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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

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Smoking and Gum Disease

The systemic risks of tobacco use are well known. Tobacco use can increase the risk for cancer, lung disease, and heart disease. But whether you smoke, dip, or chew tobacco, it also affects the oral cavity in a variety of ways. It contributes to oral cancer, stains the teeth, and contributes to tartar deposits, bad breath, and a loss of taste and smell.

Tobacco use causes inflammation of the soft tissues of the mouth, ulcers, recession, and other oral lesions. Tobacco users are two times more likely to develop periodontitis, and ten times more likely to develop acute necrotizing ulcerative gingivitis (ANUG). They also are more likely to lose teeth than those who don't smoke. Smoking is the number one most significant risk factor in the development and progression of periodontal disease.

Tobacco smoking causes periodontal bone loss that is not related to the amount of gum inflammation or plaque accumulation. Although the periodontal disease may be advanced, the classical signs of gum inflammation (redness, bleeding gums, etc.) are not usually as evident in tobacco smokers. Thus, prevention and early detection are more difficult.

Tobacco smoking has a direct effect on the oral tissues and it can alter the immune response. Although smokers do benefit from periodontal treatment, the healing is often delayed and the results are less predictable. In addition, the success rates of periodontal and implant treatment are reduced in people who use tobacco products. The amount of complications is related to the amount of daily tobacco exposure, and the number of years the person has been exposed.

The use of tobacco products can increase the risk of periodontal disease:

1. It weakens the immune system: Tobacco products suppress the body's ability to fight infection. Carbon monoxide (a major byproduct of cigarette smoke) reduces oxygen concentration and inhibits the movement of white blood cells. This reduces the capacity of the white blood cells to fight bacteria (including the bacteria that cause periodontal disease), and delays healing.

2. It masks signs of infection: Tobacco reduces the ability of blood vessels to carry infection fighting cells, nutrients, and oxygen to the tissues. As a result, the typical signs of periodontal disease (redness, swelling, and bleeding of the gums) are masked. People who smoke may have periodontal disease that is harder to diagnose.

3. It increases calculus formation: Smoking can cause more calculus (tartar) accumulation that if not removed promptly can lead to more plaque build-up and periodontal disease.

4. It reduces healing: Nicotine and other chemicals can be absorbed directly by the root surfaces of the teeth and reduce the ability of cells to reattach to the root surface during healing.

Besides the obvious health benefits of discontinuing tobacco use, quitting can also reduce the risk of oral cancer and the detrimental effects of tobacco on the gums and bone that support the teeth. In addition, another incentive to stop smoking is that former smokers respond similarly to never smokers to periodontal treatment.

Because there is a physical and psychological addiction to tobacco, quitting can be very difficult. But millions of Americans quit smoking every year. There are aids available that reduce the craving for tobacco. These include the use of systemic medications, the nicotine patch, the nicotine gum, the nicotine inhaler, and the nasal spray. See your dentist or physician for aid in stopping tobacco use.

By Laura Minsk, DMD