gum pocket cleaning in the dental office

Periodontal pocket: treatment, procedures and cost to reduce gum pockets depth

Periodontal or gum pockets are medical words to indicate that the depth of the tiny space (gingival sulcus) between the tooth and the surrounding gingival tissue, is more than 1–3 mm. If leaved untreated, periodontal disease bacteria can make the pockets to become deeper leading to the tooth supporting structures destroying and causing the dental element loss.

There are different natural remedies and periodontal treatments to reduce gum pockets such as

  • professional dental cleaning;
  • scaling and root planing;
  • local antibiotic;
  • laser therapy.

If a pocket is too deep to be treated with non-surgical procedures, an oral surgeon may be required to reduce the size and the depth of the pocket.

How do gum pockets form ?

After each meal it is very important to brush and floss teeth to remove food debris from the oral cavity especially from between dental elements. If you skip the oral hygiene, bacteria will eat that food producing toxins and acid.

Bacteria toxins are very dangerous for two main reasons:

  • First, they wear away the tooth enamel and this process will lead to deep caries;
  • Secondly, acid and toxins produced by plaque bacteria will irritate and inflame the gingival tissue that becomes swollen, reddish, bleeding and painful.

If you do not remove the inflammation cause practicing the daily at-home oral hygiene and the professional care routine, gum and teeth cleaning, the gum tissue begins to separate or pull away from the teeth. This separation leaves a larger space between the tooth and gums where bad bacteria can thrive undisturbed.

In this situation the gingival sulcus gets deeper and you cannot do anything to stop this process because the toothbrush bristles cannot reach that depth to remove the plaque. At this point an endless vicious circle is triggered: the more plaque accumulates the more the pocket becomes deep and can hide even more bacteria.

Common symptoms

In healthy condition, gingival tissue is attached to the teeth surface and has a light pink color. Instead, when gums are inflamed, they change their color tends to red. Additionally it is easy to see blood coming out while brushing and flossing and the gingival tissue becomes puffy and tender.

Because gum disease has different progressive stages, there are different gum pockets symptoms and not all of them appear in people affected by this oral pathology.

Early symptoms

Generally patients do not pay so much attention to early gum pockets symptoms because of the lack of pain and discomfort. People affected by the first stage of gum disease may notice and feel the following disease signs:

  • Gingival inflammation or pain;
  • Red and swollen gums;
  • Bleeding when you brush or floss your teeth;
  • Moderate bad breath.

Advanced symptoms

  • Yellowish teeth base (due to plaque and tartar accumulation);
  • Pus within the pocket;
  • Loose or shifting teeth
    When pockets are very deep (beyond 7mm), the infection start to attack and destroy the periodontal structures that support each teeth. In other words, there are 3 main parts that work together to keep each tooth firmly in place: the alveolar bone, the periodontal ligaments and gingiva.
    Teeth aren’t directly supported by bones but they are held in place by thousands of tiny fibers called periodontal ligaments that connect the root of the tooth to the bone. Gingival tissue is the most external layer that acts like a protection.

As more deep the pocket is as more easily the infection can reach periodontal ligaments and destroy them. The result is that the affected tooth doesn’t have the required support anymore and becomes loose.

  • Change of your bite
    At this point it is easy to guess that mobile teeth cannot support the pressure while chewing. Their movements may cause you to feel moderate to severe toothache and gingival pain.
  • Partial dentures no longer fit properly
    Partial dentures need to anchor to natural residual teeth in order to stay firmly in place. If bacteria in the pockets made them to become loose, even your partial dental prosthesis will be loose as well causing you sore spots and blisters.
  • Periodontal abscess
    necrotic, smelly tissue and pus trapped within the gum pockets need to find a way out so they create a fistula through the gingival tissue that works like a drainage point. A white head boil may appear in your mouth close to the affected area that’s why periodontal abscess is also known as gum boil or gum abscess.

Periodontal pockets diagnosis

Until the pocket leads to abscess, many people will probably do not know that pockets have formed in their mouths. However, a periodontist can easily diagnose the presence of pockets and measure their depth during a comprehensive periodontal examination.

The periodontal exam allows the periodontist to get the precise status of the patient’s periodontal structures that supports your teeth.

During the periodontal examination, your dentists will proceed measuring and recording (periodontal chart) the following structures:

  • pocket depth in millimeters (each side of each tooth),
  • bleeding spots (bleeding on probing),
  • gum and bone recession severity,
  • furcation involvement,
  • dental mobility grade.

Gum probing means that, during the periodontal examination, the periodontist gently inserts a manual tool called probe between the tooth and gum. The measurement is taken from the top of the gum to the bottom of the sulcus or pocket. These measurements are recorded in the periodontal chart that will be used to track changes in your periodontal health over time.

Gum pockets depth range in millimeters

  • 1 to 3 mm
    generally indicates a normal and healthy gingival tissue that is attached around the tooth surface;
  • 4 to 6 mm
    this pockets depth indicates a mild gum disease that didn’t attack the jawbone yet and the condition can still be reversed
  • 6 to 8 mm
    at this progress point the periodontal pathology is indicated as “moderate” meaning that in addition to redness, swelling and bleeding, pus appears and the bone starts to reabsorb (-20% respect to a patient with healthy gums);
  • 7 to 12 mm
    this is the last and most severe gum status before the patient loses the infected tooth. In fact, when there are so depth pockets, the dentist or the periodontist can be sure that the patient already lost more than 30% of the supporting mandibular or maxilla bone. Without the necessary bone quantity, the tooth cannot last long under the chew pressure.

False pockets

By the measurements listed above, 4 mm depth is often the limit between a normal sulcus and a periodontal pocket.

However, the sulcus depth by its own is not always enough to identify the presence of a gingival pocket without any doubt. There are additional factors the dentist had to take into account.

A simple gingival inflammation can lead to tissue swelling so the size of the free gingiva increases in height. The result is a false gum pocket during the periodontal measurement. In other words, the sulcus depth hasn’t change at all while the top of the gum tissue has moved upward.

On the contrary, when the periodontist is in front of a sulcus depth equal to 3 mm and the presence of additional symptoms such as bleeding on probing, plaque and tartar, he or she can be sure that a periodontal pocket formed and need to be treated.

How to reduce gum pockets without surgery ?

The first and most important gum pockets treatment is the professional teeth cleaning by the dentist or the dental hygienist. This procedure is the first step to treat pockets of any size and in any condition because, to reduce them, it is necessary to remove the infection causes such as dental plaque and tartar calculus. In case of deep pockets, it is also necessary to remove the necrotic tissue and the pus.

For measurements that are 4-5 mm, the patient generally should to undergo the professional teeth cleaning every 3-4 months and combine it with a more adequate home care.

The more frequent cleanings than 6 months, allow to stop the pockets from getting deeper and promote their healing.

Scaling and root planing

During each professional cleaning session, the dental hygienist or the dentist will use different debridement techniques with different manual and ultrasonic tools. The more conventional are called curettes or scalers;

Scaling and root planing manual techniques are useful to remove the hard tartar calculus from the exposed surfaces of the roots under the gum line. In this way cementum and dentine impregnated with calculus, toxins, or bacteria that cause inflammation, are removed as well. By creating a smooth tooth root surface, the dentist promotes a faster gum reduction and healing.

Periodontal pockets disinfection

After scaling and root planing, pockets need disinfection. The doctor will use a special oral irrigation containing chlorhexidine gluconate that has a particular antibacterial action. Unlike other antimicrobial oral rinse, chlorhexidine can infiltrate the soft gum tissue that will slowly release the active medicament during a longer period of time (generally 24h).

Local antibiotic placement

In the last  step of the conventional gum pockets treatment, the periodontist may place local antibiotic directly in the periodontal pocket following scaling, root planing and disinfection of the infected area. Site specific antibiotics release the medication slowly over a period of time and boost the gum pockets reduction.

Adequate home dental care

Here is where the most important part arrives and that must be taken into consideration by the patient who wants to recover permanently. Conventional therapies done by dentists cannot solve by them self any periodontal disease or reduce gum pockets. Each patient should to understand that the most active part of the therapy is represented by the daily oral hygiene practiced at home.

In the next paragraph there are some indication of how to care of your gum, what tools can help you to reach a proper oral cavity cleaning and what natural remedies the nature offers.

Gum pockets natural remedies and home treatments

The following lists of natural remedies such as essential oil and herbal products has the information purpose only. Please, before to try them on your own, you should talk to your doctor or dentist in order to avoid any unwanted side effects especially during pregnancy, breastfeeding or childhood.

Remove more plaque with electric or sonic toothbrush

  • Electric toothbrush
    Unlike manual, electric toothbrushes do not need human arm to move their head in order to scrape the tooth surface. The power makes the electric toothbrush head oscillating and rotating (back and forth). In this way the effectiveness is always a the top. If you have only to move the toothbrush without the need to think of the scraping movements, it is more easy to reach and clean even those mouth areas that a manual tool cannot (with the same result). Automatic oscillating and rotating make your job easier so you remove more plaque decreasing the risk of periodontal disease and gum pockets. In case you already suffer because of gingival inflammation, an electric toothbrush may speed up the recovery time.
  • Sonic toothbrush (i.e. Sonicare)
    In addition to rotating and oscillating, sonic toothbrush (like Sonicare) adds pulsating movements. Some models can generate up to 40,000 pulses per minute, whereas others stop to 20,000. The high number of pulses leads to a secondary cleaning action that makes sonic toothbrushes one step forward compared to electric ones. The secondary cleaning action is called “Dynamic Fluid Activity” meaning that the intense vibrational speed can move the fluids (water, saliva and toothpaste) around and between teeth, to the degree that they’re able to remove dental plaque where the sonic toothbrush bristles actually do not touch. By removing even plaque and bacteria that bristles do not reach, a sonic toothbrush helps you to improve your dental hygiene, shrink gum pockets and promote the gum disease healing.
  • Ultrasonic toothbrush
    an ultrasonic toothbrush is even more effective because it can emit high frequency (1.6MHz) waves that can find and break up plaque chains up to 5mm below the gumline within the gum pockets. Even if ultrasonic brush do not need any physical motion to clean the teeth, many of them also provide additional sonic vibration providing a more effective cleaning action.

Water-flosser with different periodontal pocket tips

Water flossing is the ultimate solution to the pain and hassle of traditional flossing.

It is very easy to understand how a water-flosser works. A strong, thin and adjustable stream of water replaces the conventional string so the water-flosser flush away bacteria, plaque and food debris trapped between teeth and below the gumline.

The water stream is more gentle than the standard floss string so you don’t have to worry because of pain or bleeding. WaterPik is the most famous, sold and Amazon 5 stars reviewed water-flosser on the market side by side with Philips and Oral-b brands.

Water flossing is also a great solution for people that have dental implants, crowns, a dental bridge and periodontal pockets because string flossing can be very difficult in these areas.

Most water-flossers have power settings that you can adjust as you prefer. In addition, many models also come with 1 to 6 flosser tips that are perfect to clean mouth areas with different conditions.

Let’s be honest, the last thing you want is to spend a lot of money for orthodontics appliances or complex dental restoration and then ruin your smile because of caries !

Hydrogen Peroxide 3% antiseptic solution

Hydrogen peroxide is the first gum pockets home treatment used all over the world because of its antimicrobial and antiseptic properties. When you have a mild form of gum disease such as gingivitis or your gums bleed when flossing, it means there is an active wound in your mouth that needs to be treated.

Hydrogen Peroxide 3% oral rinse works as an oxygenating agent to produce those bubbles that traps the bacteria when applied to oral wounds, removes them and helps it heal faster.

Hydrogen Peroxide is available:

  1. pure
    that means you should mixing equal parts of hydrogen peroxide with water in a normal glass or cup before to use it.
  2. ready to use
    meaning that the oral rinse is immediately available out of the box, no mixture is required
  3. in gel form
    in this case you should follow the label indication before to apply the hydrogen peroxide gel locally close to the gum pocket opening

Swish hydrogen peroxide rinse in the mouth over the affected gingival area for at least 1 minute, then spit out. Do not swallow the product.

Be careful not to rinse for too long, as it can burn the gums and/or tongue and temporarily turn some areas white.

Oil Pulling sucks bacteria away

Inherited from Ayurvedic medicine, oil pulling technique is a mouth health booster because it removes toxins. Oil pulling procedure is very simple and helps you to eliminate bad bacteria and to reduce gum pockets depth. The reason why oil pulling works is very simple, it is all about a chemical attraction between the oil fat and the outer membrane of bacteria. In other words, when you swish the oil in your mouth, bacteria will sucked away like dust by the vacuum cleaner. By eliminating the cause of the inflammation, the soft gingival tissue tends to repair itself so even a periodontal pocket tends to heal by its own.

There are different oil you can use for oil pulling purpose: sesame and olive but the most powerful is the coconut oil thanks to the high percentage of fat (lauric acid) that is the part that actually does the job.

To proceed with coconut oil pulling to reduce gum pockets, the only thing you should do is to swish 1 or 2 tablespoons of coconut oil for about 10 mins until it becomes milky and spit it. Pay attention not to swallow the rinse. This gum pockets treatment should be repeated 4 times a week to see the best results.

Aloe Vera gel calms down the gingival inflammation

Aloe Vera has so many healing benefits that is almost impossible to list them all. Thanks to its antiseptic, anti-inflammatory and healing properties, aloe vera is extremely helpful to treat gingivitis and periodontitis. It reduces bleeding, inflammation and swelling of the gums. It is a powerful antiseptic in gingival pockets where normal cleaning is impossible.

Since there are many different herbal products based on aloe vera on the market, you can chose from local/topical or internal therapy (or both).

topical aloe vera products

Even if there are mouthwashes and toothpastes made from aloe vera, the most effective preparation is in gel or spray

The usage is very simple: you should massage your inflamed gums with aloe vera gel or spray, leave the product in place for 30 mins and then rinse the oral cavity with room temperature plain water. This simple procedure should be repeated a 3 times a day for several weeks till you see gum disease improvements.

Internal therapy

According with the general herbal indications, you should drink 100 mg of aloe vera juice a day for at least 1 month to see the first results.

Cranberry Juice (Vitamin C booster)

A study published on PubMed.gov (https://www.ncbi.nlm.nih.gov/pubmed/10972636 ) revels that a lower intake of vitamin C is associated with high risk of periodontal disease.

Vitamin C has several benefits

  • Form an important protein used to repair body tissues like skin gingiva and blood vessels
  • Heal wounds and mouth ulcers
  • Repair and maintain bones, and teeth

Why is Cranberry juice so indicated for periodontal disease and gum pockets ? This forest fruit is extremely rich in antioxidants, vitamin C and salicylic acid compared to other vegetables and fruits like broccoli, spinach, and apples. In addition it contains only 45 calories per cup; so cranberry juice fits very well the dietary guidelines.

Last but not least, cranberry natural remedy restore the normal blood micro circulation.

Since bacteria in the pocket destroy gingival tissue, blood vessels and the outer part of the tooth root (cementum), cranberry is the most effective home remedy to speed up the damaged body tissues replacement.

Salt water natural remedy for pockets infection

Salt water rinse is the most used gum pocket remedy in the United States.

Salt water based mouthwash is not only useful for keeping bad bacteria under control but also promotes faster healing. Salt water is used after dental extraction, root canal treatment, gingival surgery and any situation where a disinfected oral environment is needed.

The salt water rinse usage is very simple: put a half tablespoon of salt in a half glass of room temperature water (or warm) a mix until the salt will be completely melted. Rinse the oral cavity swishing the liquid solution between your teeth for approximately half minute then spit it paying attention to not to swallow the mixture.

Even if this is a natural remedy for periodontal pocket and inflamed gums, it doesn’t mean it comes without downside effects. If you keep salt water mouthwash in your mouth for too long, you may damage the enamel of your teeth because of its acidity.

What to eat in case of periodontal pocket ?

Diet plays a big role in preventing and fighting gingival diseases because it provides the body with the necessary nutrients. If you are experiencing gingivitis associated with gum pocket, you should add more vitamin C-rich fruits and vegetables to your diet. Lemons, oranges, grapefruits, blueberries, grapes, strawberries, papaya, red pepper, broccoli, kiwi, guava and spinach are all foods very rich in Vitamin C.

Laser therapy to reduce periodontal pockets

When the periodontal pocket is too deep to be treated with conventional non-surgical therapy there still is a last chance before the standard gum surgery. We are talking about the LANAP Laser Gum Surgery. The main feature of the gum laser therapy is that it can kill 99.9% of the bad bacteria and stimulates stem cells to form new gingival tissue, periodontal ligaments and alveolar bone around the tooth. Laser gum pocket treatment is always considerated in addition to the conventional scaling and root planning and never as alternative therapy.

Surgical gum pockets reduction

In front of very a deep periodontal pocket and severe receding gum tissue, your dentist cannot do anything else than propose you a different and more invasive treatment such as gum surgery.

The surgical approach is required when the periodontist cannot clean the periodontal pocket without cutting the tissue to reach and remove the infected material. In case of poor bone quantity due to the destructive bacteria action, the bone grafting procedure may be required. In addition, even the gum graft surgery procedure may be involved in order to cover the tooth root portion leaved uncovered.