A Periodontal Pocket is a dental term indicating the presence of an abnormally deepened gingival sulcus as it contacts a tooth.
The tooth/gingiva interface
Contrary to what may be perceived by most people,
the interface between a tooth and the surrounding gingival tissue is a dynamic
place.[1] The gingival tissue forms a crevice surrounding the
tooth, not unlike a miniature fluid-filled moat, within which floats food
debris, and both endogenous and exogenous
cells and chemicals. The depth of this crevice, known as a sulcus, is in
flux with microbial invasion and subsequent immune response. Located at the
depth of the sulcus is the gingival attachment to the tooth, consisting of
approximately 1 mm of junctional epithelium and another 1 mm of gingival
fiber attachment, comprising the 2 mm of biologic
width. In a healthy gingiva there is not a clinical separation, nor fluid,
and certainly no bacteria. The sulcus is a virtual separation between the
epithelium and the tooth.
|
 |
|
Gingival and Periodontal Pockets are extensions of the gingival sulcus, which exists in health. Other
letters: A, crown of the tooth, covered by enamel. B, root of
the tooth, covered by cementum. C, alveolar
bone. D, subepithelial connective
tissue. E, oral epithelium. F, free gingival margin. H, principle
gingival fibers. I, alveolar crest fibers of the PDL. J, horizontal fibers of the PDL. K,
oblique fibers of the PDL.
|
Pockets
The normal sulcular depth is three millimeters or less. Through much
investigation and research, it has been determined that sulcular depths
of three millimeters or less are either readily self-cleansible or able
to be easily cleansed by an individual with the bristles of a properly
used toothbrush.
When the sulcular depth is in excess of three millimeters on a constant
basis, even regular toothbrushing will be unable to properly cleanse
the depths of the sulcus, allowing food debris and microbes
to accumulate and pose a danger to the PDL fibers attaching the gingiva
to the tooth. If allowed to remain for too long of a period of time,
these microbes, together with the enzymatic
particles they produce, will be able to penetrate and ultimately
destroy the delicate soft tissue and periodontal attachment fibers,
leading to an even further deepening of the sulcus.
Gingival pocket
If the depth of the sulcus has moved apically,
or towards the root of the adjacent tooth, but has not yet breached the
connective tissue fibers that connect the gingiva to the tooth, it
would be termed a gingival pocket, which is completely reversible with the onset of more adequate and thorough oral hygiene practices.
Periodontal pocket
If, however, the original depth has been violated so much that the gingival fibers that initially attached the gingival tissue to the tooth have been irreversibly destroyed, the sulcus is termed a periodontal pocket. An indicator as to when a gingival pocket has proceeded to a periodontal pocket is the incidence of bleeding on probing.
The localized inflammation at the depths of the sulci destroy and erode
the epithelium and can elicit bleeding upon even the gentlest of
manipulations.[2]
If the destruction continues apically unabated and reached the junction of the attached gingiva and alveolar mucosa (more loosely attached oral epithelium), the pocket would thus be a violation of the mucogingival junction, and would be termed a mucogingival defect.
Pseudopockets
An increased depth is not an absolute indicator of soft tissue and
periodontal fiber destruction at the base of the sulcus. If the height
of the gingival tissue increases coronally without any increase in sucular depth, a relative or pseudopocket forms. While this may initially appear as a gingival or periodontal pocket upon measuring the depth with a periodontal probe,
it is really just a change in the height rather than a change in depth.
This may happen as a result of gingival inflammation or as a response
to medications such as phenytoin or cyclosporin.
While an pseudopocket is inherantly non-pathologic, it may easily lead
to pathosis, because the increased relative depth of the sulcus remains
too deep to adequately clean with a conventional oral hygiene routine
utilizing only a toothbrush and dental floss.
If the pseudopocket is drug induced and the drug regimen cannot be
altered or if it does not resolve with more diligent hygiene then
scheduled gingivectomy procedures may be performed to maintain the gingival sulcus depths at or near depths of about three millimeters.[3]
References
- ^ Fermin A. Carranza. CARRANZA'S CLINICAL PERIODONTOLOGY, 9th edition, 2002. page 101
- ^ Fermin A. Carranza. CARRANZA'S CLINICAL PERIODONTOLOGY, 9th edition, 2002. page 105
- ^ Fermin A. Carranza. CARRANZA'S CLINICAL PERIODONTOLOGY, 9th edition, 2002. page 757