4) Lastly the final tooth bonded white filling.
Supernumerary Tooth Decay dental caries teeth x-ray Radiograph carious Temporary Crown

How to treat tooth decay in a maxillary lateral incisor adjacent to a palatally-displaced supernumerary tooth

Fig. 1 – 2. Initial presentation. Note the broken, decayed lateral tooth and the palatal location of the adjacent supernumerary tooth. Fig 3. Close up of the broken, decayed lateral and the adjacent palatally-displaced supernumerary tooth. Fig 4. X-ray. Fig 5. The same tooth after electrosurgery and initial tooth preparation. Next Fig 6. Placement of the temporary crown. Note that acrylic was extended from the temporary on the lateral to the supernumerary to provide initial stability of the temporary until root canal therapy and a cast post and core was placed. Then Fig 7. X-ray of the final root canal therapy, cast post and core and dental crown. Finally Fig 8. The result.

Incidentally this patient refused to straighten his teeth with braces.

Large Silver Filling tooth teeth dental emergency decay cavity amalgam filling silver mouth

Treatment of severe tooth decay in a molar that had root canal therapy with only a large bonded filling restoration

This neglected lower molar that had an adequate root canal yet very decayed amalgam silver filling. Next the extent of the tooth decay is visible after removal of the silver filling. Then the tooth decay is removed. Note the gutta percha coming out of the three orifices. Finally the bonded restoration, a white tooth filling. The point here is that a bonded restoration can be placed even when a crown is obviously indicated. Finally the crown will be placed after the patient completes orthodontics, braces.

abutment cavity decay caries tooth teeth dental Bridge Repair x-ray Resorption Gingival Margin

Teeth decay – dental caries – under a dental bridge that was repaired

1) – 2) Patient had a two-unit bridge on an upper canine abutment tooth, lateral incisor pontic and palatal wing attached to the distal of the central incisor. The patient presented with the bridge out. 3) Initially it seemed that there was external resorption on the facial surface of the canine near the gingival margin. To the left 4) Initial x-ray. Photo #1 of 3.
recurrent caries, teeth decay, dental cavities Bridge Repair Resorption Gingival Margin Gingivecto

Dental caries or a cavity under a dental bridge that was repaired

1) X-ray after root canal therapy. The root canal itself did not seem subject to external resorption. 2) Then gingivectomy with electrosurgery. This is a type of gum surgery. Note the still unusual look of the facial dental decay. 3) Next following tooth decay removal. Note the communication to the gutta percha. 4) Then the dental bonding restoration. Photo #2 of 3.
Radiographic Decay, x-ray cavities, xrays, radiographs, radiographic diagnosis decay caries interpr

Diagnosis of radiographic decay – x-rays of tooth decay

Ordinarily teeth cavities can be difficult to identify on x-rays. In this case dark shadows can be seen in the outer (whiter) tooth enamel.

Dentistry Diagnosis tooth Decay Cavity dental Caries teeth Bonding Cavity drill Technique diagnose

Tooth decay cavity identification, cavity removal and dental bonding fillings in two upper jaw molars

Photos #’s 1, 3, 5 and 8 show the first molar; Photos #’s 2, 4, 6, 7 and 8 show the second molar. Photos #’s 1 and 3 show the initial cavity. Photos #’s 3 – 7 show the steps in cavity removal. Lastly photo # 8 shows the final dental bonding white fillings.

Cavity Decay removal teeth Preparation, drill tooth drilling, high speed handpiece dental pain oral

Tooth decay diagnosis interpretation and removal in two molars

Image #’s 1, 3, 5 and 7 show the first molar; Image #’s 2, 4, 6 and 8 show the second molar. Image #’s 1 and 2 show the initial cavities. Image #’s 3 – 8 show progression in the still incomplete cavity removal in both teeth. Moreover for the second molar note how the decalcification and decay spread laterally from the buccal surface all the way into the mesial box in image #’s 2, 4, 6 and 8.
Cavity identification Decay diagnosis Interproximal Crack teeth tooth Decalcification

Dental caries diagnosis identification and removal in two lower molar teeth

1) The interproximal tooth decay was identified in x-rays; the teeth looked ok intraorally. 2) – 3) Then initial teeth cavity preparation into the proximal boxes. Notice that in the proximal boxes, the mesial of the second molar shows a zone of teeth decalcification (increased whiteness) and the distal of the first molar shows a black crack line. Both should be removed. Next in 4) note that tooth cavity removal shows the continued presence of teeth decalcification and decay on the lateral (buccal) edges of both proximal boxes. Lastly in 5) complete dental caries removal.

Radiographic Tooth Decay Interproximal Teeth Cavity X-ray xrays diagnosis interpretation diagnose

Tooth decay x-ray or dental caries radiograph

A tooth cavity is diagnosed by visual clinical examination and/or by xray diagnosis. In brief x-rays may sometimes offer the only way to diagnose cavities.
Radiographic Interproximal tooth Decay teeth Cavity X-ray diagnosis xrays interpretation radiographs

An x-ray showing tooth decay – it may not cause tooth pain

A radiograph of dental caries. A tooth cavity is diagnosed by visual clinical examination and/or by xray diagnosis. Generally ADA guidelines suggest taking x-rays less frequently than is found in most dental offices. For the most part insurance-focused dental practices may recommend frequent x-rays to compensate for low financial reimbursement for a prophylaxis teeth cleaning and exam.
Dental Diagnosis interpretation teeth tooth Interproximal Decay Cavity X-ray xrays x-rays xray

An x-ray showing tooth decay in multiple teeth where there was no tooth pain

In conclusion x-rays are necessary to properly diagnose dental health. However they should not be taken every six months or even every year for people who are at low risk for cavities or gum disease.

Oral Decay Mouth Cavity Cavities Diagnosis Color Shade Hue diagnose intraoral clinical examination

Tooth color can be an indication of tooth decay

1) Be suspicious when tooth color is different than what you would normally expect. Generally tooth decay will make a tooth look darker in the area around the cavity. However it became whiter in this case. 2) Particularly there was a large tooth cavity in this case.
subgingival tooth decay cavity teeth Hopeless extraction dental caries below gum subosseous

A hopeless tooth that should be extracted because of tooth decay

In brief 1) Photo of tooth #18 shows gum tissue growing into the space previously occupied by tooth structure. 2) X-ray shows significant tooth decay extending below the gum line to the level of the jawbone. A dental implant is indicated for tooth replacement.
cavity decay caries wisdom tooth teeth third 3rd molar impactions x-rays dental oral mouth pain

Wisdom teeth can cause tooth decay in the adjacent second molar

In this case 1) – 2) Two x-rays showing a lower wisdom tooth impacted on an angle and pushing into the adjacent second molar causing a large area of dental caries. 3) X-ray shows the wisdom tooth was removed and the second molar following root canal therapy with the large distal tooth cavity still present. 4) Finally cast gold post and core and crown in place. Note the distal crown margin completely covers where the distal dental decay was removed.
cavity decay caries wisdom tooth teeth third 3rd molar impactions dental oral mouth pain

Wisdom teeth can cause tooth decay in the adjacent second molar

These photos show preparation of the second molar to remove the distal dental caries after root canal therapy was performed on it and the wisdom tooth was removed. 1) – 2) Tooth Decay is present in the distal area of the second molar. Temporary dental filling material is visible in the occlusal opening following root canal therapy. 3) Next dental Decay removed. Therefore in 4) temporary filling material removal shows gutta percha in root canal orifices prior to cast post and core preparation.

cavity decay caries wisdom tooth teeth third 3rd molar impactions second diagnosis

Tooth decay in the teeth adjacent to wisdom teeth

1) X-ray showing a lower angular impacted wisdom tooth pushing into the adjacent second molar causing dental caries – a large dental cavity. 2) Tooth decay is present in the distal area of the second molar tooth. Temporary tooth filling material is visible in the occlusal opening following root canal therapy.

In conclusion Dr. Jeffrey Dorfman created all of the dentistry shown on this 4,400 page website. In brief we offer intelligent & honest diagnosis and better results for our patients who need help with tooth decay. Visit us when you want it done right the first time; you will save money by initially spending more. Therefore please call The Center for Special Dentistry®.