One of the worst things about tooth decay is that you can’t always recognize it when it’s in the early stages. That is why it is so important to see your dentist or dental hygienist regularly for a cleaning and oral exam, along with good home oral care of twice daily brushing and flossing at least once a day.Whether decayed teeth cause a toothache depends on where the decay is located. A cavity in the tooth enamel doesn’t cause pain. In fact, you won’t notice it until the decay reaches the dentin, the softer mid-layer of a tooth that lies between the enamel and the pulp. Decayed teeth can be saved if identified while they affect only the enamel or dentin, but if the decay has reached the nerve-filled pulp at the centre of the tooth, a root canal or an extraction may be necessary. A root canal may save the tooth but will then require a crown be placed to ensure long term sustainability. In severe cases of decay or fracture it may be best to extract it. An implant to replace the missing tooth is often recommended to prevent the remaining teeth from shifting and for overall better oral function.Today extraction is often the last resort but when necessary there are options available to ensure excellent function and esthetics are maintained.