Periodontal disease, also known as gum disease, is a serious condition that affects the tissues surrounding and supporting the teeth. If left untreated, it can lead to tooth loss. One of the hallmarks of periodontal disease is the formation of periodontal pockets, which are spaces that form between the gums and teeth. Periodontal pockets allow bacteria to proliferate, causing further damage. A key question many people with periodontal disease ask is: can you reverse periodontal pockets once they have formed?
What are periodontal pockets?
Periodontal pockets form when the gum tissue pulls away from the tooth, creating small spaces or “pockets” around the base of the teeth. Healthy gums fit snugly around each tooth, with no space between the tooth and gum. With gum disease, the gum tissue breaks down, and these small pockets form along the gumline and between teeth. The pockets become filled with plaque and bacteria.
Periodontal pockets are measured in millimeters to determine their depth. Shallow pockets measure 1-3 mm deep. Moderate pockets measure 4-5 mm deep. Deep pockets measure 6 mm or more in depth. The deeper the pockets, the more severe the periodontal disease.
What causes periodontal pockets?
Periodontal pockets are primarily caused by poor oral hygiene that allows plaque to build up along and under the gumline. Plaque is a sticky film composed of bacteria, food debris, and saliva. When plaque accumulates, it triggers an inflammatory response and the body’s immune system starts breaking down gum tissue. As the gum tissue pulls away from the teeth, pockets form.
Risk factors that can contribute to gum disease and pocket formation include:
- Poor oral hygiene habits like inadequate brushing and flossing
- Smoking or tobacco use
- Diabetes
- Hormonal changes
- Crooked teeth
- Grinding or clenching teeth
- Medications that cause dry mouth
- Stress
- Genetics or family history
Can you reverse periodontal pockets once they form?
The short answer is yes, it is possible to reverse pockets and restore gum health, but it requires professional treatment and excellent at-home oral hygiene. The earlier treatment begins, the better the outcomes.
The goals of periodontal pocket treatment are to:
- Reduce pocket depth
- Eliminate active disease
- Reduce inflammation
- Regrow lost bone
- Regain lost gum attachment
With non-surgical and surgical treatments, dentists and periodontists can effectively reduce pocket depths and help the gum tissue reattach to the teeth. However, pockets cannot be completely reversed to the point of restoring gum tissue to its original form before disease. Some slight pockets may persist long-term.
Non-surgical treatments
Non-surgical periodontal treatments focus on removing plaque and tartar from surfaces above and below the gumline. This immediately reduces pockets depths and inflammation. Common non-surgical treatments include:
- Scaling and root planing: Deep cleaning above and below the gumline to remove bacterial plaque, tartar, and rough spots on the tooth root surfaces. This reduces pocket depth.
- Laser therapy: Laser energy kills bacteria and removes diseased gum tissue. It also stimulates healing and tissue regeneration.
- Medications: Antibiotics or antimicrobial rinses reduce bacteria levels in pockets and fight infection. Other medications can regulate inflammation.
With compliance and proper at-home oral hygiene, non-surgical treatment can resolve early to moderate gum disease and shrink periodontal pockets 1-4 mm.
Surgical treatments
If non-surgical treatment fails to adequately reduce pocket depths and stop disease progression, periodontal surgery is recommended. Surgical treatments allow better access to the roots and inside periodontal pockets for thorough cleaning. Surgeries can also reshape gum tissue and underlying bone to reduce pocket space.
Common surgical options include:
- Flap surgery (pocket reduction surgery): The gums are lifted away from the teeth to fully access the roots and disease below the gumline. Infected tissue is removed and the gumline reshaped.
- Bone and tissue grafts: These procedures regenerate lost bone and gum tissue attachment. Natural or synthetic bone materials are placed to fill in areas damaged by disease. Soft tissue grafts also reinforce thin gum tissues.
- Laserassisted new attachment procedure (LANAP): This is an advanced technique that uses laser energy to remove diseased pocket tissue and stimulate bone regeneration and tissue reattachment around the teeth.
Following surgery and during healing, patients require detailed at-home oral hygiene. When successful, surgical pocket reduction can decrease depth by 4-6 mm or more. This shrinkage helps gums reattach to tooth surfaces.
What is involved in at-home care?
To maximize the benefits of professional periodontal treatments, excellent at-home oral hygiene is mandatory. Daily oral care halts further disease progression and allows your gums to heal and rejuvenate.
A customized at-home regimen will include:
- Proper twice-daily brushing technique
- Flossing once daily (at minimum)
- Antimicrobial mouth rinse use
- Regular cleanings and exams
- Tongue scraping
- Smoking cessation
- Following any other dentist instructions
Meticulous daily hygiene disrupts biofilms and reduces your bacterial load. With less bacteria present, inflammation subsides and your gum tissues can reattach.
Are results permanent?
With successful treatment, it is possible to maintain reduced pocket depths long-term and keep disease stabilized. However, results are not necessarily permanent, even with excellent homecare. Periodontal disease can recur if homecare lapses or certain risk factors like smoking or diabetes are not well controlled.
Some factors that influence long-term success include:
- How advanced the disease was initially
- Response to treatment
- Compliance with at-home oral hygiene
- Overall health status
- Regular professional care
Ongoing periodontal maintenance and exams help sustain treatment outcomes. Your dentist will customize a long-term care plan for monitoring your gum health and stability.
When is outlook poor for reversing pockets?
In most cases, periodontal pockets can be reduced to some degree. However, extremely deep pockets that persist after repeated treatment may have a poor outlook. Prognosis declines once pocket depths reach 7 mm or more.
Additional factors that negatively affect success include:
- Advanced bone loss
- Ongoing disease progression
- Presence of fistulas (draining abscesses)
- Poor compliance with at-home care and maintenance therapy
- Uncontrolled diabetes
- Smoking habit
In cases of severe periodontal disease with substantial bone loss, extracting hopeless teeth may ultimately be necessary. The remaining teeth can still be stabilized with treatment.
When to seek professional help
Don’t ignore the warning signs of periodontal disease, such as gum bleeding, chronic bad breath, loose teeth, and receding gums. Seeking early treatment offers the best chance of reversing pockets, before extensive damage occurs. As general guidance:
- See a dentist at the first sign of gum bleeding, sensitivity, or irritation.
- Adults should receive at least an annual dental exam to check for gum disease.
- Seek prompt evaluation if pocket depths exceed 3-4 mm.
- Moderate to advanced gum disease requires referral to a periodontist.
A dentist or periodontist can diagnose the presence and extent of periodontal pockets and disease progression. The sooner treatment begins, the better your chances of pocket depth reduction and stabilized oral health.
Conclusion
It is possible to reverse periodontal pocket depths and stabilize gum disease progression with professional treatment and meticulous at-home oral hygiene. While mild cases can be managed with non-surgical therapy, more significant disease requires surgical pocket reduction procedures. Results are not permanent or a cure, so ongoing maintenance and care is crucial for long-term success. Seeking treatment at the earliest signs allows pockets to be more effectively reduced before extensive irreversible bone loss occurs.