The gingival sulcus is the area of space between the surface of the tooth and gingival tissue which surrounds it. The sulcular epithelium lines the gingival sulcus. The depth of the sulcus is secured by two separate entities including apically, with the gingival fibers of the connective tissue attachment, and coronally, with the free gingival margin. A healthy depth of the gingival sulcus is up to 3 mm or less. This depth allows patients to thorough clean the area with a toothbrush or additional oral hygiene products.
Basic Periodontal Examination
The Basic Periodontal Examination or BPE is a straightforward and effective method which systematically screens a patient’s gingival and periodontal health. The BPE is used to manage and treat periodontal issues.
The depth of the sulcus allows dental professionals to evaluate the gum’s health. A periodontal assessment can also help determine if a patient is at risk for future developing of gum disease. In order to measure the sulcus, a small ruler, called a periodontal probe, is used. The dentist slides the probe below the gum tissue where it enters the space called the gingival sulcus. It gently presses up against the area where the gum tissue is attached to the tooth surface.
The dentogingival tissues consist of many constituents including the enamel or cementum of the tooth, the connective tissue, the gingival epithelium and the sulcular epithelium. The junctional epithelium develops when the teeth erupt. This occurs when the reduced enamel epithelium is merged with the oral epithelium. The reduced enamel epithelium forms the first junctional epithelium and securely attaches to the enamel. In some cases where gingival recession has taken place, the junctional epithelium may attach to the cementum.
When the sulcular depth exceeds 3 mm, routine at-home oral hygiene may not be sufficient to properly clean the sulcus. This can allow food debris and microbes to accumulate over time which can allow a dental biofilm to form. The biofilm can be dangerous for the periodontal ligament (PDL) fibers which connect the gingiva to the tooth. When the accumulated microbes remain undisturbed in the sulcus, they can penetrate and cause destruction to the delicate tissue and periodontal attachment fibers. This can result in a deepened sulcus, gum recession, destruction of the periodontium, tooth mobility and even losing the tooth. The term periodontal pocket is used to describe an abnormally deep gingival sulcus.
The environment of the gingival sulcus differs from other locations in the mouth as the ecosystem is more anaerobic and the site is filled with Gingival Crevicular Fluid (GCF). When periodontal disease is present, the gingival sulcus can become a periodontal pocket and the possibility of reduced oxidation will decrease to low levels as the site is very anaerobic. In addition, when gingivitis is present, the GCF increases by 147%. When periodontitis is present, the GCF can increase up to 30 times the normal level. While GCF provides for the cellular defence and humoral factors needed to prevent a microbial insult, the GCF also deliver novel substrates. This is in the form of proteins and glycoproteins, which is used for bacterial metabolism.