Perio Other – Gingival Pocket

The term gingival pocket is used to describe an abnormal depth of the gingival sulcus.

Tooth Gingival Interface

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

Gingival Pocket

A gingival pocket exists when the marginal gingiva experiences an edematous reaction. This may occur from localized irritation, inflammation, systemic issues or drug induced gingival hyperplasia. When gingival hyperplasia takes place, periodontal probing measurements can be read which gives the illusion that periodontal pockets exist. This phenomenon is sometimes called a false pocket or pseudopocket. The epithelial attachment does not migrate and remains at the same attachment level found in pre-pathological health.

There is no destruction of the connective tissue fibers or the alveolar bone in a gingival pocket. This early sign of disease is completely reversible when the etiology of the edematous reaction is eliminated. This often occurs without the need for dental surgical therapy. In some cases, however, a gingivectomy is required to reduce the gingival pocket depths to the normal size of 1–3 mm.

When the original sulcular depth grows and the apical migration of the junctional epithelium simultaneously occur, the pocket is lined by pocket epithelium (PE) instead of junctional epithelium (JE). In order to have a true periodontal pocket, a probing measurement of 4 mm or more must be identified. In this state, many of the gingival fibers which previously attached the gingival tissue to the tooth are irreversibly destroyed. To properly monitor periodontal disease, the dentist should maintain a record the depth of the patient’s periodontal pocket. Unlike clinically healthy situations, portions of the sulcular epithelium may be visible in periodontally involved gingival tissue if air is blown into the periodontal pocket. This can expose the newly exposed roots of the tooth. The periodontal pocket can then become infected which may result in the formation of an abscess with a papule on the gingival surface. It may be necessary to make an incision and drain the abscess in addition to the use of antibiotics. The dentist may also consider placing a local antimicrobial system within the periodontal pocket to reduce the local infection.

Formation of a Pocket

Various elements must be present in order for the periodontal pocket to form. This process starts with the formation of dental plaque. The invasive bacteria from the plaque eventually triggers an inflammatory response. This will then result in the gradual destruction of the tissues surrounding the teeth, called the periodontium. Plaque which is present for extended periods of time is able to harden and calcify. This welcomes additional bacteria to the pocket and makes it virtually impossible to clean with a toothbrush at home. The continuous destruction of the surrounding tissues from inflammation leads to the degradation of attachment and bone, which ultimately result in the loss of the tooth. Some conditions and risk factors can make the condition worse. Risk factors can include issues such as diabetes and smoking. The early detection of high levels of plaque at routine dental visits have been beneficial in the preventing the formation of a pocket.