Periodontology – Gingival Pocket
Gingival and periodontal pockets are dental terms which describe an abnormal depth of the gingival sulcus. This is where the gingival tissue contacts the tooth.
The area located between a tooth and the gingival tissue surrounding it is a dynamic structure. The gingival tissue creates a crevice surrounding the tooth. This may also be described as a fluid-filled moat, which can collect food debris, cells and chemicals. The depth of this crevice, or a sulcus, is in a constant state of flux from microbial invasion and the following immune response. The epithelial attachment, at the depth of the sulcus, includes approximately 1 mm of junctional epithelium and another 1 mm of gingival fiber attachment. It is comprised of 2 mm of biologic width, naturally found in the oral cavity. The sulcus is an area which separates the surface of the tooth from the surrounding epithelium.
A gingival pocket occurs when the marginal gingiva has an edematous reaction. This may be caused by various issues such as localized irritation, inflammation, systemic issues or drug induced gingival hyperplasia. When gingival hyperplasia occurs, periodontal probing measurements can be obtained and give an illusion that healthy periodontal pockets exist. This phenomenon is sometimes called a false pocket or pseudopocket. The epithelial attachment does not migrate, but actually remains at the same attachment level from pre-pathological health. The only anatomical landmark which experiences migration is the gingival margin in a coronal direction.
In a gingival pocket, there is no destruction of the connective tissue fibers or the alveolar bone. This early sign of disease can be completely reversed when the etiology of the edematous reaction is eliminated. This can often occur without the need for surgery. In some cases, however, a gingivectomy is required to properly reduce the gingival pocket depths to the healthy range of 1–3 mm.
While the original sulcular depth grows, and simultaneously the apical migration of the junctional epithelium occurs, the pocket is now lined by pocket epithelium (PE) rather than the junctional epithelium (JE). For a true periodontal pocket, a probing measurement of at least 4 mm must be obtained. In this state, most of the gingival fibers, which previously attached the gingival tissue to the tooth are irreversibly destroyed. In order to properly monitor periodontal disease in a patient, the depth of the periodontal pockets should be recorded in their record. Unlike healthy patients, parts of the sulcular epithelium may be seen in periodontally involved gingival tissue when air is blown into the periodontal pocket. This allows for exposure to the newly denuded tooth roots. A periodontal pocket may become infected and result in the formation of an abscess. An incision and the draining of the abscess may be needed, in addition to antibiotics. The dentist may also consider placing local antimicrobial systems within the periodontal pocket to minimize the chance of a local infection.
Formation of the Pocket
Various different elements must be present for a periodontal pocket to for. The process starts with the collection of dental plaque. The bacteria from the plaque, ultimately triggers an inflammatory response. This can result in the gradual destruction of the tissues surrounding the teeth, a condition called periodontium. Plaque, which is present for an extended period of time, is able to harden and calcify. This welcomes additional bacteria into the pocket and makes it virtually impossible to properly clean using a traditional toothbrush and toothpaste. The continuous destruction of the surrounding tissues from inflammation, can result in the degradation of attachment and bone. In the most severe cases, this results in the loss of the tooth. Specific risk factors can also worsen the condition. The most prevalent risk factors include diabetes and smoking. Early detection of plaque, which occurs at routine dental visits, aids in preventing the progression of gingival pocket formation.