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cavities between teeth and possibly under gumline?
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Questions in the Dental Health forum are answered by Dr. Jerome Tsang. Topics covered include bridges, cavities, crowns, and x-rays.

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cavities between teeth and possibly under gumline?

Hi, I have a few cavities between my front teeth where I *used* to have white fillings.  I will not be able to get to the dentist until next week or possibly even the week after.  In the meantime, I am worried to death about my teeth.

These cavities aren't huge or really painful, but I noticed that they go up to my gumline.  I am terrified that the decay may have spread under my gums.  What would happen in this case?  I've read that decay under the gumline is difficult to fill and sometimes requires part of the gums to be removed.  I guess gums can be grafted if necessary, but wouldn't that look ugly?

I'm also afraid that I will need have veneers or crowns put on my front teeth if the dentist has to drill out too much of my teeth.  I know you can't tell for sure without seeing me, but can you give me an idea of how large a cavity in a front tooth would generally need to be in order to call for a crown or veneer?

Thanks so much for your help!
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Yes, it depends on the extent of the cavity to determine what is the proper treatment for the tooth.  Cavities can grow under the gums and it may need some gum surgery to create access to the cavity to fill it.  If there is significant removal of the gum, it can create a defect.  You may have to see how extensive the cavity is first.  Gum grafting should yield favorable results though if required.  If it is extensive, it may be best to put a crown or veneer in place.  The extent of a cavity that determines what is needed depends on several things such as how deep below the gums it is, how large the cavity is and how close is it to the nerve/pulp.  

In terms of criteria, it depends on the doctor.  Generally though, if the cavity is well past the enamel and through into the dentin approximately 2-3mm, I would consider a crown and possibly a root canal.  Also keep in mind that the lateral incisors (the ones right next to the middle ones) are smaller and therefore 1-2mm may be too deep already.  

The criteria is pretty much based upon how much tooth structure you have left. A filling can fill a small cavity but if it gets too large, the tooth is too weak and may break with a filling.  

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Jerome Tsang, DDSBlank
Irvine Modern Dentistry
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