What Are Periodontal Pockets?

A periodontal pocket is a gap that forms between the gums and the root surface of your tooth. 

In a healthy mouth, the gingival (gum) tissue covers the bone, ligaments and other connective tissue that hold your teeth in place. The gingival margin (the gum line) forms a tight seal around the tooth, and is snugly attached to the root of the tooth below. A periodontal pocket is when the gum tissue starts to separate from the root surface of the tooth, creating space between gum and tooth. Let’s explore why that happens…

Periodontal pockets form as a result of gum disease, caused by plaque bacteria. Plaque (biofilm) is a sticky substance that builds up on your teeth and around the gum line. It contains lots of bacteria that irritate the gum tissue, causing inflammation, soreness and bleeding. This is the early stage of gum disease (periodontal disease) known as gingivitis.

Inflammation and swelling of the gums can cause them to pull away from the teeth. At this point, gingivitis progresses to a more advanced form of gum disease called periodontitis. As pockets form between the gums and teeth, plaque and tartar  (hardened plaque) spread below the gum line and start to attack the connective tissues and bone beneath. You can think of this phenomenon as a turtleneck sweater that begins to stretch out around your neck.

Over time, the periodontal pockets get deeper, and it gets harder to keep them clean. As the bone and other tissue breaks down, teeth start to loosen and can eventually fall out.

Periodontal pockets are not visible to the naked eye, so they can only be diagnosed by your dental hygienist or dentist using special tools. However, there are some signs of periodontal disease you can look out for at home: 

• Bleeding, red, and swollen gums. 

• Receding gums that appear to shrink away from the teeth. 

• Longer-looking teeth with exposed roots. 

• Bad breath. 

• Loose or shifting teeth. 

• Changes in your bite, or how your top and bottom teeth fit together. 

• Pain when chewing. 

If you notice any of these symptoms, book an appointment with your dentist or hygienist right away. The earlier you catch gum disease, the better chance you have of preventing permanent damage to your gums and teeth.

After a visual assessment of your gum tissue, your dental professional will check for periodontal pockets around each of your teeth with a periodontal probe. This is a special tool with markings, like a ruler, that is slipped below your gum line to measure the depth of periodontal pockets. This allows them to determine the presence of periodontal disease and how far it has progressed.

Your dental professional will probe six different sites around each tooth during a periodontal examination. The National Institutes of Dental and Cranial Research (NIDCR) defines periodontal disease as having a tooth with at least one periodontal site with a pocket of four millimeters or more in depth, with three or more millimeters of attachment loss.

Like many oral health issues, the first step in treating gum disease is to see your dental professional and have your teeth professionally cleaned. Also referred to as scaling and root planing, this cleaning process removes plaque and tartar and gives your gums a chance to tighten again around your teeth.

If you have no significant bone loss, this may be the only treatment you need. However, in cases where deep pockets in your gums remain, your dental professional could recommend one of several types of surgery to remove infection and reduce your gum pockets. These include flap surgery, soft tissue grafts or bone grafts, and guided tissue regeneration.

Periodontal disease is very preventable. By keeping up with regular dental visits and a consistent home-care routine, you're doing everything you can to reduce your chances of developing periodontal pockets.

Healthy gums have a shallow pocket that is easy to keep clean, measuring only one to three millimeters in depth. Here's how you can keep your gum pockets shallow and easy to clean:

• 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 months or when you see the bristles start to wear.
• If your mouth tends to build up tartar quickly, use tartar-control toothpaste.
• Cleaning between your teeth once a day is as important as brushing to prevent gum disease. You can use floss, a water flosser, or another interdental cleaning tool.
• Be sure to follow your dental professional's recommendation for professional cleanings and gum examinations. They may recommend more frequent cleanings after treating a severe case of periodontal pockets.

Diagnosing and treating periodontal disease in its early stages can eliminate unhealthy periodontal pockets. Treatment will curb its effect before it progresses to severe bone loss. Luckily, there are plenty of at-home measures you can take to prevent periodontal disease. But if you do need treatment, there are several non-surgical and surgical options. Regardless of whether you have a very early stage of gum disease or are at the point of requiring surgery, a lifelong commitment to a vigorous oral care routine will be imperative for your future smile!

This article is intended to promote understanding of and knowledge about general oral health topics. It is not intended to be a substitute for professional advice, diagnosis or treatment. Always seek the advice of your dentist or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.