Periodontal Pockets – How To Treat Them?

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Periodontal disease is called a group of inflammatory diseases that affect the support tissue of the tooth. It might affect the gingival tissues and is called gingivitis or might affect deeper periodontal tissue and is called periodontitis.

Periodontal pockets are created by the increase of the gingival sulcus. The gingival sulcus is the space between the tooth and epithelial tissue of the gengiva. Normally the sulcus is 2-3 mm. In case of periodontal disease it deepens for more than 4 mm, and in severe cases it deepens up to the root apex and the tooth begins to move until it falls. When the sulcus deepens it creates pocket called periodontal pockets. The cause of this phenomenon is principally plaque deposits on the tooth surface, which if not removed causes damages on the gum epithelium. The epithelium migrates away from plaque rich in bacteria to defend itself.

Bacterial toxins cause gingivitis. The most common symptom of gingivitis is gum bleeding with or without external trauma. The damaged gum tissue retires getting away from his original place leaving antiesthetic and sensible root exposure. After this the bone that supports the gingival tissue retires also creating these spaces called periodontal pockets. These pockets get infiltrated with dental plaque and tartar. The presence of sub-gingival dental plaque and tartar is responsible for the progression of the disease. It is difficult to clean and brush the area of the teeth under these pockets which continues to get infected by stronger types of bacteria.
The bacteria accumulated on the periodontal pockets produce toxins that kill the osteoblast cells (cells that produce the bone). So the bone absorption continuous and tooth mobility starts to get noticed. In severe cases the mobility is so big that teeth fall with a little trauma like chewing (even they are totally healthy without caries). So the risk of losing your teeth isn’t directly linked to the periodontal pocket but to the bone absorption in absence of treatment.

The creation of periodontal pockets is tightly linked to the presence of dental plaque, but other factors might help worsen the condition like:

  • Smoke- its toxic substances destroy the cells responsible for the maintenance of periodontal tissues
  • Stress- it diminishes immunity creating the perfect environment for bacterial growth
  • Pregnancy and puberty- hormonal fluctuation favor gingivitis
  • Medicines- contraceptive, anti depressions, antihypertensive, cortisones and other types of drugs facilitate with different mechanism the damages of periodontal tissue.
  • Genetic predisposition
  • Diabetes, and other systemic diseases.

Simptoms of periodontal pockets

These gum pockets can deepen without any visible symptom. Therefore often periodontal disease is diagnosed in advance faze. In those advance fazes of the condition the most common symptoms are:

  • Swollen and reddened gums
  • Bleeding gums
  • Halitosis (in 90 % of the cases it comes from bad oral hygiene, because bacteria produce volatile sulfur compounds).
  • Increase of spaces between teeth
  • Gingival recession with root exposure
  • Sensitivity because of the root exposure
  • Teeth mobility
  • Diffuse pain

Periodontal pocket diagnose

The diagnostic procedure used for periodontal pocket diagnose is called periodontal probing. It is done by inserting delicately a millimetrated probe between tooth and gingival margin. The measures are taken in different parts of the same tooth, to verify the presence of these periodontal pockets and their depth. If the gums are healthy the depth of the sulcus is 1-3 mm. Values over 4 mm are considered pathologic. The patient has to consider also that as a response to the inflammation the gums tend to be swollen and edematous, also retraction of the gengiva makes the periodontal pocket seem less deep.
Its better with the first sign of anomaly to go to the dentist even you don’t feel any pain.

Prevention and treatment

Prevention and treatment of periodontal pocket depends on what stage is diagnosed the disease. To prevent the creation of periodontal pocket, toothpaste and toothbrush aren’t enough, but they can be if used in combination with floss. Mouth wash aren’t indispensable but you have to use them if your dentist considers it useful for your situation. All of these should be combined with regular professional hygiene every 6-8 months.

The treatment of periodontal pocket doesn’t mean that those periodontal tissues are going to be exactly as they were before the disease. It’s true that some of that tissue can be restored with some surgical technique, but just a little part of it. What you lost in terms of gingival tissue, bone and periodontal ligament you can’t gain. Still is important to treat the infection in these pockets so the disease doesn’t aggravate.
There are two types of professional treatment for periodontal pocket:

  1. Scaling and root planning or conventional periodontal therapy – It’s a non-surgical treatment done by the dental hygienist or the dentist. It consists in curetting the periodontal pocket removing dental plaque, bacteria and ill gingival tissue. Depending on the severity of the periodontal disease, antibiotics and anti-inflammatory drugs might be needed.
  2. Surgery – When periodontal pocket are very deep, cleaning them with scaling is not possible. In these cases a little surgery is performed. The dentist makes an incision opens a flap and cleans the root surfaces with curettes. Your dentist may place an antibacterial agent for a couple of minutes and then sutures the flap a little higher(closer to the root apex) than the initial place. This way the dentist can see better what goes on under the gingival tissue, cleans it better and reduces the pocket placing the gingiva higher. The reduced periodontal pockets are easier to clean. After this surgery the patient is kept under control with regular checkups and regular professional hygiene.

  1. Posted by sunitha

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