Hole In Tooth: Causes, Treatment and Prevention

A hole in a tooth is also referred to as a cavity, caries or tooth decay.

It is the damage that happens when the bacteria in your mouth produce acids that dissolve the hard tooth structure. If it is not treated on time, it can lead to severe pain, infection, and eventual loss of the tooth.

Holes occur more on the chewing surfaces of molars and premolars, smooth surfaces of the sides of the teeth and less commonly on the cutting surfaces of the incisors. A hole can also develop along the margins of tooth fillings.



1. Excess Sugar Consumption

This is the most common cause of a hole in the tooth. When you consume sugary foods and drinks frequently, the bacteria that live in the mouth feed on the sugar and produce acid. This acid remains in your mouth for at least 30 minutes and your teeth are vulnerable to acid damage within this time.

2. Poor Oral Hygiene

Not brushing your teeth twice daily can cause the build-up of plaque- a white sticky film of bacteria on the teeth surface.

This build-up makes the teeth prone to having holes. Also, not brushing regularly after eating sugary foods is another reason for having a hole in the tooth.

Using a fluoride-containing toothpaste strengthens the teeth, preventing them from getting holes.

3. Inadequate Saliva Production

Saliva helps in cleaning the mouth so when enough saliva is not produced, it leads to a condition called xerostomia or dry mouth. This can be caused by taking certain medications, Sjogren’s syndrome or head and neck radiation due to cancer. This inadequate saliva production can lead to the formation of holes in the teeth.


4. Tobacco Use

Using tobacco products reduces the amount of oxygen in the mouth. This leads to dry mouth which in turn causes cavity formation.

5. Medical Conditions

Medical conditions like poorly controlled diabetes mellitus lead to a high level of glucose in the saliva which helps bacteria thrive.

Other conditions like Gastro-Esophageal Reflux Disease can cause holes in the teeth as a result of the backflow of acid from the stomach to the mouth.

An eating disorder known as bulimia nervosa (bulimia), where the stomach acid wears out the teeth from frequent vomiting, can also contribute to a hole formation.


The tooth is made up of three layers – the enamel, the dentin, and the pulp.

  • A hole starts at the enamel which is the outermost layer. At this stage, there is usually no pain and if the hole is treated on time, it does not progress.
  • If not treated, it progresses to the middle layer – the dentin. And if this is still not treated, it moves to the pulp which is the innermost layer.
  • The pulp houses blood vessels and nerves so when the decay spreads to the pulp, it causes intense pain. Advanced cases can cause pus accumulation at the root leading to abscess formation.


The symptoms of a hole in a tooth are usually dependent on the extent of the damage. These include:

  • Black spot or stain on the tooth. This is usually the earliest sign of a hole in the tooth.
  • Tooth sensitivity when you take hot, cold or sweet foods. The sensitivity can be described as a shocking, sharp pain that subsides after a few seconds.
  • Throbbing toothache
  • Sometimes there are no symptoms.


You should see your dentist if you suspect you have a hole in your tooth. Dental x-rays are usually taken by your dentist to assess the progression of the hole and aid proper treatment planning.

Tooth Filling

A hole that is at the enamel can be treated by filling the tooth with a tooth filling material such as composite, Glass ionomer cement, or a silver-colored amalgam.

Dental Crown

A dental crown or a cap is placed on the tooth if a large amount of the tooth has been destroyed. These crowns are made from porcelain or metal and help to strengthen the tooth.

Root Canal Treatment

If the hole is in the pulp, a root canal treatment might be performed by your dentist. This treatment involves removing the infected pulp and filling it with a root filling material. Antibiotics and analgesics may be prescribed for the associated pain and infection in cases of abscess formation.

Tooth Extraction

If the tooth cannot be saved or you cannot afford a root canal treatment, tooth extraction might be recommended.

Other Treatment

Frequent sips of water can help to reduce dry mouth. Other medical causes of dry mouth should also be reviewed appropriately by a physician.

Medical conditions that can make you prone to having holes in the teeth like GERD and bulimia should also be co-managed by a physician.


Preventing a hole in your tooth usually starts at home by taking proper care of your teeth. These tips are important to prevent cavities:

  • Use a fluoride-containing toothpaste to brush your teeth as this can help stop and arrest tooth decay.
  • Make sure you brush your teeth at least twice a day – in the morning and before bed.
  • Floss your teeth daily to remove food particles in between your teeth.
  • Visit your dentist at least twice a year for routine checks. A cavity can be seen early enough and treated on time.
  • A dental sealant can also be placed on the chewing surfaces of your teeth. This is a material that fills the teeth to prevent food stagnation. This, in turn, prevents tooth decay.
  • Reduce your frequency of consuming snacks rich in carbohydrate, candy, sticky foods, and drinks. If you take them, rinse your mouth with water or chew sugar-free gum.


A hole in your tooth is not normal and needs to be checked out by your dentist immediately. Proper oral hygiene practices and regular dental visits are some of the ways these holes can be prevented from occurring or getting worse.

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