Periodontitis must be graded, and staged under the new classification. In normal dogs, even without tooth brushing the bacteria do not get access to connective tissue and pocket does not form, but in neutropenic dogs, regular tooth brushing also cannot prevent plaque extension subgingivally, As the inflammation intensifies, there is degradation of connective tissue and gingival fibers. The patient may also report with sensitivity towards cold and hot, and an emergence of deep dull pain which could be localized or deep within the alveolar bone. those in the superficial layers of the epithelial attachment that are nearest to the tooth, tend to undergo degenerative changes and split, thereby forming the first stage of pocket formation. The ecological plaque hypothesis. Also, antimicrobial medications are applied to gums to remove the bacteria strains. It must be understood that the above discussion is focused on general aspects of pocket formation. Oil Pulling: One of the oldest and ayurvedic method for many benefits. So, it is the distance from the cementoenamel junction to the base of the pocket or junctional epithelium. The periodontal breakdown is dependent upon the rate of disease progression, which varies among individuals. The surface topography of the tooth wall of periodontal pocket has been studied by various authors. The cells of the epithelial attachment derive their nourishment from the lymph of the underlying connective tissue, but in a periodontal pocket, the chemical composition and hydrogen ion concentration of the underlying connective tissue is altered. Salt Water Cleaning: Mix half spoon saltwater in lukewarm water and take some into your mouth and swish it around. Classification of periodontal. The periodontal pocket formation is the first step in periodontal breakdown cascade. Below are some of the precautions as well as home remedies to stop periodontal pockets from occurring. X-ray showing supporting bone X-ray showing periodontal bone loss How are periodontal diseases treated? For example, two teeth having same pocket depth, one associated with the recession and the other with no recession have different loss of attachment. Treatment for Periodontal pockets depends on various factors like the depth of pockets and the formation of tartar or plaque around your teeth along with other symptoms. Compound pocket: It involves two or more tooth surfaces. In healthy periodontal conditions, the defense mechanisms are generally sufficient to control the constant microbiological challenge through a normally functioning junctional epithelium and the concentrated powerful mass of inflammatory and immune cells and macromolecules transmigrating through this epithelium. Bacteria toxins continue to form on the tartar and start causing inflammation in gum tissue causing gingivitis. If the local irritants are not removed, the continuous healing process results in the fibrotic or edematous changes in the pocket wall. The acidic environment in this area may soften the cementum surface. In the areas between the processes, the epithelial layer is thin and an occasional microscopic breach may occur in its continuity, thereby forming a microscopic ulcer. Once a pocket develops, purulent exudates, food remnants, serum/blood by-products, dead bacteria, leukocytes and desquamated epithelial cells overlaying the layer of calculus or plaque are usually detected in the periodontal pocket. References available in the hard-copy of the website. Author information: (1)Columbia University School of Dental and Oral Surgery, Division of Periodontics, USA. OUTLINE -Definition. Neutrophils play a very important role in the pathogenesis of periodontal pocket formation as they are the first line of defense around the teeth, epithelial barrier being the second 17. Bosshardt DD. The Journal of Periodontology. The Infrabony Pocket: Classification and Treatment ... Aman Bhagat, Anchal Ohri, Vishakha Grover, Gender-Associated Oral and Periodontal Health Based on Retrospective Panoramic Radiographic Analysis of Alveolar Bone Loss, Gender-related Differences in Health and Disease [Working Title], 10.5772/intechopen.78906, (2020). A periodontal abscess most commonly occurs as a complication of advanced periodontal disease (which is normally painless). Save my name, email, and website in this browser for the next time I comment. Bacterial plaque was seen penetrating into the enlarged intercellular spaces of the pocket epithelium). Deeper pockets are more difficult for you and your dental care professional to clean, so it’s important for you to reduce them. Areas of variable calcification can be found on the cemental surface. Studies have shown bacteria in cementum, which can be found at cementodentinal junction 43, 44 and even in the dentinal tubules 45. Tooth with the recession has more attachment loss. The clinical features vary according to the severity of the condition. Microbial etiology of periodontal pocket formation is well established. Pockets can involve more than one tooth surfaces and depths can vary and occur on one tooth surface and twisting around the tooth to involve one or more additional surfaces. The periodontal pocket is a pathologically deepened gingival sulcus. Intrabony (Infrabony, Subcrestal or intraalveolar) - In this, bottom of the pocket is apical to the level of the adjacent alveolar bone and the lateral pocket wall lies between the tooth surface & alveolar bone. Brushing Your Teeth: One of the best ways to cure pockets is to brush on a regular basis in the morning and evening. In a periodontal pocket, the extension of this zone is reduced to less than 100 μm as compared to the normal sulci where it is usually more than 500 μm. Classification of Periodontal Pockets Periodontal pockets are classified according to the relation of the base of the pocket to the alveolar crest into: Suprabony (supracrestal or supraalveolar) The bottom of the pocket is coronal to the underlying alveolar bone. By Dental Health Guide Waerhaug J. Pathogenesis of pocket formation in traumatic occlusion. We might feel swelling or observe reddish gums which are caused by tartar or plaque around the gums and teeth resulting in pocket formation. Microorganisms in plaque get embedded into the cementum 42. (2018) Proceedings of the World Workshop on the Classification of Periodontal and Periimplant Diseases and Conditions, Journal of Clinical Periodontology 45 Special Issue. Like regular health checkups, it is important to get your dental health checkup also every 3 months. The periodontal pocket usually contains the following. In the case of pseudopockets, there is no clinical attachment loss as the junctional epithelial attachment is at its normal position i.e. Usually, the treatment involves the removal of bacteria formed in the pockets and reducing the gaps between gums and teeth either with medication or surgical procedure. Periodontal probe in a periodontal pocket SAMPLE. Dentist Consultation: it is the most ignored routine for everyone. The degeneration of epithelial cells at the base of pocket actually retards pocket formation. Periodontology 2000. The mineral content of exposed cementum is increased and chemical analysis shows an increase in calcium, magnesium, phosphorus and fluoride 46, 47. at cementoenamel junction. II. Two types of periodontal pockets exist : I. Suprabony (Supracrestal or Supraalveolar) - In this, bottom of the pocket is coronal to the underlying alveolar bone. The superficial layers of the epithelium show signs of parakeratosis i.e. Initially, there is plaque formation and accumulation of Gram +ve bacteria on the supragingival tooth surface. Studies have shown the presence of filaments, rods and coccoid organisms with predominant Gram-negative organisms in intercellular spaces of the epithelium. Hypercalcified areas can be found in areas where saliva is a constant source of minerals. The degenerative changes on the lateral wall of periodontal pocket are more severe than the base of the pocket. The authors observed following areas starting from the superficial surface towards the connective tissue. Pathologic granules can be found in areas of collagen degeneration 41. These small ulcerations facilitates increased leukocytic infiltration from the underlying connective tissue which is edematous due to increased dilated and engorged blood vessels. Studies have shown that just apical to junctional epithelium, there is degradation of collagen fibers and accumulation of inflammatory cells. Periodontal pockets are caused by microorganisms and their products, which produce pathological tissue changes that lead to the deepening of the gingival sulcus. Electronic Toothbrushes: Use electronic toothbrushes for effective cleaning. Dental Health Guide, Providing information on dental care and dental hygiene along with detailing the most common dental diseases with symptoms and treatment methods. The previously types of periodontitis recognised as “chronic” or “aggressive” are now grouped under a single category of “periodontitis”. As a result, those cells which are furthest from the source of nourishment, i.e. Flap Surgery: Dentists would recommend for flap surgery as you might have deeper space between your gums and tooth. Once a patient has had any periodontal treatment (non-surgical, surgical, or a combination of both), they will require periodontal maintenance recalls at more frequent intervals in order to try to maintain their disease and try to prevent recurrence.
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