This document discusses the causes and treatment of periodontal pockets. It begins by defining periodontal pockets as deeper spaces around teeth caused by gum disease. If left untreated, pockets can lead to tooth loss. The document then classifies pockets, discusses their pathogenesis, clinical features, contents, diagnosis, and treatment options. Nonsurgical treatments include oral hygiene instruction, scaling, and use of antibiotics like metronidazole and tetracycline. Surgical treatments involve various gum surgery procedures to reduce pocket depth. Overall, the document provides an overview of periodontal pockets, how they form, how they are detected and diagnosed, and both nonsurgical and surgical treatment approaches.

1. CAUSES AND TREATMENT OF
PERIODONTAL POCKETS
SUPERVISOR:
DR.GHADEER AL-JADER
BY :
FAISAL SULEIMAN
KHALED JASSER
ABDULLAH YASSIN
SHAHID ZIYAD

2. INTRODECTION
• If your mouth is healthy, your gums should fit snugly around each tooth,
with the distance between the gum tissues and its attachment to the tooth
only one of three millimeters in depth but gum disease can lead to deeper
spaces around the teeth called periodontal pocket , and if it untreated,these
pocket can lead to tooth loss. But with early diagnosis and treatment, you
can keep your teeth for a lifetime
• Gingiva and periodontal pocket ( also informally referred to as gum pocket)
are dental terms indication the presence of an abnormal depth of gingival
sulcus near the point at which the gingival tissue

3. CLASSIFICATION :
dental pocket
1)Gingival pocket 2)Periodontol pocket
+) Supragingival pocket. +) Infragingival pocket
Supragingival pocket Infragingival pocket

4. Perodontal pocketGingival pocket
1 _Also know as absolute or true pocket.
2 _Seen in periodontitis.
3_Occurs with destruction of the supporting periodontal
tissue and lossening and exfoliation of The teeth
1_Also known as pseudo pocket or Relative
pocket or false pocket .
2_Seen in the gingivitis.
3_Formed by gingival enlargment Without
extraction of underlying perodontal tissuse
4_The sulcus is deepened because of increased
bulk of gingiva .

5. Infrabony pocketSuprabony pocket
1) Also known as subcrestal or intraalveolar pocket
2) Bottom of the pocket is apical to the crest of the
alveolar bone
3)Lateral wall consist of soft tissue and bone
4) Pattern of destruction of bone is vertical
5) Interproximally, transseptal fibers are oblique ( extend
from the cementum beneath the base of pocket along the
bone and over the crest of the cementum of the adiacent
tooth)
6)On the facial and lingual periodontal ligament fibers
follow the angular pattern.
1)Also know superacrestal or supraalveolar
pocket
2)Bottom of the pocket is coronal to the
underlying alveolar bone
3)Lateral wall consist of only from soft tissue
alone
4)Pattern of destruction of bone is
horizontal
5)Interproximally, transseptal fibers
arranged horizontally ( between the base of
pocket and the alveolar bone)
6)On the facial and lingual surfaces,
periodontal ligament fibers, follow the
horizontal _ oblique course

6. POCKET
•Complex pocket
originating on one
•tooth and twisting around
the tooth to involve one or
more additions surface
Simple pocket
Involve one
surface
compound
pocket.
involve more
than one surface

7. PATHOGENESIS OF POCKET FORMATION :
1_Presence of bacterial plaque on tooth surface
2_ Marginal gingiva become formation
3_Gingiva sulcus deepens due to oedematous enlargemen Of
gingiva
4_ formation of Gingiva pocket
5_Anaerobic organisms tend to colonize the subgingiva plaque (Spirochaetes and motile rods)
(Due to an aerobic environment created in the pocket)
6_Large number of PMN leukocytes and macrophages migrates to the gingiva tissue in response
to bacterial challenge
7-Two mechanism of collagen loss :
A-Lysosomal enzymes ( collagenase ) released by PMN leukocytes
Destruction of collagen fibers in gingival C.T
Collagen …….collegenase…..> matrix metalloproteinases
B-Fibroblast phagocytose collagen fibers by extending cytoplasmic process to the ligament
cementum interface.

8. 8_When the collagen fibers apical to junction epithelial get destroyed .the epithelial cells proliferate
along the root surface in an apical direction until they come in contact with healthy collagen fibers
9_At the same time .. coronal portion of junctional epithelium get detached from the tooth surface
10_PMN cellsmigrates towards the coronal portion of junctional epithelium
11_When volume of PMN leukocytes at the coronal portion of junctional epithelium exceeds 60% ,
the epithelium cells separate from the toothsurface
12_Pocket formation
13_Plaque removal is diffical or impossiblefrom deep pocket
14_Favoruring growth of pathogenic organism in that protected environment
15_ furher attachment loss
16_Horizontal bone loss
17_If I.F.O. present than verticle bone loss occurs ( angular bone loss)

9. CLINICAL FEATURES :-
CausesClinical features
●Due to circulatory stangation .
●Due to Distraction of gingival fiber
●Due to atrophy of the epithelium and
edema
●Due to edema and degeneratio
Bluish red discoloration of the gingiva wall of
pocket .
●Flaccidity
● A smooth, shiny surface
●Pitting on pressure
1
When fibrotic changes predominate over
exudation and degeneration
Gingival wall may be pink or firm2
Due to :
● increased vascularity
●-thinning and degeneration of epithelium
●_the proximity of the engorged vessels to
the inner surfac
bleeding on probin3
Due to ulceration of the inner aspect of the
pocket wall
probing is generally painful4

10. CONTENT OF POCKET:
1 Microorganism
2 _Bacterial products ( enzymes and endotoxin)
3_GCF
4 _remnant of food
5 _Salivary mucin
6 _Desquamated epithelial cells
7 _Leukocytes
8 _Purulent exudates may be present ( sec. Sign) Eg. Deep pocket may have little or no
pus and shallow pocket may have extensive pus formation so pus is not an indication of
the depth of the pocket .
•

11. DIAGNOSIS / DETECTION OF POCKETS
1.careful exploration with a periodental probe -accurate method
2.radiograph : pockets are not detected by radiographic examination because pocket is a soft tissue change

12. DISADVANTAGES OF RADIOGRAPH
Radiograph indicate areas of bone loss where pcket may be suspected they not show pocket presence or
depth
Radiograph show no difference before or after pocket elimination unless bone has been modified
Note: gutta percha point or calibrated silver points can be used with radiograph to assist in determining
the level of attachment of periodontal pocket

14. CLINICAL FEATURES OF PERODONTAL POCKET
1_ Bluish red, thickened marginal gingiva
2_Gingival bleeding
3_ Suppuration
4_ Tooth mobility
5_Diastema formation
6_Symptoms-locaosed pain / pain deep in the bone

15. HISTOPATHOLOGICAL FEATURES
1_ circulatory stangation
2_ Distraction of gingival fiber
3_ atrophic of epithelium
4_edema and regeneration
5_fibrotic change
6_ Increased vascularity, thinning and degeneration of epithelium
7_ Ulceration of inner aspect of pocket wall
8 Suppuration inflammation of inner wall.
•

16. TREATMENT
surgical Treatmen Nonsurgical Treatmen
Pocket depth reduction through
different surgical procedures :
1)Gingival curettage .
2)Gingivectomy .
3)perodontal flap procedure
4)osseous surgery
5)periodontal regeneration
procedure
1)oral hygiene instruction and
their follow through
2_Scaling
3_Root planning 4_periodontal
medication _Tetracycline _
Metranidazole

17. METRONEDAZOLE :
Mechanism of action of Mtronedazol
It inhibits nucleic acid synthesis by disrupting the DNA of microbial cells. This
function only occurs when metronidazole is partially reduced, and because this
reduction usually happens only in anaerobic bacteria and protozoans, it has
relatively little effect upon human cells or aerobic bacteria

19. NAUSEA, VOMITING, LOSS OF APPETITE, STOMACH PAIN;DIARRHEA,
CONSTIPATION;HEADACHE;UNPLEASANT METALLIC TASTE;RASH, ITCHING;VAGINAL ITCHING OR
DISCHARGE;MOUTH SORES; OR.SWOLLEN, RED, OR "HAIRY" TONGUE.
Side effect
Interaction of metronidazole
• With Alcohol
• Sesitive to sun
• Tell your doctor about all prescription, non-prescription, illegal, recreational, herbal, nutritional, or
dietary drugs you're taking, especially:
• Antabuse (disulfiram)Anticoagulants (blood thinners) such as Coumadin (warfarin)Dilantin
(phenytoin)Hismanal (astemizole)Lithobid (lithium)Phenobarbital (Luminal and Solfoton)Tagamet
(cimetidine)Vitamins

20. CONTRAINDICATION
should not take Metronidazole?
meningitis not due to an infection.low levels of a type of white blood cell called
neutrophils.alcoholism.alcohol intoxication.a low seizure threshold.a painful condition that
affects the nerves in the legs and arms called peripheral neuropathy.prolonged QT interval on
EKG.
•

21. TETRACYCLINE

22. MECHANISM OF ACTION
Tetracycline antibiotics are protein synthesis inhibitors. They inhibit the initiation of translation in variety
of ways by binding to the 30S ribosomal subunit, which is made up of 16S rRNA and 21 proteins. They
inhibit the binding of aminoacyl-tRNA to the mRNA translation complex.

23. SIDE EFFECTS MAY INCLUDE
nausea, vomiting, diarrhea, upset stomach, loss of appetite;white patches or
sores inside your mouth or on your lips;swollen tongue, black or "hairy"
tongue, trouble swallowing;sores or swelling in your rectal or genital area;
or.vaginal itching or discharge.

24. TETRACYCLINE INTERACTIONS
Tetracycline may reduce the effectiveness of some oral birth control pills. You should use another method of birth
control while taking this medication. Calcium supplements, iron products, laxatives containing magnesium, and
antacids may make tetracycline less effective
You should take tetracycline two hours before or three hours after taking iron products and vitamins that contain iron.
Anticoagulants (blood thinners), such as warfarin (Coumadin)PenicillinIsotretinoin (Accutane)Tretinoin (Retin-
A)Cholesterol-lowering drugs, such as cholestyramine (Prevalite, Questran) or colestipol (Colestid)Any product that
contains bismuth subsalicylate, such as Pepto-BismolPhenytoin (Dilantin)Carbamazepine (Tegretol)Barbiturates, such
as phenobarbital

25. CONTRANDICATION
Sulfite hypersensitivity, tartrazine dye hypersensitivity, tetracyclines
hypersensitivity. Pregnancy. Children, infants, neonates. Breast-feeding.Renal
disease, renal failure, renal impairment.Hepatic disease.Sunlight (UV)
exposure. Surgery.

26. TREATING GUM DISEASE
WITH LASERS

27. Lasers in medicine and dentistry are considered cutting-edge technology, but they’ve actually been
around for quite a while. The first mention of a possible application in dentistry was almost 50 years ago
when Leon Goldman, MD experimented with a ruby laser. Today’s dental lasers are more focused and
targeted for specific issues, including treatment of periodontal (gum) disease. This has allowed research
to directly compare such innovative laser treatment techniques with traditional treatment regimens —
important when you want to know if they really work!Periodontists (dentists who have three years of
specialty training in the diagnosis and treatment of diseases and disorders of the supporting structures
of the teeth) in particular have found that removing diseased tissue with lasers rather than a scalpel can
be more comfortable for dental patients. That’s partly because a laser actually seals the tissue it cuts,
rather than leaving a wound that requires stitches; there are no incisions separating the gum tissue from
the underlying bone so that it is considered minimally invasive. There are other interesting differences
between laser surgery and traditional therapy — both of which are effective in treating gum disease.
But let’s start by exploring why a person may need periodontal (gum) treatment in the first place.

28. INDEX
1…introdection
2…classefication
3…pathogenesis
4….Clinical features
5… Content of pocket
6…Diagnosis / detection of pockets
7… Clinical features of perodontal pocket
8… Histopathological features
9…treatment
10 …metronedazole
11..tetracycline
12.index

29. THE END
•Thank you for reading