Gingival pockets are pockets in the gums that are abnormal in depth. The gingival sulcus is the crescent-shaped area where the gum tissue makes contact with the tooth. This area is considered an area of potential space, as, in a healthy mouth, the gum tissue is securely connected to the tooth by connective tissue attachments, leaving a groove that is only about 1 to 3 millimeters in depth between the gum tissue and the tooth. This shallow crevice is often the home of food debris, cellular material, and chemicals; when the gums are healthy, the crevice is shallow enough that regular and thorough cleaning with a soft-bristled toothbrush can remove this matter, with dental floss and fluoride toothpaste playing effective supporting roles. Sometimes, however, this area experiences inflammation and swelling. This edematous reaction may be due to localized irritation, systemic problems with the host, or drug-induced gingival enlargement. When this inflammation occurs, it creates the illusion that a pocket has formed in the gingival sulcus. This illusion is due to the larger overall size of the gingiva, however, and not due to detachment of the periodontal ligament. Because the periodontal ligament is still attached in these cases, these pockets are considered false pockets or pseudopockets. Actually periodontal pockets are formed when the attachment at the base of the sulcus migrates or is damaged. With gingival pockets, the only movement is the movement of the gum tissue in a coronal direction due to swelling.
In most cases, gingival pockets can be completely reversed when the cause of swelling is removed. While this is often an early sign of gum disease, with treatment and maintenance it can often be reversed. In certain situations, however, the gum tissue may need to be surgically reduced with a gingivectomy in order to return the gingival sulcus to a healthy depth of no more than 3 millimeters and to allow the area to remain free of future bacterial accumulation. The plaque and calculus that have accumulated in the gingival pocket must first be clinically removed, and the area must be thoroughly cleaned and disinfected. Then, if necessary, the patient will learn effective new oral hygiene skills and aim to manage the accumulation of dangerous amounts of plaque through diligent home care.
If left untreated, inflammation in the gums and bacterial buildup in the gingival sulcus may cause the connective tissue fibers at the base of the gingival sulcus to begin to experience destruction, characterizing the onset of periodontitis. Periodontitis is also characterized by destruction or resorption of the alveolar bone, and this destruction of the gingiva and the bone cannot be reversed. Periodontitis is instead treated with management and retention of the teeth as the ultimate goal. Because of the destructive nature of periodontitis, effective management of bacterial plaque and calculus is of the utmost importance. Regular, effective oral hygiene habits combined with periodic clinical checkups and cleanings can keep the oral cavity healthy and are the recommended line of attack against periodontitis. Brushing twice daily with a soft-bristled toothbrush and fluoride toothpaste, in conjunction with interdental cleaning with a tool such as dental floss, is the best first defense against plaque; combined with clinical removal of calculus through professional cleanings by a dental hygienist, you can prevent inflammation and effectively help maintain the health of your oral cavity.