Periodontology - Gingival Pocket

Marin Contemporary Perio & Implant Concepts

Gingival and periodontal pockets are dental terms used to describe an abnormal depth of the gingival sulcus near the location where the gingival tissue contacts the tooth.

Tooth Gingival Interface

The area between a tooth and the gingival tissue which surrounds it is a dynamic structure. The gingival tissue forms a crevice that surrounds the tooth. This can be described as a fluid-filled moat, where food debris, cells and chemicals float. The depth of this crevice, which is called a sulcus, fluctuates from microbial invasion and the immune response that follows. The epithelial attachment, which is located at the depth of the sulcus, consists of about 1 mm of junctional epithelium and another 1 mm of gingival fiber attachment. It is comprised of 2 mm of biologic width that is naturally found in the oral cavity. The sulcus is the area that separates the surrounding epithelium and the surface of the tooth.

Gingival pocket

A gingival pocket exists when the marginal gingiva has an edematous reaction. This may be caused by localized irritation, inflammation, systemic issues or drug induced gingival hyperplasia. When gingival hyperplasia occurs, periodontal probing measurements can be taken and create the illusion that periodontal pockets are present. This phenomenon is sometimes called a false pocket or pseudopocket. The epithelial attachment does not migrate, but rather remains at the same attachment level that is found in pre-pathological health. The gingival margin in a coronal direction is the only anatomical landmark which experiences migration.

There is no destruction of the connective tissue fibers or the alveolar bone in a gingival pocket. This early sign of disease in the mouth is entirely reversible when the etiology of the edematous reaction is eliminated. This frequently can occur without the requirement of any dental surgical therapy. In certain situations, however, a gingivectomy is required in order to reduce the gingival pocket depths to a normal 1–3 mm.

While the original sulcular depth grows and the apical migration of the junctional epithelium occurs simultaneously, the pocket is now lined by pocket epithelium (PE) instead of junctional epithelium (JE). In order to have a true periodontal pocket, a probing measurement of at least 4 mm must be identified. In this state, much of the gingival fibers which initially attached the gingival tissue to the tooth are permanently destroyed. In order to properly monitor the periodontal disease, the depth of the periodontal pockets should be recorded in the patient’s record. Unlike that found in clinically healthy situations, parts of the sulcular epithelium may be seen in periodontally involved gingival tissue if air is blown into the periodontal pocket. This can expose the newly denuded roots of the tooth. A periodontal pocket can become infected and may result in the formation of an abscess with a papule on the gingival surface. An incision and draining of the abscess may be required, as well as antibiotics. The dentist may also condier the placement of local antimicrobial systems within the periodontal pocket in order to reduce localized infections. This is classified as supra bony and infra bony based on its depth in relation to alveolar bone.

Pocket formation

In order for the periodontal pocket to form, various elements must be present. The process begins with dental plaque. The invasion of the bacteria from the plaque can eventually trigger an inflammatory response. This then can result in the gradual destruction of the tissues that surround the teeth. This condition is known as the periodontium.  Plaque which has been present for extended time and is able to harden and calcify, welcomes additional bacteria to the pocket and makes it nearly impossible to clean using traditional toothbrush. The continuous destruction of the surrounding tissues from inflammation leads to the degradation of attachment and bone, which ultimately causes tooth loss. Specific conditions and risk factors can worse the condition. These can include things such as diabetes or smoking. The early detection of high levels of plaque at routine dental visits have been beneficial in preventing the progression of the pocket formation.

 

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