Periodontology - Periodontal Pocket

A periodontal pocket is characterized by a probing depth of 4 mm or more. This occurs when the gingival fibers that once attached the gum tissue to the tooth have been irredeemably damaged and are destroyed. The gingival sulcus is the crescent of gum tissue that forms the gumline; between the gum tissue and the tooth, there is a small crevice that contains bacteria, debris, cells, and fluids. The depth of the gingival sulcus is measured and this probing depth is recorded during a basic periodontal exam and must be noted so that the progress of periodontal disease can be monitored. Periodontal pockets are particularly susceptible to infection, which may result in abscess, and it is also possible for the roots of the tooth to sustain damage when they are no longer protected by the sulcular epithelium. When abscess occurs, this usually requires drainage and both systemic and local antibiotic treatment. The periodontal pocket is defined as either supra bony or infra bony, depending on its location in relation to the alveolar bone. If the periodontal pocket is not treated, it can damage the soft tissues beyond the gingiva, becoming a mucogingival defect. Dental scaling and root planing, also known as a dental deep cleaning, is the preferred treatment for periodontal disease; in this treatment, a dental health professional will scrape away the calculus that has accumulated on the teeth both above and below the gumline, and will also scrape and reshape the roots of the teeth to discourage further bacterial inflammation. When dental scaling and root planing is successful, it can help the tissues of the gums retain their healthy shape and size, reducing the depths of pockets and encouraging the gums to comfortably surround the teeth once more.

Periodontal pockets begin with dental plaque. When bacteria from plaque invade the tissues of the periodontium, inflammation results. This inflammation destroys the tissues of the periodontium over time. When plaque hardens and turns into dental calculus, it is impossible to clean without professional treatment. It also creates a rough surface that encourages the adhesion of even more bacterial plaque, which continues to cause damage and inflammation and also to build up as even more calculus. This causes periodontal pockets to deepen, as the gum tissue is pushed away from the teeth by inflammation, calculus, and debris. This continuous cycle of damage gradually leads to a loss of attachment of the gingival tissues and degradation of the bone. Periodontitis is exacerbated by certain risk factors, including smoking, diseases like diabetes, or misshapen dental restorations that trap food or debris. Proper oral hygiene is the best way to manage the level of plaque in the oral cavity, and professional cleanings are necessary to remove calculus from the teeth, both above and below the gums, which discourages the buildup of further plaque. Proper oral hygiene requires twice-daily brushing with a soft-bristled toothbrush and fluoride toothpaste, and interdental cleaning, with either interdental brushes or dental floss, once daily. Regular dental checkups facilitate early detection of periodontal pockets, and, since periodontitis is largely devoid of symptoms until considerable damage has been sustained, early detection is an integral part of successful treatment.