Gingival and periodontal pockets (also informally referred to as gum pockets[1]) are dental terms indicating the presence of an abnormal depth of the gingival sulcus near the point at which the gingival tissue contacts the tooth.
The interface between a tooth and the surrounding gingival tissue is a dynamic structure.[2] The gingival tissue forms a crevice surrounding the tooth, similar to a miniature, fluid-filled moat, wherein food debris, endogenous and exogenous cells, and chemicals float. The depth of this crevice, known as a sulcus, is in a constant state of flux due to microbial invasion and subsequent immune response. Located at the depth of the sulcus is the epithelial attachment, consisting of approximately 1 mm of junctional epithelium and another 1 mm of gingival fiber attachment, comprising the 2 mm of biologic width naturally found in the oral cavity. The sulcus is literally the area of separation between the surrounding epithelium and the surface of the encompassed tooth.
Gingival pocketedit
A gingival pocket presents when the marginal gingiva experiences an edematous reaction, whether due to localized irritation and subsequent inflammation, systemic issues, or drug induced gingival hyperplasia. Regardless of the etiology, when gingival hyperplasia occurs, greater than normal (the measurement in a pre-pathological state) periodontal probing measurements can be read, creating the illusion that periodontal pockets have developed. This phenomenon is also referred to as a false pocket or pseudopocket. The epithelial attachment does not migrate, it simply remains at the same attachment level found in pre-pathological health. The only anatomical landmark experiencing migration is the gingival margin in a coronal direction.
In a gingival pocket, no destruction of the connective tissue fibers (gingival fibers) or alveolar bone occurs. This early sign of disease in the mouth is completely reversible when the etiology of the edematous reaction is eliminated and frequently occurs without dental surgical therapy. However, in certain situations, a gingivectomy is necessary to reduce the gingival pocket depths to a healthy 1–3 mm.
Periodontal pocketedit
1: Total loss of attachment (clinical attachment loss, CAL) is the sum of 2: Gingival recession, and 3: Probing depth
As the original sulcular depth increases and the apical migration of the junctional epithelium has simultaneously occurred, the pocket is now lined by pocket epithelium (PE) instead of junctional epithelium (JE).[3] To have a true periodontal pocket, a probing measurement of 4 mm or more must be clinically evidenced. In this state, much of the gingival fibers that initially attached the gingival tissue to the tooth have been irreversibly destroyed. The depth of the periodontal pockets must be recorded in the patient record for proper monitoring of periodontal disease. Unlike in clinically healthy situations, parts of the sulcular epithelium can sometimes be seen in periodontally involved gingival tissue if air is blown into the periodontal pocket, exposing the newly denuded roots of the tooth. A periodontal pocket can become an infected space and may result in an abscess formation with a papule on the gingival surface. Incision and drainage of the abscess may be necessary, as well as systemic antibiotics; placement of local antimicrobial delivery systems within the periodontal pocket to reduce localized infections may also be considered. It is classified as supra bony and infra bony based on its depth in relation to alveolar bone.[4]
Mucogingival defectedit
If the destruction continues unabated apically and reaches the junction of the attached gingiva and alveolar mucosa, the pocket would thus be in violation of the mucogingival junction and would be termed a mucogingival defect.[5]
Pocket formationedit
For the periodontal pocket to form, several elements need to be present. It all starts with the dental plaque[tone]. The invasion of the bacteria from the plaque eventually triggers inflammatory response. This in turn results in the gradual destruction of the tissues surrounding the teeth, known as the periodontium.[6] Plaque that has been present long enough to harden and calcify will welcome additional bacteria to the pocket and make it virtually impossible to clean by means of a traditional toothbrush.[7] Continuous destruction of surrounding tissues due to inflammation will lead to degradation of attachment and bone, eventually causing tooth loss. Certain circumstances can worsen the condition and are known as risk factors. These can either be systemic (like diabetes or smoking) or local (like overhanging dental restorative materials causing food trap).[8] It is, therefore, important to manage plaque levels by appropriate oral hygiene measures. The importance of using interdental brushes along with standard or electric toothbrushing should be stressed early on. Early detection of high plaque levels at routine dental visits are found to be beneficial to avoid progression of the pocket formation.[9]
External linksedit
Scapoli, L; Girardi, A; Palmieri, A; Testori, T; Zuffetti, F; Monguzzi, R; Lauritano, D; Carinci, F (2012). "Microflora and periodontal disease". Dental Research Journal. 9 (Suppl 2): S202–6. doi:10.4103/1735-3327.109755 (inactive 31 January 2024). PMC3692174. PMID 23814584.{{cite journal}}: CS1 maint: DOI inactive as of January 2024 (link)
Referencesedit
^"What do your Gum Pocket Measurements really mean?" (Staff Blog). Lorne Park Dental Associates. 3 May 2017. Retrieved 4 December 2018.
^Antonio Nanci, Ten Cate's Oral Histology, Elsevier, 2007, page 383
^Illustrated Dental Embryology, Histology, and Anatomy, Bath-Balogh and Fehrenbach, Elsevier, 2011, page 129
^Carranza's Clinical Periodontology, Newman, et al, Elsevier, 2011
^Lamont, Thomas; Worthington, Helen V; Clarkson, Janet E; Beirne, Paul V (2018-12-27). Cochrane Oral Health Group (ed.). "Routine scale and polish for periodontal health in adults". Cochrane Database of Systematic Reviews. 12 (4): CD004625. doi:10.1002/14651858.CD004625.pub5. PMC6516960. PMID 30590875.
^Worthington, Helen V; MacDonald, Laura; Poklepovic Pericic, Tina; Sambunjak, Dario; Johnson, Trevor M; Imai, Pauline; Clarkson, Janet E (2019-04-10). Cochrane Oral Health Group (ed.). "Home use of interdental cleaning devices, in addition to toothbrushing, for preventing and controlling periodontal diseases and dental caries". Cochrane Database of Systematic Reviews. 2020 (4): CD012018. doi:10.1002/14651858.CD012018.pub2. PMC6953268. PMID 30968949.
^Manresa, Carolina; Sanz-Miralles, Elena C.; Twigg, Joshua; Bravo, Manuel (1 January 2018). "Supportive periodontal therapy (SPT) for maintaining the dentition in adults treated for periodontitis". The Cochrane Database of Systematic Reviews. 1 (1): CD009376. doi:10.1002/14651858.CD009376.pub2. ISSN 1469-493X. PMC6491071. PMID 29291254.
^"CKS is only available in the UK". NICE. Retrieved 2020-02-19.
March 17, 2024
gingival, periodontal, pocket, this, article, needs, additional, citations, verification, please, help, improve, this, article, adding, citations, reliable, sources, unsourced, material, challenged, removed, find, sources, news, newspapers, books, scholar, jst. This article needs additional citations for verification Please help improve this article by adding citations to reliable sources Unsourced material may be challenged and removed Find sources Gingival and periodontal pocket news newspapers books scholar JSTOR May 2016 Learn how and when to remove this template message Gingival and periodontal pockets also informally referred to as gum pockets 1 are dental terms indicating the presence of an abnormal depth of the gingival sulcus near the point at which the gingival tissue contacts the tooth Gingival and periodontal pockets are extensions of the gingival sulcus G 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 H principal gingival fibers I alveolar crest fibers of the PDL J horizontal fibers of the PDL K oblique fibers of the PDL Contents 1 Tooth gingival interface 2 Gingival pocket 3 Periodontal pocket 4 Mucogingival defect 5 Pocket formation 6 External links 7 ReferencesTooth gingival interface editThe interface between a tooth and the surrounding gingival tissue is a dynamic structure 2 The gingival tissue forms a crevice surrounding the tooth similar to a miniature fluid filled moat wherein food debris endogenous and exogenous cells and chemicals float The depth of this crevice known as a sulcus is in a constant state of flux due to microbial invasion and subsequent immune response Located at the depth of the sulcus is the epithelial attachment consisting of approximately 1 mm of junctional epithelium and another 1 mm of gingival fiber attachment comprising the 2 mm of biologic width naturally found in the oral cavity The sulcus is literally the area of separation between the surrounding epithelium and the surface of the encompassed tooth Gingival pocket editA gingival pocket presents when the marginal gingiva experiences an edematous reaction whether due to localized irritation and subsequent inflammation systemic issues or drug induced gingival hyperplasia Regardless of the etiology when gingival hyperplasia occurs greater than normal the measurement in a pre pathological state periodontal probing measurements can be read creating the illusion that periodontal pockets have developed This phenomenon is also referred to as a false pocket or pseudopocket The epithelial attachment does not migrate it simply remains at the same attachment level found in pre pathological health The only anatomical landmark experiencing migration is the gingival margin in a coronal direction In a gingival pocket no destruction of the connective tissue fibers gingival fibers or alveolar bone occurs This early sign of disease in the mouth is completely reversible when the etiology of the edematous reaction is eliminated and frequently occurs without dental surgical therapy However in certain situations a gingivectomy is necessary to reduce the gingival pocket depths to a healthy 1 3 mm Periodontal pocket edit nbsp 1 Total loss of attachment clinical attachment loss CAL is the sum of 2 Gingival recession and 3 Probing depthAs the original sulcular depth increases and the apical migration of the junctional epithelium has simultaneously occurred the pocket is now lined by pocket epithelium PE instead of junctional epithelium JE 3 To have a true periodontal pocket a probing measurement of 4 mm or more must be clinically evidenced In this state much of the gingival fibers that initially attached the gingival tissue to the tooth have been irreversibly destroyed The depth of the periodontal pockets must be recorded in the patient record for proper monitoring of periodontal disease Unlike in clinically healthy situations parts of the sulcular epithelium can sometimes be seen in periodontally involved gingival tissue if air is blown into the periodontal pocket exposing the newly denuded roots of the tooth A periodontal pocket can become an infected space and may result in an abscess formation with a papule on the gingival surface Incision and drainage of the abscess may be necessary as well as systemic antibiotics placement of local antimicrobial delivery systems within the periodontal pocket to reduce localized infections may also be considered It is classified as supra bony and infra bony based on its depth in relation to alveolar bone 4 Mucogingival defect editIf the destruction continues unabated apically and reaches the junction of the attached gingiva and alveolar mucosa the pocket would thus be in violation of the mucogingival junction and would be termed a mucogingival defect 5 Pocket formation editFor the periodontal pocket to form several elements need to be present It all starts with the dental plaque tone The invasion of the bacteria from the plaque eventually triggers inflammatory response This in turn results in the gradual destruction of the tissues surrounding the teeth known as the periodontium 6 Plaque that has been present long enough to harden and calcify will welcome additional bacteria to the pocket and make it virtually impossible to clean by means of a traditional toothbrush 7 Continuous destruction of surrounding tissues due to inflammation will lead to degradation of attachment and bone eventually causing tooth loss Certain circumstances can worsen the condition and are known as risk factors These can either be systemic like diabetes or smoking or local like overhanging dental restorative materials causing food trap 8 It is therefore important to manage plaque levels by appropriate oral hygiene measures The importance of using interdental brushes along with standard or electric toothbrushing should be stressed early on Early detection of high plaque levels at routine dental visits are found to be beneficial to avoid progression of the pocket formation 9 External links editScapoli L Girardi A Palmieri A Testori T Zuffetti F Monguzzi R Lauritano D Carinci F 2012 Microflora and periodontal disease Dental Research Journal 9 Suppl 2 S202 6 doi 10 4103 1735 3327 109755 inactive 31 January 2024 PMC 3692174 PMID 23814584 a href Template Cite journal html title Template Cite journal cite journal a CS1 maint DOI inactive as of January 2024 link References edit What do your Gum Pocket Measurements really mean Staff Blog Lorne Park Dental Associates 3 May 2017 Retrieved 4 December 2018 Fermin A Carranza CARRANZA S CLINICAL PERIODONTOLOGY 9th edition 2002 page 101 Antonio Nanci Ten Cate s Oral Histology Elsevier 2007 page 383 Illustrated Dental Embryology Histology and Anatomy Bath Balogh and Fehrenbach Elsevier 2011 page 129 Carranza s Clinical Periodontology Newman et al Elsevier 2011 Lamont Thomas Worthington Helen V Clarkson Janet E Beirne Paul V 2018 12 27 Cochrane Oral Health Group ed Routine scale and polish for periodontal health in adults Cochrane Database of Systematic Reviews 12 4 CD004625 doi 10 1002 14651858 CD004625 pub5 PMC 6516960 PMID 30590875 Worthington Helen V MacDonald Laura Poklepovic Pericic Tina Sambunjak Dario Johnson Trevor M Imai Pauline Clarkson Janet E 2019 04 10 Cochrane Oral Health Group ed Home use of interdental cleaning devices in addition to toothbrushing for preventing and controlling periodontal diseases and dental caries Cochrane Database of Systematic Reviews 2020 4 CD012018 doi 10 1002 14651858 CD012018 pub2 PMC 6953268 PMID 30968949 Manresa Carolina Sanz Miralles Elena C Twigg Joshua Bravo Manuel 1 January 2018 Supportive periodontal therapy SPT for maintaining the dentition in adults treated for periodontitis The Cochrane Database of Systematic Reviews 1 1 CD009376 doi 10 1002 14651858 CD009376 pub2 ISSN 1469 493X PMC 6491071 PMID 29291254 CKS is only available in the UK NICE Retrieved 2020 02 19 Retrieved from https en wikipedia org w index php title Gingival and periodontal pocket amp oldid 1201895061, wikipedia, wiki, book, books, library,
