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Dentists remove tooth decay by simply drilling the part of the tooth that has decayed and filling the hole with a "cement", followed by a sealant to prevent bacteria from getting in and causing more decay.
If you have a cavity that if farther below the surface of the tooth, they will begin by adding local numbing gel and an anesthetic injection.
Surface cavities usually do not require anesthetics and will take about 20-30 minutes to complete the procedure.
If bacteria has rotted most of the tooth, it will require removal or a root canal.
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