What Should You Do About Periodontal Pockets?

Your teeth are held in place by your gums and jawbone. The space between your gums and teeth is small and measured in millimetres. This may sound negligible, but it may be a symptom of periodontal disease if the distance starts to widen and deepen. These gaps are known as periodontal pockets and can become filled with bacteria that lead to infection, tooth decay and even tooth loss. The size of a periodontal pocket determines the severity of your periodontitis or gum disease.

Let’s dive into how periodontal pockets are formed and what can be done to prevent and treat them.

Periodontal Pockets

Typically, there is a small space known as the sulcus between the gums and teeth in a healthy mouth. These shallow pockets collect food particles that are easily cleaned away during your regular brushing and flossing routine. If food particles are not removed regularly, plaque can form, eventually building up and forming a hardened substance called tartar. Tartar is difficult to get rid of and can cause gingivitis. Gingivitis is inflammation and infection of the gingiva, i.e., the pink tissue surrounding your teeth typically referred to as your gums. If gingivitis is left untreated, it can worsen and become periodontal disease.

Inflammation and swelling of the gums can result in your gum tissue pulling away from your teeth. The healthy sulcus then widens, resulting in a periodontal pocket. As the growth of bacteria increases, gum attachment decreases, and the pocket keeps getting deeper. If left untreated, further erosion can jeopardize your tooth and surrounding structures.

Diagnosis

Periodontal disease in its earliest stages starts with bleeding and inflammation of the gingiva. If you are experiencing symptoms of gingivitis, your periodontist will assess your gums to determine their condition. They will measure the space between your gum tissue and your teeth using a small tool called a periodontal probe. Periodontal probes are calibrated in millimetres; the higher the measurement, the greater the attachment loss of your gums to your teeth. Here are some facts to keep in mind:

• Healthy and normal gums measure between 1mm and 3mm.
• Mild periodontitis yields measurements between 4mm and 5mm. At this stage, gingivitis is present, but the inflammation has extended and may be causing some bone loss.
• Moderate periodontitis typically results in 20-50% bone loss around the root of the tooth. The periodontal probe measures between 5mm and 7mm at this stage.
• Advanced periodontitis has pocket depths of 7-12mm and bone loss from 50-85%. The tooth may start to loosen and cause discomfort.

According to the National Institute of Dental and Craniofacial Research in the United States, periodontal disease is present when at least one periodontal site has a pocket with at least 3mm of gum attachment loss and a pocket depth of 4mm.

Treatment of Periodontal Pockets

Treatment for periodontal pockets depends on the size and depth of the pocket, how far the inflammation has spread and if there is tooth and bone loss. Your periodontist will give you an X-ray if bone loss is suspected to determine the degree of loss.

The first step is to clean your teeth and remove plaque and tartar. In mild cases of periodontal disease, removing the plaque barrier with professional cleaning and an augmented home dental care regime will be sufficient to reduce the inflammation of the gum tissue. This process allows your gums to heal, tighten and reattach to your teeth. If there is no bone loss, your dentist may recommend brushing with a soft toothbrush and flossing twice a day. You might also need to use an oral antibiotic rinse.

In more advanced cases of periodontal disease, your dentist will perform a deeper cleaning procedure called scaling and root planing. This procedure removes plaque and tartar from the surface of teeth and periodontal pockets and smooths the tooth surface to encourage reattachment of the gums. If there is bacteria deeper in the periodontal pocket, your periodontist may also do laser periodontal therapy. This minimally invasive procedure involves the use of amplified light to remove inflamed and diseased gum tissue. The laser will clean any bacteria that may still be inside the periodontal pocket and sterilize the area. The laser is designed not to harm healthy gum tissue. When handled by a trained dental professional, lasers reduce the risk of infection and require a shorter healing time than gum surgery.

Prevention

Properly treating periodontal disease in its early stages can rule out the risk of developing periodontal pockets down the road. Furthermore, by maintaining a consistent home oral care routine and visiting your dentist twice a year, you will help keep your gums healthy. Other preventative measures include:

• Brushing twice daily in a circular motion with a soft toothbrush and fluoride toothpaste, paying attention to the gum line to avoid plaque build-up.
• Using floss at least once daily to remove food particles between the teeth that might be missed when brushing.
• Using a mouthwash that dissolves plaque and fights tartar build-up. If you suffer from a dry mouth, try using an alcohol-free oral rinse.
• Replacing your toothbrush every three months.

You should also be mindful that lifestyle habits, like a diet high in sugary foods and drinks or smoking and chewing tobacco, can negatively affect your oral health. Additionally, health conditions such as diabetes, leukemia, rheumatoid arthritis and autoimmune disease may put your oral health at higher risk and require you to visit your dentist more frequently.