Hole in a Tooth: What It Means and What Happens Next
A hole in a tooth, or cavity, can be a sign of tooth decay and does not heal on its own. This page explains why it may not hurt, how its depth points to a filling, onlay, crown or root canal treatment, and what happens if it is left. NHS advice is to see a dentist as soon as possible if you think you have decay.
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Clinically reviewed by Dr Ibraheem Ijaz, dentist · GDC 301711
Medical disclaimer: This page is for general information only. It does not replace an examination or treatment by a dentist.
Dr Ibraheem Ijaz, principal dentist at Deepcar Dental Care, reviewed this page. He is a General Dental Practitioner, GDC 301711, with a BDS, BSc (Hons), MSc (Leeds) and postgraduate qualifications in implant, restorative and aesthetic dentistry.
What is a hole in a tooth?
A hole caused by tooth decay, called a carious cavity, forms where decay has broken down the tooth's surface. NHS guidance says a hole can form if decay gets worse.
A tooth has three layers, enamel, dentine and pulp: hard enamel outside, dentine beneath, and the soft pulp in the middle. Dental caries, the disease behind a cavity, has its own page, while a broken-down tooth, worn teeth and failing old fillings are among the options in this section.
Can a hole in a tooth heal?
No, a hole in a tooth does not heal on its own. Sedek and Holiel's 2025 review explains that natural enamel cannot regenerate, as the cells that form it are lost after the tooth has formed; repair relies mainly on remineralising shallow, early defects.
NHS guidance says fluoride treatments like mouthwash or varnish can reverse early tooth decay, but you will probably need a filling once there is a hole.
Why does a hole in a tooth not always hurt?
A hole may not hurt, and tooth decay may not cause any symptoms at first, NHS guidance says. Renton's 2011 review of dental pain explains that toothache is caused by inflammation of the pulp.
NHS guidance says a hole may bring toothache, a sharp pain with hot, cold or sweet things, or white, brown or black spots. Its advice:
- See a dentist as soon as possible if you think you have tooth decay, and see one for problems like toothache or a sharp pain when eating or drinking, or gums that are painful, swollen or bleed when you brush.
- See a dentist if toothache lasts more than 2 days, does not go away with painkillers, comes with a high temperature, pain when you bite, red gums or a bad taste in your mouth, or your cheek or jaw is swollen. If you do not have a dentist or cannot get an emergency appointment, call 111 or visit 111 online.
- Go to A&E if you have toothache and the area around your eye or your neck is swollen, or swelling in your mouth or neck makes it difficult to breathe, swallow or speak. Do not drive: ask someone to take you or call 999.
Toothache and swelling are covered on our urgent dental care pages.
To ask about a hole in a tooth, book online or call 0114 288 2121.
How does the depth of a hole decide the treatment?
How deep a hole goes, and how much strong tooth is left around it, guides the repair a dentist suggests. In general, a dentist examines the tooth and may use dental X-rays, which the ICCMS caries system says help estimate how deep decay reaches.
| Depth | What it means | Guidance |
|---|---|---|
| A small break in the enamel | Enamel breaking down, with no dentine showing. | ICCMS: minimally invasive care, removing little or no dentine, matched to whether the decay is active. |
| A hole into the dentine | A clear cavity exposing the dentine. | Bristol Dental School: a filling replaces lost tooth tissue to stop food and bacteria entering the cavity. |
| A large hole or weakened cusp | A very large cavity, or a weakened cusp (a raised point of a back tooth). | NHS: crowns can be fitted where a tooth has broken, decayed or been damaged. Dental Update review: covering weakened cusps is a minimally invasive alternative to a conventional crown. Bristol Dental School: if the tooth needs more reinforcement, an inlay or onlay may be considered; white fillings are not appropriate in some situations, including very large cavities. |
| Decay reaching the pulp | Decay in the pulp, the tooth's soft centre. | NHS: you may need root canal treatment, then a filling or crown to seal the tooth; sometimes the tooth may need removing. |
Four ways of repairing and rebuilding damaged teeth, which aim to save natural teeth, have their own pages: white fillings, inlays and onlays for larger cavities, crowns for damaged teeth, which cover the whole tooth, and endodontic treatment to save a tooth with an infected pulp. Choosing between a crown and a filling compares those two.
Restorative treatments and extractions at Deepcar Dental Care
Treatments offered at Deepcar Dental Care include white fillings, composite and ceramic inlays and onlays, crowns, root canal treatment and extractions.
What happens if a hole in a tooth is left untreated?
Left untreated, a hole can get worse, and NHS guidance says untreated problems could become harder to treat. Decay reaching the pulp may need root canal treatment or removal of the tooth, and infection can sometimes cause a painful build-up of pus (a dental abscess). NHS abscess guidance says:
- Ask for an urgent dentist appointment or get help from NHS 111 if you think you have a dental abscess.
- Call 999 or go to A&E if you find it hard to breathe, speak or swallow, have a swollen or painful eye or sudden problems with your eyesight, have a lot of swelling in your mouth, or find it hard to open your mouth. Do not drive to A&E: ask someone to take you or call 999.
Frequently asked questions
What does a black hole in a tooth mean?
A black or dark area can be a sign of a hole from decay; an examination can show whether it is. NHS guidance lists white, brown or black spots among the signs of a hole and says to see a dentist as soon as possible if you think you have decay.
Can you have a hole in a molar and not know?
Yes. NHS guidance says a hole may bring signs, not that it will. It advises regular check-ups even if you have no problems, as a check-up lets your dentist see whether you have any. If you think you have decay, see a dentist as soon as possible.
Can a dentist fix a hole in a tooth without drilling?
Usually not in adult teeth. A 2021 Cochrane review says holes have traditionally been treated by removing the decay and placing a filling, and found too little evidence, all of very low certainty, to tell whether sealing over a hole without removing decay works as well.
Is treatment for a hole in a tooth available on the NHS?
NHS guidance says fillings, crowns and root canal treatment are usually available on the NHS. Adults usually pay a contribution, but it is free for some people, including under-19s in full-time education, anyone pregnant or who has had a baby in the past 12 months, and people on some benefits. Ask your dentist about NHS availability and cost first.
Should you see a GP about a hole in a tooth?
No. NHS guidance says not to go to your GP, as they cannot give you dental treatment; contact a dentist. In an emergency or out of hours, call your dentist: if they are closed, their answerphone may tell you what to do. If you have no dentist or cannot get an emergency appointment, call 111 or visit 111 online.
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334 Manchester Road
Deepcar, Sheffield S36 2RH
0114 288 2121
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Open 8am to 8pm, seven days
Free parking at the door