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Dental Procedure, Pocket Depth Reduction

As the bacteria that cause periodontal disease release toxic substances, they trigger the breakdown of gum and bone. The gum then separates from the teeth, forming gaps that are called periodontal pockets. Bacteria settle in these pockets and because they cannot be removed by the patient's daily oral hygiene, they continue to accumulate and reproduce. Without proper treatment, the bacteria will continue to populate these pockets, creating further gum and bone destruction.

The first step in the treatment of periodontal disease involves the removal of the bacteria that inhabit the periodontal pockets in the form of plaque and tartar. The removal of the pocket irritants, scaling and root planing is combined with oral hygiene instructions that are aimed at improving the patient's ability to control plaque and avoid bacteria from re-infecting the periodontal pockets. Several weeks after completion of scaling and root planing, a periodontal re-evaluation should be completed to assess the healing response. If the periodontal pockets do not reduce to below 4 mm and the gums are still unhealthy, surgical treatment may be indicated.

Pocket depth reduction is a term used for a series of different surgical procedures (gingivectomy, flap surgery, osseous surgery). The purpose of these procedures is to gain access to the root surface to effectively remove calculus and to reduce the size of the pockets to help prevent bacteria from settling in.

What to Expect

Pocket depth reduction is done in the dentist's office with local anesthesia (lidocaine). After lifting the gum back, the bacterial plaque and tartar are removed from the root surfaces. It also may be necessary to remove the infected gum tissue and to smooth the bone surface. Stitches (sutures) are placed to aid in healing. The stitches are usually removed five to ten days after the surgery. Follow-up appointments are scheduled as necessary to evaluate healing and plaque control.

Post-surgical discomfort may last a few days and is usually minimal. It can be easily managed with commonly available over-the-counter medications such as aspirin, acetaminophen, or ibuprofen. Patients can expect to follow their normal routine the day after surgery. A dentist will provide special instructions related to diet, exercise, and medications.

After pocket depth reduction, patients may experience heightened tooth sensitivity. This is temporary and usually resolves within a few weeks. There are chemical aids available that help reduce sensitivity.

Some people also may experience looser teeth after periodontal surgery. This also is a transient finding that occurs as part of the normal healing process. With proper plaque control and bite adjustment, the teeth usually tighten up in a few weeks.

Another concern after pocket depth reduction is that the teeth may appear longer and that there are spaces in between the teeth. Actually, longer teeth are the result of periodontal disease, not of periodontal surgery. As periodontal disease infects and destroys the bone that encases the roots, the root surfaces become exposed. They do not appear exposed because they are covered by the inflamed, swollen gums that form the periodontal pocket. Without proper treatment, the periodontal pockets continue to deepen, giving way to more infection, bone loss, and eventually tooth loss and systemic complications.

There are treatments that can help improve esthetics after periodontal treatment. In addition to periodontal plastic surgery procedures, orthodontic tooth movement (braces) or restorative treatment (crown and bridges) can help create a more pleasing smile line.

Benefits

If periodontal pockets do not resolve after scaling and root planing, a dentist may recommend pocket depth reduction. Whether a dentist performs a gingivectomy, periodontal flap surgery, or osseous surgery, the patient will benefit from the reduction in pocket depth and the reattachment of the gums to the root surface. Pocket depth reduction, when followed by supportive periodontal treatment, is a predictable procedure that can help keep teeth healthy and reduce the risk of serious health problems related to periodontal disease. If a general dentist does not frequently do surgeries, he or she may refer the individual to a periodontist that specializes in this technique.

By Laura Minsk, DMD

+Jim Du Molin is a leading Internet search expert helping individuals and families connect with the right dentist in their area. Visit his author page.

Bleeding Gums

If you have bleeding gums, you may have periodontal disease. We're learning more about this common infection all the time. Below are some of the latest findings. It should help you understand why it's so important that you take action with your periodontist to eliminate periodontal disease, the sooner the better.

Some patients think swollen gums aren't as critical as tooth decay, but that's just not so. Periodontal disease begins as a minor infection and, if it doesn't show signs of stabilizing, is bound to get worse. Untreated, it can eventually result in tooth loss.

Type I periodontitis (gingivitis) consists of tender gums and a little bacteria-filled pocket between your tooth and gum. The disease is very treatable at this point. But if the infected pockets are allowed to enlarge, the inflammation extends to the bone beneath, which begins to erode.

There's another reason to take periodontal disease seriously. The Journal of the American Dental Association recently reported on a study of nonsmokers. Researchers found that periodontal disease was a stronger risk factor for heart disease than such typical symptoms as high cholesterol or high blood pressure. Also, periodontitis in pregnant mothers has been linked to premature and low birth-weight babies.

Your periodontist's concerns for your health don't stop with your teeth. That's why it's important, if you're suffering from gingivitis, that you schedule an appointment and get it treated. When you do, make sure you let your dentist know if you are also being treated for heart disease by your medical doctor.

+Jim Du Molin is a leading Internet search expert helping individuals and families connect with the right dentist in their area. Visit his author page.