On every healthy tooth, there is a gap between the gum line and the attachment point of the gums to the tooth surface. In dentistry this gap is called "Sulcus", which is usually between 0.5 and 2mm deep.
If this measurable depth increases by more than 2mm, it is called a gingival pocket because a piece of the gum has become detached from the tooth. This is not a disease in and of itself, but a concomitant symptom of a disease or an indication of a disease of the periodontium, such as periodontal disease.
Therapy of gingival pockets
The therapy of gingival pockets corresponds practically to the treatment of periodontal disease. First the curettage, a "scraping clean" of the tooth and root surface under local anesthesia. The dentist removes plaque and tartar as well as bacteria and sick or dead tissue. A rinsing solution with hydrogen peroxide is then poured directly into the gingival pocket and sucked off after a short exposure time. This is used for local disinfection.
Systemic antibiotic therapy (if a germ determination has been carried out beforehand) can also be ordered. This should especially be done if the patient complains of general malaise and fever.
Maintenance therapy in order to avoid recurrence or aggravation of the gingival pocket is, in addition to changed home oral care, regular professional tooth cleaning in the dental practice.
The patient himself can also influence the success of the treatment, e.g. by quitting smoking or a well-controlled diabetes The patient must also be clear that the disease can only be stopped and not cured, or that once broken bones cannot grow back.
In principle, curettage and professional teeth cleaning in patients with heart disease (heart valve replacement or a heart attack less than 6 months ago) may only be carried out after having been given antibiotics in consultation with the treating physician or cardiologist.
In pregnant women, periodontitis or gingival pockets may only be treated in the second trimester of pregnancy.
Meridol® for the treatment of gingival pockets
Meridol® is ideally suited for the supportive, home treatment of gingival pockets or after general surgical interventions in the mouth area. The bacteria-inhibiting effect is produced by the ingredients amine fluoride and tin fluoride. It is also used in some toothpastes.
After brushing your teeth, rinse with Meridol® twice a day and spit out. Like all mouthwash solutions, Meridol® should not be swallowed. The mouthwash is also intended for long-term use. The pharmacist, dentist or the manufacturer himself can provide further information.
In addition to the normal Meridol® mouth rinse, there is also the special form Meridol® med CHX 0.2% with chlorhexidine added.
Chlorhexidin® for the therapy of gingival pockets
The product Chlorhexidin® is based on the active ingredient chlorhexidine bisgluconate and is 0.2% free for sale in pharmacies both with and without an alcoholic base, i. H. available without a prescription. It is used as a mouth rinse solution after general oral surgery or periodontal surgery as well as for supporting oral hygiene in orthodontic therapy. It has a strong antibacterial effect.
To do this, about 10 ml of the mouth rinse solution is kept in the mouth for about 1 minute once or twice a day and then spat out again. With prolonged use, however, all tissues in the mouth (teeth, tongue, oral mucosa) often turn brown. However, professional teeth cleaning can restore the original condition.
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Hydrogen peroxide for treating gingival pockets
Periodontal pockets can be rinsed with 3% hydrogen peroxide. Hydrogen peroxide has a bleaching effect and is used, for example, in hair dye or teeth whitening. The antibacterial effect of hydrogen peroxide is used in gingival pockets. In this way, the inflammation can be fought and healing can be supported.
Due to the difficult handling (slightly corrosive), hydrogen peroxide should not be used as a home remedy, but should be used by a specialist, i.e. in the dental practice.
Home remedies for gum pockets
Home remedies are, for example, commercially available over-the-counter rinsing solutions that contain, for example, the active ingredient chlorhexidine bisgluconate or concentrated chamomile preparations in ointment or gel form or as a simple liquid.
Homeopathy can also be used here as a home remedy, e.g. Bach flower preparations. In the case of slight inflammation, symptoms such as redness, swelling and pain can be alleviated. However, they should only ever be considered as a temporary first aid solution.
How long does a gingival pocket last?
The duration of therapy depends on the severity of the disease, i.e. the pocket depth, the degree of bone loss in the jaw, but also on the patient's ability to learn and cooperation. In addition, factors and circumstances that can be influenced from outside should definitely be changed. This includes stopping smoking and having a well-controlled diabetes by the family doctor, as well as excellent oral hygiene and regular follow-up visits to the dentist and their prophylactic staff.
If it is an irreversible gingival pocket, which is caused by periodontitis, then the pocket will continue to exist after the therapy. It must also be clear to the patient that the disease can only be stopped and not cured.
What is the best way to clean a gum pocket?
A gum pocket is best cleaned by the dentist, since the most common household remedies that are freely available in the trade, such as chamomile rinsing solution or chlorhexidine, neither reach the desired depth nor offer the same level of success as medication prescribed by a dentist.
In the dental practice, the first immediate measure under local anesthesia is ultrasound-assisted scaling (rinsing out and scraping off diseased tissue) after previously staining the biofilm. A 3.0% hydrogen peroxide solution can then be used to rinse the bag. In addition, low-dose ointment containing cortisone can be applied to the gingival pocket to suppress the inflammation.
To support the treatment of inflamed gingival pockets, home remedies can be used (in consultation with the treating dentist).
Causes of a gum pocket
The most common gum pockets occur in the context of inflammation of the gums or the gums. Therefore, the reasons for the development of a gingival pocket and periodontitis and gingivitis are very similar.
Inadequate oral care plays the biggest role in the formation of gum pockets (especially cleaning the spaces between the teeth). However, certain medications as well as hormonal changes or reduced salivation, misaligned teeth (and thus difficult dental care), diabetes and smoking can all contribute to the formation of gum pockets. But also patients whose immune defense has been deliberately paralyzed (e.g. after an organ transplant) can be affected by gingival pockets.
In daily oral care, it is therefore important to completely remove bacterial plaque, the main factor behind the formation of gingival pockets. With the help of plaque coloring tablets or liquid, which make the plaque (dental plaque) visible, it is possible to remove it with a toothbrush and interdental brushes and dental floss. Children and senior citizens need special help, since one target group does not yet have fine motor skills and the other does not work 100%.
The dentist and his team will be happy to help if you have any questions about correct dental care.
You can also find out more at: This is how you can remove plaque
What to do if the gingival pocket is inflamed?
If the gingival pocket is inflamed, the dentist should be consulted.
Home remedies, such as Chamomile or rinsing solutions with chlorhexidine are useful as a support and should only be used for a short period of time. The dentist can clean and disinfect the gingival pocket with anti-inflammatory drugs under local anesthesia. However, a complete cleaning of the entire oral cavity with professional teeth cleaning is generally recommended with subsequent so-called full-mouth disinfection (disinfecting the oropharynx including the tongue).
A pocket depth measurement can then be carried out after about a week. A germ collection from the clean tooth to determine the germs (amount and type of germs) can then be carried out from the pocket. The main treatment is carried out after prior approval by the health insurance company.
Under local anesthesia, the pocket and the associated tooth and root surface are also removed Curettes (Special instruments for removing tartar and biofilm) cleaned. For pocket depths over 6mm, surgical treatment, i.e. additional exposure of the operating area, is necessary in order to remove the inflammation and achieve a successful treatment. This also applies if the non-surgical therapy was unsuccessful.
Pus in the gum pocket
Pus is the union of bacteria, proteins and cell and tissue residues that occurs when there is inflammation. Depending on the composition, the color is white-yellowish cloudy or slightly reddish (may contain red blood cells). Pus occurs, among other things, in infected wounds or abscesses and can therefore also be found in large or inflamed gum pockets.
Abscess on a gingival pocket
Most abscesses result from untreated inflammation that spreads to other tissues. An inflamed gingival pocket can develop into a pus-filled abscess in the mouth.
In general, an abscess is not to be trifled with. Because the growing abscess displaces tissue, it can be dangerous near the throat. There is a risk of shortness of breath. Therefore, a visit to the dentist is strongly recommended if there is a suspicion of an abscess in the mouth.
Read more about this at: Abscess in the mouth
How deep can gum pockets get?
In principle, gingival pockets can become as deep as the roots of the teeth on which they arise are long.If, however, bone loss has taken place due to the inflammation, there is a risk of tooth loss because there is no longer sufficient support. In this case, there is chronic periodontitis.
Read also under: chronic periodontal disease
Accompanying symptoms of a gum pocket
The most common symptoms of inflammation of the gums and periodontal disease are bleeding gums (the toothpaste foam when brushing your teeth turns pink when rinsed), pain in the affected area and swollen gums. Patients also frequently complain of bad breath, which persists even after brushing their teeth.
Food residues, bacteria and their metabolic products are deposited in the gum pockets. Since the pocket cannot clean itself, the bacteria multiply and cause inflammation in the gingival pocket. This in turn leads to the fact that the gums retract further and thus the gum pocket becomes even deeper.
Without treatment it can happen that the gum pockets can reach to the tip of the tooth. This enables the bacteria to enter the root canal via this entry point and to infect the nerves it contains.
An inflamed tooth nerve causes very severe toothache in most patients, but there are also cases in which this so-called tooth root inflammation is not painful. So the absence of pain is not a clear sign of a healthy tooth.
In addition to the symptoms described, it should also be mentioned that patients with untreated periodontitis have an approximately 30% higher risk of heart attacks and general cardiovascular diseases. In women of childbearing potential, non-treatment can also lead to an increased risk of premature births and miscarriages.
Aching gum pockets
It is entirely possible that gingival pockets cause pain. On the one hand, an inflammatory process takes place there, which is usually painful in itself, and on the other hand, the build-up of pressure is noticeable from the pus foci.
Diagnosis of gingival pockets
The easiest way to diagnose a gingival pocket is with a so-called periodontal probe.
The probe is guided down between the tooth and the gingival margin to the bone and the depth of the pocket on the instrument is read off. All values between 0 and 2.0 mm are normal healthy values. Pocket depths over 2mm are considered pathological and actually signal the need for treatment. Here, however, there is a kind of gray area for those with statutory health insurance, as the health insurance company only gives its approval for treatment when the values are above 3.5 mm.
In the case of a long-standing or aggressive periodontal disease, bone involvement can also be seen on the X-ray. In addition to horizontal bone loss, vertical fractures of the bone can also be seen there, which, depending on the extent, can lead to loosening and subsequent loss of the corresponding teeth.
A detailed consultation with the patient provides information about the possible causes of the gingival pocket and so the optimal treatment plan can be drawn up to reduce the risk of tooth loss.
Measurement of the depth of the gingival pockets
You can measure the depth of both a healthy and a pathologically altered gingival pocket, preferably with a periodontal probe, also known as a WHO probe. This probe is similar in structure to the simple dental probe, but is more compact in structure and has a millimeter scale at the outer end, limited by a small metal ball. It is guided down between the tooth and the gums down to the bone and the corresponding value is read off the scale at the top of the gums.
Periodontal pocket types
A distinction is made between reversible (i.e. which can be returned to the original healthy state) and irreversible (which cannot be returned to the original healthy state) gum pockets. For example, the gum pockets caused by hormonal changes during pregnancy usually recede after pregnancy, i.e. they are reversible.
Irreversible damage, on the other hand, is characterized by the involvement of the jawbone lying under the gums. The bone that is lost due to inflammation cannot form again, so the defect is irreversible.
The term "pseudo-pocket" describes the phenomenon that the impression of a deep gum gap is created by severely swollen gums, although there is no gingival pocket at all.