Gingival or periodontal pocket :
Gingival or periodontal pockets are measurements of the gingival sulcus depth. They measure the distance from the gingival margin to the gingival fibers above the bone level around the teeth. These terms usually indicate the presence of an abnormal depth of the gingival sulcus near the point at which the gingival tissue contacts the root of the tooth.
Multiple anatomical structures constitute the gingival system, your dentist can give you more details about the exact problem you have, but we’ll make a short description of the common structures and problems encountered.
We classify problems with the foundation (gum system that hold the teeth in) as mild, moderate or severe depending on how deep the probe goes:
1) 1-3 mm: indicates health
2) 4-5 mm: a mild problem
3) 6-7 mm: a moderate problem
4) 8-9-10 mm: a severe problem
Tooth gingival interface:
Probing depths greater than 3 mm can mean that there is actual bone loss around ‘that’ area of the tooth which was probed, that the gums are inflamed or swollen or a combination of both.
The interface between a tooth and the surrounding gingival tissue is a dynamic structure. The gingival tissue forms a crevice surrounding the tooth where food debris, cells, and chemicals float. The depth of this crevice, known as a sulcus, is in a constant state of flux due to microbial invasion and subsequent immune response. Located at the depth of the sulcus is the epithelial attachment. It consists of approximately 1 mm of junctional epithelium and another 1 mm of gingival fiber attachment, comprising the 2 mm of biologic width naturally found in the oral cavity. The sulcus is literally the area of separation between the surrounding epithelium and the surface of the tooth.
A gingival pocket is present when the marginal gingiva experiences an edematous reaction, whether due to localized irritation and subsequent inflammation, systemic issues, or drug induced gingival hyperplasia. Regardless of the etiology, when gingival hyperplasia occurs, greater than normal periodontal probing measurements are present, creating the illusion that periodontal pockets have developed. The epithelial attachment remains at the same attachment level found in pre-pathological health.
In a gingival pocket, no destruction of the connective tissue fibers (gingival fibers) or alveolar bone occurs. This early sign of disease in the mouth is completely reversible when the etiology of the edematous reaction is eliminated and frequently occurs without dental surgical therapy. However, in certain situations, a gingivectomy is necessary to reduce the gingival pocket depths to a healthy 1–3 mm.
If the probing depth is greater than 3mm, then we hope that it is because the gums are swollen (edematous). The reason being that the problem of swollen gums can be reversed quite easily by stepping up with your brushing and flossing, particularly the flossing.
If your gums bleed while flossing, just keep flossing and massaging them, even if they hurt. By continuing to work on your gums they will eventually tighten up and stop bleeding and the pocket measurements will reduce.
As the original sulcular depth increases and the apical migration of the junctional epithelium has simultaneously occurred, the pocket is now lined by pocket epithelium instead of junctional epithelium. To have a true periodontal pocket, a probing measurement of 4 mm or more must be clinically evidenced. In this state, much of the gingival fibers that initially attached the gingival tissue to the tooth have been irreversibly destroyed. The depth of the periodontal pockets must be recorded in the patient record for proper monitoring of periodontal disease.. A periodontal pocket can become an infected space and may result in an abscess formation with a papule on the gingival surface. Incision and drainage of the abscess may be necessary, as well as systemic antibiotics; placement of local antimicrobial delivery systems within the periodontal pocket to reduce localized infections may also be considered.
If the probing measurements (greater than 3 mm) are due to actual bone loss and not swollen gums, then we will be able to see the bone loss on x rays. In addition to this, the tooth may be loose. If there is less bone holding onto the root of the tooth, then the tooth will be loose.
When the destruction continues apically and reaches the junction of the attached gingiva and alveolar mucosa, the pocket would thus be in violation of the mucogingival junction and would be termed a mucogingival defect.
There are different ways to treat the pockets that are greater than 3mm. The type of treatment depends on the severity of the pocketing measurement.
1) Probing measurements that are 3 mm or less are considered to be healthy. We advise the patient to keep up their home care and come in for regular cleanings (usually every 6 months).
2) For measurements that are 4-5 mm, we generally start by evaluating the need for curettage or deep cleaning and place the patient on a 3-4 month recall cleaning frequency, and combine it with good home care. By having the patient in for more frequent cleanings than 6 months, we are able to get into the deeper areas and clean them out with our specialized instruments. This will prevent them from getting deeper.
3) For pocketing measurements that are 6 mm or greater, the treatment will involve more complex gum procedures in order to reduce the deeper numbers. The goal of treatment is to lower the pocketing measurements to numbers that the patient can deal with and keep clean on their own.
The text above is for information purposes only. To have the proper medical treatment and diagnosis, please consult your health professional.
The masculine gender was used to make the reading easier.
For more information talk to your dentist, or if you wish to make an appointment with our team, call us at: 514-366-3738