Gingival Pocket

Gingival pockets are pockets that are located between the gums and the teeth, specifically in the area called the gingival sulcus. The gingival sulcus is the crescent-shaped crevice at the base of each tooth where the gum tissue meets the tooth. The gingival sulcus of each tooth is a tiny area of potential space where multiple chemicals, cellular materials, and food debris can be found. As microbes interact with the tissue of the gums, this can trigger an immune response wherein the gum tissue becomes inflamed in an attempt to eject microbial irritants. The area at the depth of gingival sulcus, where the gingival tissue attaches to the cementum that covers the tooth’s root, is the epithelial attachment. When this attachment begins to separate as the tissue of the gums is destroyed, this creates a periodontal pocket, indicative of periodontitis. Before this, when the epithelial attachment is still in place and no irreversible damage has occurred, the inflamed pockets is considered a gingival attachment.

Gingival pockets appear when the gum tissue at the margin of the gingival sulcus becomes swollen. This swelling can occur because of localized irritation, systemic conditions, or because of the use of certain drugs that can stimulate gingival hyperplasia. When swelling occurs in the gum tissue, no matter the reason, periodontal probing measurements register that a pocket has formed, and, depending on the amount of swelling, these probing measurements may make it appear that a periodontal pocket has formed. However, because the epithelial attachment is intact and still in its proper place, these are not periodontal pockets. The only part of the periodontium that has actually migrated is the gum tissue itself, which registers a pocket of greater depth solely because the tissue itself has increased in a coronal direction. These gingival pockets, where no destruction has occurred, may be referred to as false pockets or pseudopockets.

At the stage where gingival pockets appear, gum disease is completely reversible. In many cases, when the cause of inflammation is removed, the swelling subsides and the gingival sulcus returns to a healthy appearance and depth. In some cases, however, any excess gum tissue may need to be surgically removed in order to restore gingival pocket depths to a healthy measurement and to help keep bacteria from accumulating in the sulcus. If the cause of inflammation is not addressed, however, the gingival pocket will continue to accumulate destructive bacteria, which become increasingly difficult to remove as inflammation increases. Gradually, this proliferation of bacteria can cause destruction of the epithelial attachment, which migrates toward the root of the tooth, and can also lead to destruction of the alveolar bone that supports the teeth. When this level of irreversible destruction occurs, probing depths accurately reflect the formation of periodontitis, which is treatable but not reversible.

The best defense against periodontal diseases is effective oral hygiene. Brushing the teeth with fluoride toothpaste and cleaning between the teeth with dental floss or another interdental cleaning tool can help manage the amount of plaque that is allowed to accumulate in the gingival sulcus. Dental calculus, which is bacterial plaque that has calcified, can be removed with regular professional dental cleanings, and this helps prevent the accumulation of additional bacteria. Because plaque forms nearly constantly, however, and everything we eat and drink can affect the balance between our gums and the bacteria that live among them, regular cleaning is instrumental in the prevention and management of gum disease.