Periodontology Correlation – Periodontal Pocket

The terms gingival and periodontal pockets are used to describe an abnormal depth of the gingival sulcus, near where the gingival tissue makes contact with the tooth.

Tooth Gingival Interface

The area located between the teeth and the surrounding gingival tissue are dynamic structures. The gingival tissue creates a crevice surrounding the tooth. This area is essentially a fluid-filled moat which collects food debris, cells and chemicals. The sulcus, or the depth of this crevice, can be in a state of fluctuation from a microbial invasion and the response from the immune system.

Gingival Pocket

A gingival pocket is created when there is an edematous reaction in the marginal gingiva. This reaction can be caused by inflammation, a localized irritation, systemic issues or drug induced gingival hyperplasia. When gingival hyperplasia occurs, a periodontal probing measurement can be obtained and give the impression of healthy periodontal pockets. This phenomenon can be called a pseudopocket or false pocket. While the epithelial attachment does not migrate, it remains at the same attachment level which is recorded in pre-pathological health. The only anatomical landmark which experiences migration is the gingival margin in a coronal direction.

Destruction does not occur in the connective tissue fibers or the alveolar bone in a gingival pocket. Fortunately, this early sign of disease is complete reversible when the etiology of the edematous reaction is eliminated. This often occurs without the need for a surgical procedure. In some cases, however, the patient will require a gingivectomy to reduce the gingival pocket depths to a healthy range of 1–3 mm.

Periodontal Pocket

As the original sulcular depth grows and the apical migration of the junctional epithelium simultaneously occur, the pocket is lined by pocket epithelium (PE) rather than the junctional epithelium (JE). In order to possess a true periodontal pocket, a probing measurement of at least 4 mm must be obtained. Once this state is reached, many of the gingival fibers that originally attached the gingival tissue to the tooth, are now irreversibly destroyed. In order to monitor for periodontal disease, the dentist should record the patient’s depth of the periodontal pockets. Compared to that which is found in clinically healthy situations, parts of the sulcular epithelium may be seen in periodontally involved gingival tissue when air is blown into the periodontal pocket. This exposes the newly denuded tooth roots. Periodontal pockets can become infected and this may result in the formation of an abscess. An incision and 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 reduce the risk of local infections.

Pocket Formation

Various elements must be present in order for the periodontal pocket to form. The process starts with the formation of plaque. The invasion of the bacteria from the plaque eventually triggers an inflammatory response. This can then result in the gradual destruction of the tissues surrounding the teeth, a condition called periodontium. Plaque is then able to harden and calcify, which introduces additional bacteria to the pocket and makes it nearly impossible to clean without assistance from a dental professional. The continual destruction of the surrounding tissues caused by inflammation leads to the degradation of attachment and bone. This can ultimately lead to the loss of the tooth. Some conditions and risk factors can make the condition worse. The most prominent risk factors include diabetes and smoking. Early detection of high plaque levels at routine dental visits in beneficial in the preventing of periodontal pocket formation.