Periodontal pockets Flashcards
Periodontal pocket means
Pathologically deepened gingival sulcus
Deepening of periodontal pocket is due to 3 reasons
coronal movement of gingival margin,apical displacement of gingival attatchment,combination
Classify pocket
1.gingival pocket
2.periodontal pocket : Suprabony pocket and infrabony pocket
Other 2 names of suprabony pocket?
1.supracrestal
2.supraalveolar
Other 2 names of infrabony pocket?
1.subcrestal
2.infraalveolar
Bone loss pattern in suprabony pocket?
Horizontal
bone loss pattern in infra bony pocket?
vertical
what are 3 pockets classfication based on involved tooth surfaces
1.simple
2.compound
3.spiral/complex
Flowchart: Changes in Sulcus During Periodontitis
1️⃣ Healthy Sulcus (1-3 mm depth)
⬇️
2️⃣ Plaque & Bacteria Accumulate → Gingival Inflammation
Swelling & redness
Formation of pseudopocket (no bone loss)
⬇️
3️⃣ Periodontal Pocket Formation (4mm+)
Junctional epithelium detaches
Gingival fibers break down
True periodontal pocket develops
⬇️
4️⃣ Bone & PDL Destruction
Osteoclasts activated → Alveolar bone loss
PDL fibers damaged → Tooth mobility increases
⬇️
5️⃣ Advanced Periodontitis (6mm+ pockets)
Pus formation & abscesses
Severe mobility
Tooth loss/extraction required
Explain Supra and Infrabony pockets?
Two types of periodontal pockets exist :
I. Suprabony (Supracrestal or Supraalveolar) - In this, bottom of the pocket is coronal to the underlying alveolar bone.
II. 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.
T/F , infrabony pockets most often occur interproximally but may be located on the facial or the lingual tooth surfaces
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Depending upon the nature of the soft tissue wall of the pocket:
(1) Edematous Pocket.
(2) Fibrotic Pocket
Depending upon disease activity:
(1) Active Pocket.
(2) Inactive Pocket.
Symptoms Of Pocket?
Localized pain or “pain deep in the bone”
Usually painless but may give rise to localized / radiating pain or sensation of pressure after eating which gradually reduces.
A foul taste in localized areas.
Sensitivity to hot & cold.
Toothache in the absence of caries is also sometimes present.
A tendency to suck material inter proximally.
Feeling of itching in the gums.
Urge to dig a pointed instrument in the gums.
Feeling of loose teeth.
CF of periodontal pockets?
- Bluish red discoloration of gingival pocket wall
- Flaccidity
- Smooth and shiny surface
- Pitting on pressure
- Less frequently gingival wall may be pink and firm
- Bleeding on gentle probing
- Inner wall of pocket is painful
- Pus discharge on applying digital pressure
Histopathology of pockets?
- Circulatory strangulation
- Destruction of gingival fibers and surrounding tissue
- Atrophy of epithelium
- Edema and degeneration
- Fibrotic changes predominate over exudation and degeneration
- Increased vascularity, thinning of epithelium and proximity of engorged vessels to inner surface.
- Ulceration of inner aspect of pocket wall.
- Suppurative inflammation of inner wall.
Pocket Content?
Debris (consisting of microorganism & their products mainly enzymes, endotoxins and other metabolic product)
Gingival fluid
Food remnants
Salivary mucin
Desquamated epithelial cells & Leukocytes
Plaque covered calculus projects from tooth surface.
If purulent exudate present:consists of–Living, degenerated and necrotic leukocytes,Living and dead bacteria
serum and scanty amount of fibrin.
T/F Extensive pus formation may occur in shallow pockets whereas deep pockets may exhibit little or no pus.
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Site specificity of periodontal disease means?
Periodontal destruction does not occur in all parts of the mouth at the same time but rather on a few teeth at a time or even only some aspects of some teeth at any given time. This is referred to as the site specificity of the periodontal disease.
