Periodontal (gum) disease affects millions of people all over the world. It is the number one cause of adult tooth loss, and has been linked to a host of other ailments like diabetes, heart disease and problems in pregnancy. However, because the symptoms can be very subtle, many don’t realize they have gum disease until it starts to take a serious toll. If your mouth is healthy, your bone and gum tissue should fit snugly around each tooth, like a turtleneck sweater around your neck. The distance between the gum tissue and its attachment to the tooth should only be one to three millimeters in depth. But gum disease can lead to deeper spaces around your teeth called periodontal pockets — spaces around the teeth, below the gum line, that have become infected. If untreated, these pockets can lead to tooth loss. But with early diagnosis and treatment, you can keep your teeth for a lifetime.
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 most are removed through brushing and flossing. That bacteria in your mouth continually forms a sticky film of plaque on your teeth, especially around the gum area. If not removed, this plaque eventually hardens into tartar, which can’t be brushed off without a dentist or dental hygienist removing it during a professional cleaning appointment. Ultimately, the toxins from the bacteria continue to form on the tartar and can cause inflammation in your gum tissue, creating a condition referred to as gingivitis. That inflammation and swelling due to plaque and tartar can result in pocket formation between the gums and the teeth and the once healthy sulcus becomes deeper because it is diseased. As it pulls away from your teeth, this inflamed gum tissue is now the perfect venue for more plaque and tartar to hide, deepening the pocket causing further loss of bone and gum tissue attachment beneath the gum line, and eventually eroding the structures that hold the teeth in place.
If you’re experiencing any of the warning signs of gum disease – such as bad breath, bleeding, red and swollen gums or gums that have pulled away from your teeth – an oral examination from your dentist is in order. Beyond a visual assessment of your gum tissue, your dentist will measure the pocket depth around each tooth with a periodontal probe, allowing him or her to determine the presence of periodontal disease or how far it has progressed. The periodontal probe is a small hand-held instrument that measures the gap where the tooth meets the gum. During the periodontal examination, the dentist gently inserts the probe between the tooth and gum, and then measures from the top of the gum to the bottom of the sulcus or pocket. Six measurements, in millimeters, are taken around each tooth: three on the outer (lip) side and three on the inner (tongue) side. These measurements are recorded, and can be used to track changes in your periodontal health over time. Measurements of four millimeters or more are an indication that some gum tissue has detached from the tooth or that there is the beginning of bone loss. Severe periodontal disease is defined as having at least two teeth with measurements of six millimeters or more, and at least one tooth that has a five-millimeter reading around the area of an adjacent tooth.
Since every periodontal pocket is different, specific treatment recommendations will depend on the depth and shape of the pocket, and whether the inflammation is restricted to the gum tissue, or if it has spread to the bone that lies beneath. Your dentist may wish to take X-rays to determine if there is bone loss from around the teeth, and to what degree. Getting rid of plaque bacteria and tartar is the first step in keeping gum disease from getting worse. In the case of inflamed gums with no bone loss, even a pocket depth of 4 mm or 5 mm may be treated with professional cleanings to remove the causes of the inflammation. If more severe periodontal disease is present, a procedure called scaling and root planing may be recommended. This thorough cleaning procedure not only removes the plaque and tartar, but also smooths the root surface so the gum tissue can reattach to the tooth, shrinking the pocket. Sometimes, antibiotics may be used to reduce inflammation and help control bacteria underneath the gum line. If a pocket is too deep to be treated with non-surgical procedures, surgery may be recommended to reduce the size of the pocket. This procedure is often done by a periodontist — a dentist who specializes in the treatment of the gums and other supporting structures of the teeth — and may be performed with standard surgical tools or with laser instruments.
Periodontal disease is very preventable, and by keeping up with regular dental visits and a consistent home-care routine, the subsequent periodontal pockets will be something you only have to read about. Here’s how to keep your pocket depths at one to three millimeters. Use a soft-bristled toothbrush to clean your teeth twice a day, brushing carefully around your gum line where plaque tends to accumulate. Replace your toothbrush every three to four months or when you see the bristles start to wear. If your mouth tends to build up tartar quickly, use tartar-control toothpaste. Flossing daily is just as important as brushing when it comes to preventing gum disease, but be sure to follow your dentist’s recommendation for professional cleanings and gum examination. Diagnosing and treating periodontal disease in its early stages can eliminate unhealthy periodontal pockets and curb the effect before it progresses to severe bone loss.
Do you have any questions about periodontal pockets? Call Westermeier Martin Dental care to schedule an appointment with your dentist 716-655-5000 or request an appointment online.