What are Periodontal Pockets?

Gum disease is often classified into two groups Gingivitis and Periodontitis;

In health, the gum should form a tight cuff around each tooth, this cuff should measure somewhere between 1 and 3 millimetres, when probed by a dentist or hygienist.

Gingivitis;
Is inflammation of the gums or Gingiva. When plaque is left on the gum margin the gum reacts to the bacteria in the plaque by becoming inflamed, often appearing red and swollen, with a tendency to bleed. At this stage it is quite easily reversed with good oral hygiene at home and scaling with the dentist or hygienist.

Periodontitis;
Is the inflammation of the gums and the supporting structures of the teeth (the periodontium). Longstanding gingivitis can progress to periodontitis if left untreated. As the gums become more inflamed, the once tight cuff can become deeper, forming a periodontal pocket. This can progress, gradually affecting the bone and ligaments that hold your teeth in place. As the depth of the pocket increases more plaque and tartar can form on the the root surface of the tooth, below the gum level. This area becomes increasingly difficult to clean at home as the pockets become deeper and harder to access. If left untreated periodontitis can; destroy the bone supporting the teeth, cause recurrent gum infections, teeth to become loose, and ultimately can lead to tooth loss.

Treatment;
The most important treatment of gingivitis and periodontitis happens at home on a daily basis. It is recommended that patients clean their teeth twice a day, preferably with an electric toothbrush for at least two minutes. As well as toothbrushing it is important to use something, in between all the teeth, at least once a day. Floss or interdental brushes for example. The dentist or hygienist can help tailor oral hygiene advice to individual patients’. Explaining areas that need special attention, and possibly recommending additional oral hygiene aids.

Treatment at the practice will vary according to the severity of the gum disease. Patients with gingivitis may only need a general scale and polish every 6 months, when the gums will be assessed, any tartar removed, and advice regarding home care given.

Treatment for periodontitis will again vary according to each patient’s need but will include;
Oral hygiene advice to improve plaque control.
A detailed charting of the pockets known as a 6 point pocket chart. This is when a probe is inserted into the pocket so the dentist or hygienist can measure the depth of the pocketing in millimetres at 6 points around each tooth. This enables the clinician to assess and monitor the patient’s condition and creates a very detailed map of the distribution of the pocketing.
Deep scaling and root debridement will be carried out, sometimes over a series of 4 or 6 appointments with local anaesthetic if necessary. This is usually, and preferably, carried out using an “ultrasonic scaler”. This instrument disturbs the harmful bacterial layer that exists under the gum known as the Biofilm, and therefore promotes healing.

If a patient’s pocketing improves or is stable the hygienist or dentist might suggest a 3 monthly recall for scaling and monitoring. Patients who have periodontitis with deep pockets that don’t respond to non surgical scaling and root debridement, have the option of being referred to see a specialist periodontist.

If you have any questions regarding your own periodontal health please don’t hesitate to ask your dentist or hygienist.

Jo Loram
Dip Dent Hygiene Lond
Hygienist at Tavern Street Dental Practice

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