One of the chief signs of gum disease is the presence of periodontal (“peri” – around; “odont” – tooth) pockets — that is, spaces around the teeth, below the gum line, that have become infected. Pockets provide an ideal environment for bacteria to grow, and may spread infection to the structures that keep teeth anchored in the mouth. Although periodontal pockets are invisible to the eye, they can be detected during an oral exam, when the space between the gums and teeth is measured.
During a comprehensive examination, your dentist or hygienist may probe your gums and read off numbers like “three-two-three…four-three-three…” These numbers indicate whether periodontal pockets are present, and how deep they are. Pocket measurements taken together with levels of bleeding and deposits can give your dentist a picture of the health of your gums.
The Anatomy of a Periodontal Pocket
Even in healthy gums, the top of the gum tissue does not attach directly to the tooth. Instead, there is a small space between the tooth and gum called a sulcus. Bacteria and food particles may collect in the sulcus, but for the most part they are removed by brushing and flossing. However, a toothbrush generally does not reach more than 2-3 millimetres (about one tenth of an inch) below the gum line. If the sulcus is deeper, bacteria and food debris can build up below the gums, causing inflammation and swelling. When gum tissue begins to separate or pull away from the teeth, it leaves a larger space between the tooth and gums where harmful bacteria can thrive.
At this point the space is called a “pocket.” Inflammation is present, and the once healthy sulcus has become deeper because it is diseased. If bacteria in the pocket remain undisturbed, they will continue to accumulate there with the potential to cause further loss of bone and gum tissue attachment beneath the gum line, and possibly eroding the structures that hold the teeth in place.
How Gum Disease Progresses
The early stage of gum disease is called gingivitis, or “inflammation of the gums.” Here, plaque builds up around the gum line, the gums become inflamed, and they may begin to swell. There is no bone loss with gingivitis — and fortunately, this common form of gum disease can almost always be reversed with good oral hygiene and regular professional cleaning. Left untreated, gingivitis can progress to a more serious stage of gum disease called periodontitis. Periodontitis causes damage to the tissues surrounding the teeth, including bone, periodontal ligaments and the gum tissues.
While many think teeth are directly supported by bones in the jaw, the true anatomy is more complex. Teeth are actually held in place by thousands of tiny fibres that connect the root of the tooth to the bone. These fibres can be damaged or destroyed by bacterial infections that stem from untreated periodontal disease. In a case of periodontitis, pockets allow infection to spread, resulting in bone loss underneath the gums. These are the kind of “deep pockets” that no one wants, so it’s important to diagnose and treat them before they threaten the integrity of the structures that support the teeth — or even cause tooth loss.
Treating Periodontal Pockets
Getting rid of plaque bacteria and tartar is the first step in keeping gum disease from getting worse. In the case of inflamed and swollen gums with no bone loss, a pocket may be treated with professional cleaning to remove the causes of the inflammation, along with an enhanced at-home oral care regimen. This will likely include, brushing your teeth twice a day with an electric or manual toothbrush and fluoride toothpaste; flossing or using interdental brushes is essential for removing plaque between the teeth where your brush can’t reach. Your hygienist may clean deeper beneath the gum line to remove the plaque and bacteria you cannot reach and may place anti-bacterial gel into a pocket to aid healing after scaling and reduce the bacteria numbers.
What You Can Do
Although gum disease is one of the most common health problems throughout the world, it’s largely preventable with good oral hygiene. That means brushing twice a day for two minutes each time, and cleaning between your teeth with floss or interdental brushes once a day, every day. And fortunately, in many cases, gum disease can be reversed if caught early. But left unchecked, periodontal disease can lead to tooth loss and other negative health outcomes. Periodontal pockets are one of the major signs of gum disease. Even though you can’t see them, your dentist and hygienist can detect them during a regular examination, and offer treatment before the pockets progress any further.
You can play a key role in your own oral health by scheduling regular visits to see our dentist and hygienist, quitting habits like smoking, and practicing good oral hygiene at home. Keeping your teeth and gums healthy is the best way to ensure you’ll have a bright smile for years to come. If you have questions about how to keep your mouth health ask your dentist or hygienist for advice. They will be more than happy to advise you.