CATEGORY AUSTRALASIAN DENTIST 65 CLINICAL millimeters, are taken around each tooth: three on the outer (lip) side and three on the inner (tongue) side. These measurements are recorded and can be used to track changes in your periodontal health over time. Measurements ranging from 1 mm to 3 mm generally indicate a normal, healthy attachment of the gum tissue around the tooth. A snug fit between tooth and gum (no more than 3 mm) makes it easier to remove plaque bacteria from beneath the gum line, where it can affect the attachment of gum tissue to the tooth. Any space over 3 mm deep may signify gum disease, particularly if gums bleed. Larger numbers (usually ranging from 5 to 12 mm) reveal the presence of periodontal pockets, which make it more difficult for an individual to control plaque effectively with at-home oral hygiene. In most cases, the larger the number, the more bone loss is present, and the more difficult it is to keep teeth and gums healthy. All pockets are not equal A 4 mm measurement is often the dividing line between a normal sulcus and a periodontal pocket. However, while pocket depth is significant, other factors must be taken into consideration when diagnosing gum disease. For example, even mild gum disease (gingivitis), where inflammation has not spread beyond the gum tissue, may lead to a higher reading. This can occur when inflammation causes the gums to become swollen, which in turn causes the dimension between the bottom of the sulcus and the top of the gum tissue to increase. In the presence of other signs such as bleeding gums, a measurement of 4 mm could very well indicate a periodontal pocket. However, your dentist may consider a healthy 4 mm space to be a sulcus, as long no bleeding is present. On the other hand, even a normal measurement, such as a 3 mm space, could be considered a pocket if inflammation, bleeding and tartar are present. Treating periodontal pockets Since every periodontal pocket is different, specific treatment recommendations will depend on the depth and shape of the pocket, and whether the inflammation is restricted to the gum tissue, or if it has spread to the bone that lies beneath. Your dentist may wish to take x-rays to determine if there is bone loss from around the teeth, and to what degree. Getting rid of plaque bacteria (also called biofilm) and tartar is the first step in keeping gum disease from getting worse. In the case of inflamed gums with no bone loss, even a pocket depth of 4 mm or 5 mm may be treated with professional cleanings to remove the causes of the inflammation, along with an enhanced at-home oral care regimen. This will likely include, at minimum: brushing your teeth twice a day with a soft toothbrush and fluoride toothpaste; flossing daily to remove plaque between the teeth where your brush can’t reach; and using an oral rinse if recommended by your dentist. If more severe periodontal disease is present, a procedure called scaling and root planning may be recommended. This thorough cleaning procedure not only removes the plaque and tartar but also smooths the root surface so the gum tissue can reattach to the tooth, shrinking the pocket. Sometimes, antibiotics may be used to reduce inflammation and help control bacteria underneath the gum line. Antibiotics can be given in pill form, but most often are directly applied inside the periodontal pocket. If a pocket is too deep to be treated with non-surgical procedures, surgery may be recommended to reduce the size of the pocket. This procedure is often done by a periodontist – a dentist who specializes in the treatment of the gums and other supporting structures of the teeth – and may be performed with standard surgical tools or with laser instruments. u About the author Dr Mario Vilardi graduated from the University of Pennsylvania School of Dentistry in 1974 and obtained his Certificate in Periodontology from the same school in 1977. He is a Diplomate of the American Board of Periodontology, a Fellow of the Academy of Osseointegration and a Fellow of the Academy of Aesthetic Dentistry. For over 10 years, Dr Vilardi served as Associate Clinical Professor of Dentistry at Columbia University School of Dental and Oral Surgery. He has lectured extensively on the subjects of dental implants and cosmetic dentistry, and his work has been published in the Journal of Clinical Periodontology and Practical Periodontics and Aesthetic Dentistry. The co-founder and publisher of Dear Doctor magazine, Dr Vilardi maintains a private practice limited to periodontics and implant dentistry.
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