Hole in a Tooth — What Should You Do?

Discovering a hole in your tooth — whether you feel it with your tongue, notice it in the mirror, or a dentist points it out — is one of those moments where the temptation to wait and see is strong. Resist it. Tooth decay is a progressive disease. What is a small filling today becomes a large filling tomorrow, a crown next year, and potentially a root canal or extraction the year after that.

What causes a hole in a tooth?

A hole — clinically called a cavity or carious lesion — is the physical result of tooth decay. The process begins long before the hole appears.

Bacteria in the mouth, primarily Streptococcus mutans, feed on fermentable carbohydrates — sugars and refined starches — and produce acid as a byproduct. This acid demineralises enamel, progressively softening and dissolving tooth structure. Initially the damage is microscopic and reversible with fluoride and good oral hygiene. Once the enamel surface breaks down entirely, a physical cavity forms — and at that point the damage cannot be reversed without intervention.

The most common sites for cavities are the biting surfaces of back teeth, where deep fissures trap bacteria and food; the contact points between teeth, where flossing is the only effective cleaning method; and the exposed root surfaces of teeth with gum recession, which have no enamel protection.

What does a hole in a tooth feel like?

Not all cavities are symptomatic — particularly in their early stages. Many are discovered at routine check-ups through clinical examination and X-rays before the patient has felt anything at all. This is one of the strongest arguments for regular dental visits: catching decay before it becomes painful is always better than waiting for pain to drive the appointment.

When symptoms do occur they typically follow this progression:

• Sensitivity to sweet foods and cold — early dentine involvement
• Lingering cold sensitivity — decay approaching the pulp
• Spontaneous aching or throbbing — pulp inflammation, indicating significant depth
• Sensitivity to heat, or pain that wakes you at night — irreversible pulpitis, requiring root canal treatment or extraction
• Swelling, abscess, or a pimple on the gum — infection has spread beyond the tooth

Pain is not a reliable indicator of severity. A tooth can have extensive decay with no symptoms at all until the pulp is involved. Conversely, a relatively small cavity in a sensitive location can be acutely painful. Clinical and radiographic assessment is the only reliable way to determine what is actually happening.

What happens if you leave a hole in a tooth untreated?

Decay does not stabilise without treatment. The bacterial process continues, the cavity deepens, and the structural integrity of the tooth progressively diminishes. The clinical consequences of delay follow a predictable path:

Small cavity in enamel or superficial dentine → simple filling, completed in one appointment, minimal cost, tooth fully preserved.

Moderate cavity in deeper dentine → larger filling or possible onlay, more tooth structure removed, higher cost, some risk of sensitivity post-treatment.

Deep cavity approaching or involving the pulp → root canal treatment or extraction. Root canal treatment preserves the tooth but requires multiple appointments and subsequent crown placement in most cases. Extraction removes the problem but creates a gap that requires management — implant, bridge or denture — to prevent adjacent teeth drifting and opposing teeth over-erupting.

Dental abscess → urgent treatment, possible hospital admission in severe cases, risk of spreading infection to jaw, neck and beyond. Dental infections, while rarely life-threatening in healthy adults, can become serious rapidly in immunocompromised individuals.

The cost — financial, biological and in treatment complexity — escalates at every stage. A filling placed early costs a fraction of what root canal treatment and a crown costs later.

How Tooronga Family Dentistry treats cavities

Small to moderate cavities — tooth-coloured composite fillings We use tooth-coloured composite resin for the vast majority of fillings. Modern composite is strong, aesthetically natural, and requires less removal of healthy tooth structure than the amalgam fillings of previous decades. For patients across Glen Iris, Malvern and Hawthorn who have old silver amalgam fillings they’d like replaced for aesthetic or health reasons, composite replacement is a straightforward option we discuss at consultation.

The procedure is straightforward: local anaesthesia, removal of decayed tissue, conditioning of the tooth surface, placement and shaping of composite resin in layers, curing with a light, and final polishing. Most fillings are completed in a single appointment of 30 to 60 minutes.

Large cavities — onlays and crowns When decay has destroyed a significant portion of tooth structure, a filling alone may not provide adequate strength or longevity. An onlay — a laboratory-fabricated restoration bonded to the remaining tooth structure — or a full crown may be recommended. These restorations are more durable for heavily broken-down teeth and distribute biting forces more effectively than large direct fillings.

Deep cavities near the pulp — protective measures When decay is deep but the pulp has not been directly exposed, we place a protective liner or base beneath the filling to promote pulp recovery and reduce the risk of post-operative sensitivity. In some cases a tooth requires monitoring after a deep filling to confirm the pulp remains healthy before a final restoration is placed.

Root canal treatment Where the pulp is irreversibly inflamed or infected, root canal treatment removes the pulp tissue, disinfects the root canal system, and seals the tooth. Modern root canal treatment at Tooronga Family Dentistry is performed under local anaesthesia and is significantly more comfortable than its reputation suggests. The majority of patients report the procedure as no more uncomfortable than a routine filling.

Emergency care for painful cavities We understand dental pain doesn’t follow business hours. If you are experiencing acute toothache from a cavity — particularly spontaneous pain, throbbing, or pain that prevents sleep — contact us as a priority. We accommodate urgent appointments for patients across Glen Iris, Malvern, Hawthorn, Hawthorn East and Ashburton.

What you can do right now

If you’ve noticed a hole in a tooth, the single most useful thing you can do is book a dental appointment promptly. In the meantime:

• Avoid very hot, cold, or sweet foods that trigger pain
• Keep the area clean — don’t avoid brushing a decayed tooth for fear of pain
• If the cavity has a sharp edge catching your tongue or cheek, temporary dental cement from a pharmacy can provide short-term protection while you wait for your appointment
• Take paracetamol or ibuprofen at recommended doses for pain relief — clove oil applied to the cavity can provide additional temporary relief
• Do not place aspirin directly on the gum or tooth — this causes chemical burns to soft tissue

Prevention — making the next cavity less likely

Once decay has been treated, attention turns to preventing recurrence. At Tooronga Family Dentistry we don’t simply fill and farewell — we review why the cavity developed and address those factors directly.

• Fluoride treatments applied in-chair strengthen enamel and dramatically reduce cavity risk
• Fissure sealants on back teeth with deep grooves prevent bacteria and food from becoming trapped in the highest-risk sites
• Dietary review — identifying the frequency and timing of sugar exposure in your diet
• Oral hygiene instruction — ensuring brushing technique and interdental cleaning are genuinely effective
• Regular check-ups and X-rays — catching the next lesion before it becomes a cavity

Found a hole in your tooth or experiencing toothache? Don’t wait. Book an appointment at Tooronga Family Dentistry — we provide prompt, thorough care for patients across Glen Iris, Malvern, Hawthorn, Hawthorn East and Ashburton.

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Blog 15: Sudden Sharp Pain When Chewing — What Is It and What Should You Do?

Sharp pain when you bite down is one of those symptoms that’s hard to ignore — and shouldn’t be.

A sudden, sharp pain when chewing is your tooth signalling that something is structurally or biologically wrong. Unlike the dull ache of a developing cavity or the generalised sensitivity of enamel erosion, pain specifically triggered by biting or chewing is highly localised and diagnostically meaningful. It narrows the possible causes considerably — and most of them require professional assessment rather than watchful waiting.

Why biting causes pain — the underlying mechanics

When you chew, you apply significant force through your teeth — the average bite force on a molar is between 400 and 800 newtons. In a healthy tooth this force is distributed evenly through intact tooth structure and absorbed by the periodontal ligament — the fibrous tissue suspending the tooth in its socket. Pain occurs when this force encounters a structural defect, an inflamed ligament, or an exposed nerve — concentrating stress in a way that triggers an acute pain response.

The most common causes of sharp pain when chewing

Cracked tooth syndrome The most common and frequently missed cause of sharp biting pain. A crack in a tooth — often invisible on X-ray and sometimes invisible to the naked eye — creates an unstable segment of tooth structure that flexes under biting load. This flexion stimulates the nerve acutely, producing a sharp pain that typically occurs on biting down and releases suddenly when pressure is removed. The pain on release is particularly characteristic of a cracked tooth.

Cracks most commonly affect back teeth and are strongly associated with large old fillings that have weakened surrounding tooth structure, grinding and clenching, and biting hard objects. Ice chewing is a surprisingly common precipitating factor.

The challenge with cracked tooth syndrome is that the crack may not be visible on X-ray, making diagnosis dependent on clinical testing — bite testing with a specialised instrument on individual cusps, transillumination with a bright light to reveal crack lines, and dye staining. An experienced clinician can usually identify the offending tooth and cusp with targeted testing.

Treatment depends on crack depth. A crack confined to enamel and dentine is typically managed with a crown, which holds the tooth together and prevents the crack propagating further. A crack extending into the pulp requires root canal treatment before the crown. A crack extending below the gumline into the root — a vertical root fracture — often cannot be saved and requires extraction.

A failing or fractured filling An old filling — particularly a large amalgam filling — can fracture or develop a crack in the surrounding tooth structure over time. The remaining tooth walls, unsupported and weakened, flex under load and produce sharp pain. Sometimes the fractured cusp is visible; sometimes it requires magnification to identify. Treatment typically involves replacing the filling with a crown or onlay to restore structural integrity.

Decay beneath an existing restoration Secondary decay — decay developing at the margin of an existing filling or crown — undermines the restoration and the tooth structure beneath it. Biting load applied to a compromised tooth produces pain. X-rays are usually diagnostic. Treatment involves removing the failing restoration, excavating the decay, and replacing with a new filling or crown depending on the extent of destruction.

Periodontal abscess or acute gum infection An abscess in the gum tissue or periodontal ligament causes exquisite sensitivity to biting — the inflamed ligament cannot absorb occlusal load normally. Unlike pulp-related pain, periodontal pain tends to be more constant, associated with visible swelling or a pimple on the gum, and often accompanied by a bad taste. The tooth is typically tender to touch on its side as well as to biting. Treatment involves draining the abscess, cleaning the periodontal pocket, and antibiotic therapy where indicated.

Reversible pulpitis Inflammation of the pulp — from deep decay, a recent filling, or trauma — can cause pain on biting before progressing to spontaneous aching. At this stage the inflammation may still be reversible with appropriate treatment. A recently placed filling that produces biting pain may simply require adjustment of the bite — a high filling concentrates occlusal force on the restored tooth and causes disproportionate discomfort.

Irreversible pulpitis and pulp necrosis When pulp inflammation progresses beyond the reversible stage, biting pain is typically accompanied by spontaneous aching, sensitivity to heat that lingers, and eventually the development of an abscess. This requires root canal treatment or extraction — not a wait-and-see approach.

Dentine hypersensitivity at a specific tooth Localised enamel loss or root exposure at a single tooth can produce sharp pain with certain foods or biting pressures. This is typically less severe than crack-related pain and more consistently triggered by specific stimuli — cold, sweet, or acidic — rather than pure biting force.

Loose crown or broken tooth A crown that has lost its cementation moves fractionally under load, producing sharp pain or sensitivity. This is usually identifiable — the crown may feel slightly mobile or different under biting pressure. A loose crown requires re-cementation promptly; leaving it risks decay developing on the exposed tooth preparation underneath.

Diagnosing the cause — why this requires professional assessment

Sharp biting pain cannot be reliably self-diagnosed. Several of the causes above — particularly cracked tooth syndrome — are genuinely difficult to identify even clinically and require systematic testing. Attempting to diagnose by process of elimination at home wastes time and allows potentially serious conditions to progress.

At Tooronga Family Dentistry we use a structured diagnostic protocol for biting pain:

• Detailed history — when does it occur, which tooth, biting down or releasing, hot or cold sensitivity, spontaneous pain
• Visual examination with magnification and transillumination
• Bite testing with a Tooth Slooth — isolating individual cusps to identify the exact site of pain
• Percussion testing — tapping teeth to assess periodontal ligament involvement
• Thermal testing — cold and heat to assess pulp status
• Digital X-rays — assessing for decay, bone loss, abscess, and restoration integrity
• Probing — assessing gum pocket depths around the affected tooth

This systematic approach almost always identifies the cause — even when the crack or defect is not immediately visible. The diagnostic appointment is the most important step.

Why you should not delay assessment

Sharp biting pain rarely resolves spontaneously. The underlying causes — cracks, decay, failing restorations, pulp inflammation — are progressive. A cracked tooth diagnosed and crowned early is saved. The same tooth left until the crack propagates into the root is extracted. A deep cavity causing biting pain that is treated now may need only a filling. Left until the pulp is involved it needs root canal treatment and a crown.

The window for conservative treatment is open now. It closes progressively with time.

Immediate measures while waiting for your appointment

• Avoid chewing on the affected side
• Avoid very hard foods — crusty bread, nuts, raw carrots — that concentrate biting force
• Avoid temperature extremes if thermal sensitivity is also present
• Take paracetamol or ibuprofen at recommended doses for pain management
• Do not attempt to diagnose or treat by biting on something to identify the tooth — this risks propagating a crack further

Experiencing sharp pain when you chew? This is not something to monitor at home. Book an assessment at Tooronga Family Dentistry — we see patients from Glen Iris, Malvern, Hawthorn, Hawthorn East and Ashburton and have the diagnostic tools and clinical experience to identify the cause accurately and treat it promptly.