Whats is periodontal disease?

Periodontitis is inflammation of the Periodontium, the tissues holding the teeth within the jaws. If left untreated, it can lead to tooth loss and bad breath. It is a major cause of tooth loss in adults.Bacteria contained in the plaque on the surface of the tooth can stimulate an inflammatory response by the body. Initially this damage is reversible and known as gingivitis. In susceptible individuals, persistent inflammation can lead to damage to the structures which support your teeth. In Periodontitis, this damage is irreversible and treatment revolves around stopping further loss of the attachment which keeps teeth firm, and to keep teeth for as long as possible. Gum disease around implants is known as either ‘peri-implant mucositis’ if there is no bone loss, or ‘peri-implantitis’ if there is radiographic or clinical evidence of bone loss around the implant.


What are pockets?

Inflammation from bacteria leads to the formation of a deepening crevice around the neck of a tooth. This is known as a pocket. Pockets harbour bacteria and tartar, and if unmanaged, can lead to a site of continued destruction of the gum support. We measure pockets as a number, in millimetres, around 6 points on every tooth present in the mouth. These numbers are used to monitor the severity of disease, as well as their response following any treatment provided.

What is the importance of the depth of a pocket?

It is well established that a 4mm pocket or less, without bleeding represents periodontal health. Any pockets above this threshold are ones which require treatment. We know from studies that the depth of a pocket is inherently linked to probability of tooth loss (expressed as ‘Odds Ratios’). A 5mm pocket with bleeding is associated with a 7x increased risk of tooth loss. A 6mm pocket with bleeding is associated with a 11x increased risk of losing that tooth. A 7mm pocket is associated with a 64x increased risk of tooth loss (a 6400% higher chance).

The aim of periodontal therapy, in simple terms, is to reduce the depth of these pockets. Deeper pockets are likely to require multiple appointments of root surface debridement or ultimately surgery to resolve them.  

A dental hygienist or general dental practitioner are likely to struggle to resolve deeper pockets with simple treatment alone. Specialist input is often required for management of cases such as these.