Gingival pocket symptoms. Features of the treatment of the gingival pocket. How to remove and clean the gum pocket

A gingival pocket is a recess that separates the gum from the tooth. When periodontal tissue disease occurs, it increases, due to which food particles get into the recess, accumulation occurs soft plaque and deposition of tartar. These adverse factors cause inflammation of the gums and, if left untreated, lead to loosening and gradual loss of teeth. You can prevent their loss by seeking medical help in time.

Development of the pathological process

Normally, the pocket in the gum is deepened by no more than 3 mm. The small depth of the neck formed from soft tissues does not prevent its self-cleaning. Progressive deepening and inflammation of the gum pockets - characteristic symptom periodontal disease. The gum between the teeth swells, begins to hurt, and pus may appear from it. The initial stage of the development of the disease is gingivitis. At this stage, it is quite easy to remove inflammation - you need to carefully monitor oral hygiene, regularly undergo professional teeth cleaning with the removal of soft and hard plaque, rinse your mouth with antiseptics and herbal infusions.

Further development inflammatory process accompanied by a significant increase in the number of bacteria. The enzymes secreted by them negatively affect the periodontal fibers, gradually causing their destruction. At this stage, the gum pockets undergo a series of changes and become periodontal. The activity of the inflammatory process increases, the soft tissues affected by it bleed when touched, erosion occurs on the gums.

The cavity between the tooth and the gum becomes deeper, the connective tissues that ensure the integrity of the dentition are affected by inflammation and weaken.

In the absence of treatment and cleaning of the gum pockets, the process will spread not only to the fibers of the periodontal ligaments, but also to bone tissue jaws.

Receding gums lead to gradual exposure of the tooth. Destroyed tissues are not able to secure the top of the root in the hole and at some point it falls out.

On the initial stage diseases pockets in the gums are washed once a year antibacterial agent. In addition, daily application of drugs to the affected areas, rinsing the mouth with medicinal compositions is prescribed. With periodontitis moderate the method of curettage is effective; in severe cases of the disease, photodynamic, surgical methods and cable-stayed splinting are used.

Types of curettage, indications for the procedure

There are open and closed types of curettage. This technique provides effective removal of tartar, food debris, affected gum tissue and softened tooth cement. For closed curettage, use diode laser or ultrasonic scaler. This method of treating pockets in the gums is used in cases where the depth of the cavity surrounding the tooth does not exceed 5 mm. The deepening is cleaned, the tooth root is processed and polished, the affected tissues are removed. This helps to restore the connection between teeth and gums.

Open curettage is a surgical intervention using local anesthesia. During the operation, the tissue in the area of the interdental papillae is dissected, the tartar is removed, the gingival pocket is thoroughly cleaned of deposits. Then a drug is applied that accelerates the growth of the epithelium and suppresses the vital activity of pathogenic microbes. The tooth root is polished for a tighter fit of the mucous membrane to it, and the wound is sutured. The rehabilitation period after the procedure is two weeks, after which patients report positive results - the gum does not bleed, does not hurt, hyperemia and swelling go away, the depth of the pocket decreases.

Indications for curettage are:

the depth of the pocket of exfoliated gingival tissue exceeds 3 mm;
accumulated a large amount of solid deposits;
the gum is affected by the inflammatory process.

Photodynamic method

A non-surgical way to treat an advanced or severe form of periodontal disease can be with the help of photodynamic therapy. Before the procedure is performed professional cleaning oral cavity, after which the gums are treated with chlorophyll obtained from spirulina algae. In response to its application, epithelial cells begin to produce photosensitizer substances. After 30 minutes, the doctor sends a laser beam to the diseased tissue. Its radiation leads to the decay of photosensitizers with the release of active oxygen.

Under the influence of the oxidative process, the microbes that caused inflammation are completely destroyed. The doctor removes damaged areas of tissue and closes the gum pocket. The advantage of this method of treatment: sparing, painless effect and high efficiency - a single procedure is enough to eliminate inflammation and bleeding. A film is formed on the gums that prevents the penetration of infection and the recurrence of the disease. The use of osteogenic preparations and amino acids helps to restore the affected tissues.

With a periodontal pocket depth of more than 4–5 mm, a patchwork method is used. During the operation, the gum is separated from the surface of the tooth, the contents of the pocket are removed, the cleaned cavity and root are treated with an antiseptic. The soft tissues of the gums are then fixed in the correct position with sutures. In most cases, the method gives positive results. Its disadvantages include the stress experienced by the patient and a long recovery period.

Cable-stayed splinting

This method of treatment allows you to strengthen teeth that have begun to loosen. Splinting technology consists in tying the moving units of the dentition with aramid thread, which is particularly durable. Thin grooves are drilled along the perimeter of adjacent teeth, after laying the thread is covered with a reflective material. The color of the filling matches the shade of the teeth, so it is almost invisible.

The cable-stayed splinting method prevents the loosening of the dentition, while at the same time ensuring the natural mobility of the teeth, preventing the jaw bones from atrophying. Fastening with aramid thread does not disturb diction and does not cause discomfort in the patient. To restore the voids of the dentition in place of lost teeth, it is advisable to use prostheses not made of metal-ceramic, but combining ceramics and glass or titanium, so as not to overload the jaw.

At the initial stage of periodontal disease, preparations made from herbal ingredients according to prescriptions can be used to improve the condition of the gums. traditional medicine. They inhibit bacteria and improve wound healing. Additionally, it is useful to massage the gums with a soft-bristled toothbrush, followed by rinsing the mouth with infusions of chamomile, oak bark or sage.

Good healing effect provide the following tools:

Peel unripe walnuts infused with olive oil (1 tablespoon per 250 ml). For infusion, the mixture should be placed in the refrigerator. Periodically you need to get a jar and shake it. After a week, strain and use to lubricate the gums 3-5 times a day.
Infusion or juice of plantain. To prepare the infusion, pour 20 g of leaves with a glass of boiling water. Use for mouthwash. The juice squeezed from the fresh leaves of the plant is applied to the diseased areas of the gums 3 times a day.
Compresses from grated fresh beets. The mass, without squeezing, is wrapped in gauze and kept on the gum for 15 minutes. Frequency of use - 3 times a day.
Infusion of grass highlander kidney. Pour a spoonful of crushed vegetative parts of the plant with a glass of boiling water. Let it brew for 15 min. Use 2 times a day, applying tampons moistened with warm infusion to the gums.
Gruel from crushed sea buckthorn berries. Wrap the mass of fruits in a two-layer piece of gauze and apply to diseased areas 2 times a day for 20 minutes.
Tincture of viburnum fruits with honey. It is necessary to mix 500 g of berries with the same amount of buckwheat honey and 500 ml of 70% ethyl (medical) alcohol. Put in a dark place for 2 weeks. How to use: 1 tbsp. l. 3-4 times a day for 20 minutes. before meals. Taking the remedy helps to strengthen the immune system and cure periodontal disease. Additionally, cotton swabs moistened with tincture can be applied to the gums.

Prevention of the development of periodontal disease

Prevent gum inflammation and deepening of gum pockets regular cleaning teeth, rinsing the mouth after each meal, using floss (special thread) to clean the interdental gaps. Periodically, but not constantly, pastes containing abrasives should be used to remove hard deposits. High-quality removal of tartar will provide professional teeth cleaning using ultrasound.

For the timely detection and elimination of pathological processes occurring in the oral cavity, it is recommended to visit the dentist 2 times a year.

Some diseases of the oral cavity require a special approach. Often, medical treatment is not enough, it is necessary to eliminate the cause of the disease and get rid of its consequences. One of the clearest examples of an inflammatory process that affects the bones of the jaw and even ligaments that can hold the crown in place is periodontitis.

Curettage of the tooth socket will help to cure such a disease. With the help of this procedure, carried out by an open or closed method, the doctor will be able to remove the accumulated plaque and stone with a curette and an irrigator, as well as clean the wells from the waste products of bacteria and viruses.

Periodontal pockets - what is it?

Over time, tartar is deposited, its accumulation can lead to the development of an inflammatory process in periodontal tissues and their further destruction with bone tissue affected. As a result of inflammation, a depression is formed, starting from the gum and ending with the cervical part of the crown, called the "periodontal pocket".

Depending on the depth and width of the pocket between the teeth, the doctor will be able to determine the extent of the disease. An early stage can be diagnosed with an X-ray examination, and if the inflammation progresses, it can be determined visually. Normally, the recess should not exceed 3 mm - if the gum pocket goes beyond the specified limits, this indicates the presence of a dental disease.

Curettage of the gingival pocket in dentistry

Curettage is a medical term for the cleansing of body cavities, organs, or skin using a special instrument called a curette. With the help of this surgical procedure, the doctor removes the affected areas and cleans in places where pathogenic microorganisms accumulate. Also, the curette will help to perform diagnostic curettage, in order to subsequently transfer the obtained biological material to a laboratory study.

Well curettage is one of the most common medical procedures carried out in the treatment of periodontitis that occurred after tooth extraction. During the procedure, the dentist removes purulent neoplasms, tartar located under the gum, and areas of the destroyed tooth.

Indications for the procedure

A patient at a dentist's appointment may be recommended curettage of periodontal pockets in case of:

Curettage of periodontal pockets is a completely different procedure than cleaning the enamel, in which only plaque is removed. Cleaning the tooth pocket allows you to get rid of accumulated deposits, and also prevents further decay of tissues.

When is treatment contraindicated?

The operation should be abandoned if there is purulent discharge, there is a high probability of developing an abscess, or the gum pocket has spread to the bone structures. If the depth of the periodontal pocket is more than 5 mm, the gums are too thin, fibrotic changes are present, or the tooth mobility reaches 3 degrees, then the doctor will refuse to perform this surgical procedure. Also, the procedure for curettage of the hole, in order to avoid complications, should not be sent if there is an acute infection in the oral cavity or with impaired physiological functions.

Pros and cons of curettage

There are several positive and negative aspects of such a procedure as curettage. The advantages of this procedure include:

Unfortunately, there are also disadvantages. Concerning private method, then in the advanced stages of periodontitis, relapses almost always occur. Another disadvantage is the duration of the procedure. The patient during open curettage on 6-7 teeth you will have to spend about two hours.

The open method requires the utmost concentration and care from the surgeon. An unqualified doctor can injure the mucous membrane and teeth.

Procedure procedure

Translated from of English language"curettage" is nothing more than "curettage". In dentistry, the meaning of this term is much broader. When conducting scraping for the treatment of gum disease, doctors adhere to the following tactics:

the place of the procedure is treated with an antiseptic solution;
anesthesia is administered;
plaque and calculus are removed from the surface of the teeth (as seen in the photo) using a periodontal irrigator;
the affected area of cement and dentin is removed from the root of the tooth with scraping movements;
the root of the tooth is leveled and polished;
tissue damaged by the infection is eliminated;
an antiseptic agent is applied to the cleaned tissues;
a fixing bandage is applied to the gum pressed against the tooth.

After a correctly performed operation, shown in the video, blood circulation and lymph flow are restored in the gingival canal. Thus, all conditions are created for the speedy regeneration of tissues.

Closed

A distinctive feature of the closed method of treating periodontal pockets is the inability to visually track the condition of the tooth roots, so granulation and tartar can remain intact. The effect of the procedure is possible if the depth of the periodontal pocket is not more than 3 mm. With periodontitis, only temporary relief is possible, the disease itself will continue to progress.

A doctor in one procedure of closed curettage of periodontal pockets can clean the cavity of 2-3 teeth, after the procedure, the healing process can take up to a week. Diagnosis can be carried out no earlier than a month after dental intervention. Usually, gum curettage is used only in those dental clinics where there are no highly qualified specialists, and the procedure is performed not by an experienced surgeon, but by a dentist therapist.

Open

Open curettage allows you to remove all existing subgingival deposits and damaged tissues in the area of one tooth, synthetic bone tissue is planted, and during the treatment, the gingival pocket disappears. Open curettage is performed under local anesthesia.

In the process of laser curettage, the surgeon makes an incision in the area of the necks of the tooth, and then exfoliates the gum. The doctor is able to detect all existing subgingival deposits, so that later such treatment allows them to be removed using a curette or irrigator. The area where the operation is performed must be treated with an antiseptic. If the bone pocket is deep, then the doctor uses a synthetic material for extension.

At the end of the operation, the doctor applies stitches, which must be removed after ten days. In the process laser surgery it is possible to dissect tissues without contact, minimize pain and instantly coagulate blood vessels. Restoration of gingival papillae postoperative period happens faster.

Curettage and flap surgery on the gums

The use of flap surgery for inflammation of the gums leads to good results. During the operation, the surgeon has good visual control, so all affected areas are removed. This surgical intervention involves cutting out the periosteal surface of the periodontium, including the processing of root and soft tissues.

Complications are possible in the postoperative period. The necks of the teeth may be exposed, or changes in the alveolar processes will occur. Aesthetic defects or the occurrence of dentinal hypertension are also possible.

Is it possible to carry out treatment at home?

If the periodontal period hurts, self-medication at home means deliberately taking risks. Periodontal disease is serious illness requiring medical supervision.

At home, you can resort to the help of various methods that will be combined with therapy prescribed by an experienced periodontist. For example, gum sockets can be treated using various ointments and gels that can improve metabolism and blood circulation in tissues.

Folk remedies for periodontal pocket disease can also help if we are talking about the initial stage of the disease. Solutions and decoctions of medicinal plants with an antimicrobial and wound-healing effect help well, they can be used to rinse your mouth.

Possible Complications

If the curettage of periodontal canals is carried out by an experienced doctor and strictly adheres to the methodology for its implementation, then complications can be avoided. However, there are cases when, due to a certain set of circumstances, complications arose:

profuse blood loss;
inflammation in the postoperative period;
secondary infection.

If the doctor is not experienced enough in performing such operations, or the work was done carelessly during the operation, then not all pathogenic tissues will be removed from the periodontal pocket. In this case, the likelihood of relapse is high. The patient needs to re-apply for help to a specialist who is able to perform high-quality cleaning of periodontal cavities.

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Development of the pathological process

Normally, the pocket in the gum is deepened by no more than 3 mm. The small depth of the neck formed from soft tissues does not prevent its self-cleaning. Progressive deepening and inflammation of the gum pockets is a characteristic symptom of periodontal disease. The gum between the teeth swells, begins to hurt, and pus may appear from it. The initial stage of the development of the disease is gingivitis. At this stage, it is quite easy to remove inflammation - you need to carefully monitor oral hygiene, regularly undergo professional teeth cleaning with the removal of soft and hard plaque, rinse your mouth with antiseptics and herbal infusions.

Further development of the inflammatory process is accompanied by a significant increase in the number of bacteria. The enzymes secreted by them negatively affect the periodontal fibers, gradually causing their destruction. At this stage, the gum pockets undergo a series of changes and become periodontal. The activity of the inflammatory process increases, the soft tissues affected by it bleed when touched, erosion occurs on the gums.

The cavity between the tooth and the gum becomes deeper, the connective tissues that ensure the integrity of the dentition are affected by inflammation and weaken.

In the absence of treatment and cleaning of the gum pockets, the process will spread not only to the fibers of the periodontal ligaments, but also to the jaw bone tissue.

Receding gums lead to gradual exposure of the tooth. Destroyed tissues are not able to secure the top of the root in the hole and at some point it falls out.

At the initial stage of the disease, pockets in the gums are washed with an antibacterial agent once a year. In addition, daily application of drugs to the affected areas, rinsing the mouth with medicinal compositions is prescribed. In case of moderate periodontitis, the method of curettage is effective, in case of severe course of the disease, photodynamic, surgical methods and cable-stayed splinting are used.

Types of curettage, indications for the procedure

There are open and closed types of curettage. This technique provides effective removal of tartar, food debris, affected gum tissue and softened tooth cement. For closed curettage, a diode laser or an ultrasonic scaler is used. This method of treating pockets in the gums is used in cases where the depth of the cavity surrounding the tooth does not exceed 5 mm. The deepening is cleaned, the tooth root is processed and polished, the affected tissues are removed. This helps to restore the connection between teeth and gums.

Indications for curettage are:

the depth of the pocket of exfoliated gingival tissue exceeds 3 mm;
accumulated a large amount of solid deposits;
the gum is affected by the inflammatory process.

Photodynamic method

A non-surgical way to treat an advanced or severe form of periodontal disease can be with the help of photodynamic therapy. Before the procedure, a professional cleaning of the oral cavity is performed, after which the gums are treated with chlorophyll obtained from spirulina algae. In response to its application, epithelial cells begin to produce photosensitizer substances. After 30 minutes, the doctor sends a laser beam to the diseased tissue. Its radiation leads to the decay of photosensitizers with the release of active oxygen.

Cable-stayed splinting

At the initial stage of periodontitis, to improve the condition of the gums, you can use preparations made from herbal ingredients according to traditional medicine recipes. They inhibit bacteria and improve wound healing. Additionally, it is useful to massage the gums with a soft-bristled toothbrush, followed by rinsing the mouth with infusions of chamomile, oak bark or sage.

A good therapeutic effect is provided by the following means:

Peel of unripe walnuts infused with olive oil (1 tablespoon per 250 ml). For infusion, the mixture should be placed in the refrigerator. Periodically you need to get a jar and shake it. After a week, strain and use to lubricate the gums 3-5 times a day.
Infusion or juice of plantain. To prepare the infusion, pour 20 g of leaves with a glass of boiling water. Use for mouthwash. The juice squeezed from the fresh leaves of the plant is applied to the diseased areas of the gums 3 times a day.
Compresses from grated fresh beets. The mass, without squeezing, is wrapped in gauze and kept on the gum for 15 minutes. Frequency of use - 3 times a day.
Infusion of grass highlander kidney. Pour a spoonful of crushed vegetative parts of the plant with a glass of boiling water. Let it brew for 15 min. Use 2 times a day, applying tampons moistened with warm infusion to the gums.
Gruel from crushed sea buckthorn berries. Wrap the mass of fruits in a two-layer piece of gauze and apply to diseased areas 2 times a day for 20 minutes.
Tincture of viburnum fruits with honey. It is necessary to mix 500 g of berries with the same amount of buckwheat honey and 500 ml of 70% ethyl (medical) alcohol. Put in a dark place for 2 weeks. How to use: 1 tbsp. l. 3-4 times a day for 20 minutes. before meals. Taking the remedy helps to strengthen the immune system and cure periodontal disease. Additionally, cotton swabs moistened with tincture can be applied to the gums.

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What is a periodontal pocket?

The accumulation of a large amount of deposits leads to development of inflammation in periodontal tissues. As a result of this process, there is a gradual destruction of periodontal and bone tissue. The simultaneous decay process leads to the formation of a periodontal pocket.

By the width and depth of the gap formed, one can judge the degree of tissue destruction. In the early stages, the gum pocket can be diagnosed using an x-ray. Progressive inflammation reveals the presence of pockets on visual inspection.

Symptoms

Formation of gum pockets may be asymptomatic up to a certain point. But with the development of the disease, its main symptoms also appear:

discomfort in the gum area;
bad breath that does not disappear after high-quality cleaning and the use of rinses;
redness and swelling of the gums. In this case, soft tissues have a shiny surface;
bleeding, even with little impact on the gums. For example, when cleaning crowns;
on palpation of periodontal tissues, soreness and pronounced suppleness of the gums are noted;
in advanced cases the size of the periodontal pocket increases. When pressed, there may be a release of purulent contents;
teeth become mobile;
expanding interdental spaces;
a general deterioration in the patient's condition is possible.

When these symptoms are detected you should contact your dentist immediately, even if the problem is localized only near one tooth, otherwise the situation will worsen every day and lead to the progression of the disease.

Reasons for education

The main cause of periodontal pockets is accumulation of bacterial deposits in the cervical region of the crown. Microbes form an invisible film over the entire surface of the enamel and secrete their metabolic products, which cause inflammation.

The main factors that provoke the growth of microbes include:

malnutrition, mainly carbohydrate foods;
poor quality of oral hygiene;
bad habits;
general diseases;
hormonal disorders;
immunodeficiency;
dental diseases.

Consequences of the disease

A gum pocket is not just a periodontal deformity. it serious pathology requiring adequate and timely treatment, the absence of which can lead to serious complications.

Most often there is an acute abscess, later acquiring a chronic form.

This pathology is accompanied by strong tooth mobility and soreness. In the absence of proper treatment, the tooth completely falls out of the alveolar socket. The development of inflammation leads to lymphadenitis and general intoxication organism.

What treatments are available

Before the treatment procedure, a diagnosis is made, which determines the degree of the disease. This stage is necessary in order to select the maximum correct method to eliminate pathology.

At the initial stage, they use conservative therapy aimed at relieving symptoms. In difficult cases, the most effective is recommended - surgical method treatment of a periodontal pocket, which ensures the removal of plaque completely.

Therapeutic methods for eliminating the periodontal pocket

This method of treatment can be used with a small recess of the pocket, not exceeding 0.15 mm. In this case, on the subgingival part of the tooth should be minimal amount deposits and no signs of soft tissue inflammation.

Therapeutic treatment includes the following procedures:

Hygienic cleaning of teeth with an ultrasonic scaler. Removal of stone and plaque occurs by its destruction, without damaging the gums. This method in recent times more popular than laser curettage, where the affected area is treated with a laser to treat a periodontal pocket.

Medical therapy. As a rule, it is prescribed immediately after the completion of dental cleaning. At mild degree disease is used only aseptic processing: rinsing, baths, irrigation. To do this, use Chlorhexidine or Miramistin.

AT severe cases need to take a course of antibiotics Lincomycin, Amoxocillin, Azithromycin.

These procedures may be useless if the pocket depth exceeds 2 mm. In such a situation, the doctor will not be able to completely remove the stone from under the gums. In addition, the periodontium is additionally injured. As a result of the manipulations, inflammation and tissue destruction only intensifies.

Surgery

Surgical method of treatment provides for direct mechanical action with special tools on the subgingival areas. Depending on the degree of damage, there are two surgical methods for eliminating this problem: closed and open curettage.

The elimination of periodontal pockets by surgical methods is currently considered the most effective. After treatment with this method, the patient is guaranteed a positive result with complete restoration of the periodontium. But it should be borne in mind that each method has its own specific indications and features.

Closed operation

The purpose of closed-type curettage is to remove the growing granulation tissue of periodontal pockets and eliminate all deposits on the tooth under the gum.

The peculiarity of the method is that the procedure for cleaning the cavity is carried out without violating the integrity of the gums.

The main factor in choosing closed curettage is cavity depth not more than 3 mm. Therefore, the method is used only for mild form periodontitis.

With more complex forms of pathology, this method will bring only temporary relief. The main disadvantage of this technique is that cleaning is carried out without visual control. From what deposits and granulations partially remain in place.

Operation steps

Local anesthesia.
After that, the pocket cavity is cleaned with a curette. First, the walls of the tooth and gums are processed, then the bottom.
After complete removal stone and granulation, the pocket is irrigated with a solution of sodium chloride.
Finally, a protective dressing is applied to the treated segment. For this, zincoplast, stomalgin, repin are used.

Vacuum curettage

If there is a large accumulation of plaque under the gum, it can be used alternative method– vacuum curettage. Its main difference from the classical method is that the procedure uses hollow curettes attached to a vacuum apparatus.

During clipping of pathological particles, they are immediately removed by vacuum. Thus, the occurrence of further complications is excluded.

open procedure

main goal this method is not only the elimination of granulation and deposits, but also the restoration of bone tissue.

With open curettage, the effect on tissues is carried out by exfoliating part of the mucosa. Therefore, this procedure requires detailed preparation, which consists in the following:

Performing dental cleanings.
If necessary, prescribe anti-inflammatory therapy.
According to the indications, splinting is performed.

How is the operation

A small mucosal flap is exfoliated from the bone after cutting the tissue in the region of the necks of the teeth. In case of severe deformation of the gum edge, the incision is made, stepping back from the edge by 1.5 mm. The remaining strip is subsequently removed.
After exposing the surface of the roots, the doctor performs a deep cleaning.
Next, an osteogenic preparation is injected into the gum pockets, which compensates for the bone tissue.
At the end of the procedure, suturing is performed in the area of the interdental papillae. With a cut edge of the deformed gum, the mucosa is pulled up to the necks and fixed in this position. Sutures are usually removed on the 10th day after surgery.
To consolidate the effect, a gum bandage is applied.

Often, with the formation of deep periodontal pockets, there is a significant exposure of the roots. In order to eliminate this defect in the process of open curettage, soft tissue transplantation is performed, transplanting tissues from the soft palate onto the gum.

Contraindications

This technique is considered the most effective, but it has certain contraindications:

abscess in acute form;
fibrous tissue growths;
excessive thinning of the gums;
strong mobility of the crown;
pocket depth exceeding 6 mm.

The price of all types of operations

The average cost of services for the treatment of periodontal pockets in Russia has a slight difference. The main factors that affect pricing are the method of anesthesia and the technological capabilities of the clinic. Not the last aspect will be the status of the clinic.

Average, price range for closed curettage is in the range of 5000-12000 rubles. The procedure using open curettage will cost 9,000–18,000 rubles.

As practice shows, the most effective method to eliminate pockets in moderate and severe periodontitis, is open curettage. This technique allows not only to eliminate growths and damaged elements, but also to completely restore the lost bone over time.

The downside of this method can only be called a long healing process. In contrast, closed curettage is bloodless and less painful. But, unfortunately, it can be used only at the initial stage of the disease.

Patient reviews

Most patients undergoing periodontal pocket treatment are of the opinion that surgical method - the only way, which is guaranteed to eliminate the problem.

Reviews show that therapeutic treatment most often does not give results, only temporarily stopping the symptoms of the disease. If you have encountered similar pathology, and have experience in its treatment, you can leave your feedback in the comments to this article.

We offer you to watch a video about the process of performing the operation "open curettage of periodontal pockets":

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The structure of periodontal pockets and the stage of the disease

Periodontal pockets appear with gum disease - periodontitis, periodontal disease and gingivitis. Due to inflammation, the integrity of soft tissues is violated, they begin to “depart” from the enamel, gradually the necks of the teeth are exposed, and atrophy of the alveolar bone occurs.

Only periodontitis is accompanied simultaneously infectious inflammation and tooth mobility. With periodontal disease, the destruction of connective tissues occurs without the formation of pus, and with gingivitis, the integrity of the dentition is preserved.

Periodontitis creates an ideal environment for the reproduction of microbes and bacteria. The bottom is filled with food particles, plaque and pus. The patient cannot fully clean the pocket on his own. Over time, the process is aggravated: the space is filled deeper and deeper with solid deposits, and granulation tissue and the alveolar processes atrophy.

Important! The main methods for examining gum pockets are radiography and probing. The picture clearly shows dark areas in the place where the soft tissues move away from the tooth.

There are three stages of the disease:

Light. The pocket depth is up to 3.5 mm.
Average. Destruction reaches 4 mm.
Heavy. Lesions exceed 5 mm.

Causes and symptoms

The main factor leading to the formation of periodontal pockets is the accumulation of bacteria and plaque, which literally rushes to the surface of the enamel. The reasons for the development of pathology include:

Poor or improper oral hygiene.
The use of large amounts of soft and carbohydrate food: sweets, pastries, fast foods.
Lack of solid vegetables and fruits in the diet: hard food helps to get rid of plaque, promotes proper blood supply to the gums and teeth strength.
Bite defects: crowding, curvature of teeth.
Diabetes.
Hormonal disbalance.
Immunodeficiency.
Poor-quality or incorrectly made fillings, crowns, bridges, prostheses.

Important! Smokers are the most susceptible to plaque formation on their teeth. Nicotine resins coat the surface of the enamel, especially with inside. For patients with addiction mandatory professional cleaning to avoid the risk of developing periodontitis.

The formation of periodontal pockets is accompanied by:

Itching in the gums.
Bleeding under mechanical impact.
Bad breath that does not disappear even after brushing and rinsing with solutions.
Separation of purulent contents when pressed.
Reaction to cold, hot, sour, sweet.
Discomfort while eating.
Visual enlargement of the tooth due to periodontal dystrophy.
Mobility and loosening of teeth - in a severe stage.

Treatment

Treatment of periodontal pockets is carried out in several ways. Which technique will be chosen depends on the depth of the lesion and the stage of the disease.

Laser cleaning

It is used at the first stage of pathology. Tartar is removed by the dental apparatus "Vector". High-frequency ultrasonic vibrations emitted by the scaler tip remove deposits located in periodontal pockets. In parallel, the gaps are disinfected and pathogenic microorganisms are eliminated.

Important! Laser cleaning is usually performed without anesthesia. The procedure is painless slight discomfort. Anesthesia is used if the patient has hypersensitivity Or he is very afraid.

Photodynamic therapy

PDT is a modern non-surgical method of treating any stage of the disease. The pocket in the gum is cleaned of plaque and a special preparation is applied - concentrated chlorophyll. It is made from seaweed - spirullins. The substance contributes to the development of photosensitizers.

When exposed laser beam an oxidative reaction begins with the release of oxygen. Microbes and bacteria die, and a protective layer forms on the mucosa. At the end of the procedure, the gum pockets are closed. Further therapy is aimed at restoring bone and granulation tissues.

curettage

The most common treatment. There are two types of procedure:

Open. It is carried out when the depth of the pockets does not exceed 5 mm.
Closed. It is used in the third stage of the lesion.

The general principle of both closed and open curettage is the same. The only difference is the excision of soft tissues. It is carried out with the second type of method.

The procedure consists of several stages:

Treatment of the oral cavity with antiseptic solutions: Chlorhexidine, Miramistin.
Anesthesia.
Mechanical removal of plaque, deposits, pus. If necessary, excision of the affected tissues.
Re-disinfection of mucous membranes.
Application of drugs that promote osseointegration - growth bone cells and gum healing.
Suturing (if there are incisions), applying a protective bandage.

Important! Usually they prefer to carry out an open type of curettage. It is more efficient and gives full access to gum pockets.

After the procedure starts recovery period. It lasts from 14 to 21 days. By the end of the third week, the connective tissues are completely restored.

Flap operation

Surgical intervention is carried out at the third stage of the disease, when the periodontal pocket has reached a depth of 5 or more millimeters. The operation is traumatic, painful, accompanied by physical and psychological discomfort. But it allows you to completely eliminate the lesions of connective tissues.

Procedure steps:

Anesthesia.
Vertical excision of the gums in two places.
Exfoliation of the periosteal flap.
Mechanical removal of affected tissues, dental deposits, pus.
Antiseptic treatment and application wound healing drugs that stimulate the growth of new cells.
Suturing.

Important! As the anesthesia wears off, patients begin to feel pain. Therefore, after the operation, it is recommended to take painkillers.

During the rehabilitation period, wound healing gels are prescribed and antiseptic solutions for rinsing. Most often, Asepta, Metrogil Denta, Solcoseryl, Actovegin are prescribed. If the disease is accompanied by an extensive inflammatory and purulent process, antibiotics are indicated.

Prices

The cost of treating periodontal pockets depends on the type of procedure and the amount of treated area. Average prices for therapy:

- Processing with the “Vector” apparatus – 2,500 per jaw,
- Closed curettage - 1,400 per tooth,
- Open curettage - 2,700 per tooth,
- Flap surgery – From 2,500 to 3,500 depending on the number of roots in the tooth,
- PDT — 1,500 for one gingival pocket.

Periodontal pocket appears with the development of periodontitis. The disease is accompanied by pain, bleeding, and in advanced cases - a violation of interdental bonds and adentia. Treatment is carried out with the help of laser devices, mechanical cleaning and surgical excision.

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Treatment

A gum pocket is a reversible condition that can be cured with proper hygiene. In case of a disease, for example, periodontal disease, treatment by a dentist will be required. Especially in the case of inflammation, soreness, swelling of the gums with the release of pus, a surgical operation can be used. Otherwise, it will lead to tooth loss.

With inflammation of the gum pocket, treatment is carried out different ways. Therapeutic methods are applied if the depth is not more than 4 mm. First of all, it is necessary to carry out cleaning of plaque, calculus, microbes, deposits, so that the neck closes, the attachment of the gums to the teeth is restored.

In case of bleeding, you should consult a doctor. Medical procedures are carried out with the help of:

hand tools;
ultrasonic scaler;
photosensitizer;
surgery.

The pocket area is cleaned with an ultrasonic sclera, then the surface of the tooth root is processed with polishing. Excess growths are removed from the inflamed tissue. Thus, conditions are provided for the restoration process for the normal attachment of the gums to the teeth.

Photodynamic therapy – modern method, with the help of which an advanced form of the disease is treated without surgical intervention. The principle of the method is that after brushing the teeth, a special substance consisting of concentrated chlorophyll is applied to the surface of the gums.

It is obtained from spirullins - seaweed. In the destroyed, inflamed cells under the action of the drug, photosensitizers develop, and after that, after a certain period of time, the specialist applies a laser beam to the gums. Its light acts on photosensitizers with the release of oxygen. In this case, an active oxidative reaction occurs, as a result of which dies pathogenic flora and harmful bacteria. When the affected tissue areas in the periodontal pocket are removed, it closes completely. With the help of one procedure, you can completely cure the pocket and get rid of inflammation, bleeding. If the treatment is carried out with a laser, then a protective formation is created on the mucous membrane, preventing microbes from entering the gums, and also contributes to recovery. normal state pocket. After carrying out procedures to remove infected gum tissue, bone tissue should be restored. Successful Therapy will be in case of complete restoration of periodontal joints and gum functions.

For this, a patchwork technique is used, in which the gums are peeled off in the area of several teeth located nearby. Pockets are cleaned after opening manually, and then the root of the tooth is processed and the gum is sewn.

Such an operation is almost always carried out with a positive effect, but the only disadvantage of the procedure may be the difficulty in psychological aspect for the patient himself. You can consider the result of the operation of the tooth pocket, the photo of which is presented above.

Many patients are interested in how to treat a pocket in the gum between the teeth with curettage technology, which is often recommended by specialists. It is considered effective and less painful. Distinguish between open and closed way. During the procedure, gum pockets are thoroughly cleaned from deposits, tartar, and altered tissues.

The dentist prescribes a cleaning, taking into account the degree of the disease.

Closed curettage carried out by laser, ultrasound at a small depth of formation, not exceeding 5 mm.
Open curettage is a surgical operation that is performed with the use of anesthetics. In the process, an incision is made in the gums in the area of the interdental papillae, then cleaning is carried out and a means for effective healing after which the wound is sutured.

The result after curettage is noticeable after two weeks. Puffiness, redness, bleeding of the gums disappear, the depth of the pocket is reduced. To find out how to treat pockets in the gums, which method would be better, you need to seek advice from specialists at the first sign of the onset of the disease.

Preventive actions

To prevent re-treatment in the dental pocket, preventive measures should be taken in a timely manner. When the curettage procedure is performed, the doctor prescribes a series preventive measures to be done regularly:

brushing teeth;
use cleaning products, pastes with an abrasive effect, where deposits are removed with the help of solid particles and polished teeth;
use floss ( dental floss) for cleaning between teeth;
preventive visit dental clinic at least twice a year;
compliance with additional recommendations of the doctor will reduce the growth of pockets, prevent complications of a different nature.

Treatment with folk remedies

Patients, when contacting a dentist, often ask if the dental pocket can be treated at home.

In this case, antiseptic solutions, decoctions from medicinal plants with a wound healing effect can effectively help. Several recipes can be found below.

Walnut. The recipe uses green peel. Grind a tablespoon of peel and pour olive oil in a warm state - 0.25 ml. Pour the product into a jar and close tightly, then refrigerate for a week with occasional shaking. After infusion, the resulting solution is filtered and the gums are lubricated five times during the day.
Plantain. Boiled water - 0.25 ml pour 20 grams of crushed plantain leaves and insist for at least an hour. They rinse the mouth four times throughout the day. In the summer, plantain juice helps a lot, for which the leaves are crushed in a blender and the juice is squeezed out with gauze. You can see the result of treatment with juice of gum pockets, the photo of which is presented below. Positive effect reached on the third day.
Eucalyptus oil. In 200 ml of boiled water, add 2 teaspoons of oil, stir, then rinse at least three times a day for seven days. The tool is excellent for strengthening the gums.
Hydrogen peroxide. 1 teaspoon of peroxide is added to 100 ml of water. The mouth must be rinsed twice a day for a week.
Sugar beet. Grate the beets and wrap the resulting slurry in the amount of one teaspoon in cheesecloth, do not squeeze the juice. The remedy is applied for fifteen minutes to the inflamed areas. The procedure is carried out at least three times a day with a new compress. The expected result can come after two days of regular treatment.
Highlander kidney. With this tool, treatment is carried out for a week. Highlander's spoon is poured boiled water 0.25 ml, then infused for 25 minutes. It is necessary to moisten a piece of cotton wool in the resulting tincture, apply to the inflamed area, hold for 10 minutes. The agent is applied twice a day. The infusion is applied hot, but not boiled.
Leaves and stems of golden mustache. The leaves of the plant are applied to the places of inflammation, and rinse the mouth with a tincture of the stems. One spoonful of the plant is brewed with half a liter of boiling water and infused for 30 minutes. Rinse is carried out at least three times a day.
Lemon peels. Brew chopped lemon peel with a glass of boiling water, leave for half an hour and rinse your mouth three times a day for ten days.
Air, propolis. The resulting remedy is effective for inflammation, as an anesthetic, wound healing. Preparation is carried out in advance with the addition of vodka. This will require one liter of vodka best quality, grind the root in an amount of 250 gr., And propolis - 20 gr. Each component is taken separately, poured with five hundred milliliters of vodka and infused for ten days with daily shaking. After preparation, proceed to treatment. The treatment is carried out over four weeks. To do this, mix calamus tincture with propolis tincture in a teaspoon.

In conclusion, it should be noted that self-treatment gum disease is not recommended without the advice of specialists. Desirable healing procedures perform in combination traditional methods with traditional medicine.

From this article you will learn:

surgical methods for the treatment of periodontitis - reviews of dentists,
flap surgery, curettage of periodontal pockets - price 2019.

The article was written by a periodontal surgeon with more than 19 years of experience.

Why do you need to do curettage?

To understand why you need to do curettage or flap surgery, you need to go a little deeper into the details of the development and course of periodontitis. Periodontitis develops against the background of poor oral hygiene, the presence of a large amount of soft microbial plaque and hard dental deposits. The latter trigger an inflammatory process in the gum, which first manifests itself as bleeding when brushing the teeth, pain and swelling of the gums, and later these symptoms are also accompanied by tooth mobility, their displacement, suppuration from under the gums, etc.

So, in the dentogingival sulcus, it turns into a hard tartar, which is very tightly attached to the surface of the neck of the tooth (Fig. 1.2). Tartar microorganisms produce toxins that trigger inflammation in the gums.

In the process of inflammation occurs:

Bone atrophy around the tooth –
those. the bone begins to gradually dissolve. Compare the level of bone tissue in relation to the roots of teeth in a person without concomitant periodontitis (X-ray 3a) and in a person with moderate periodontitis (X-ray 3b). The distance between "a" and "b" is the level of complete destruction of the bone tissue, which can be seen from the absence of bone trabeculae in this area.
Moreover, it should be noted that bone tissue does not simply disappear without a trace, but is replaced by the so-called granulation tissue, which contains a large number of microbial cells, bone-resorbing cells (osteoclasts), etc. The appearance of granulation tissue contributes to an even faster subsequent destruction of the bone.
Formation of periodontal pockets –
under the influence of inflammation caused by dental deposits, not only the bone is destroyed, but also the periodontal attachment of the tooth to the bone (Periodont). Periodontium is such microligaments between the root of the tooth and the bone, with the help of which the tooth is securely attached to the bone tissue.
In Figure 4, you can see the differences between diseases such as Gingivitis (in which there is no bone destruction, there are no periodontal pockets) and Periodontitis (in which there is active destruction of the bone and the formation of periodontal pockets). With periodontitis, the cumulative destruction of bone tissue and periodontal ligaments leads to the formation of periodontal pockets (Fig. 4).
A periodontal pocket is such an area, to the width and depth of which the bone tissue has been destroyed, there is no attachment of the gum to the surface of the root of the tooth, and the defect itself is filled with granulation tissue, dental deposits, and pus. Patients often refer to periodontal pockets as dental pockets, gum pockets, or gum pockets. Such gingival pockets can be identified by probing with special periodontal probes, or radiographically.
In Figures 4-6 you can see the clinical situation in one patient regarding a deep periodontal pocket in the interdental space between the canine and premolar:
→ in Fig. 4 you can see that the periodontal probe penetrates under the gum by 5-6 mm, at a rate of 1-2 mm.
→ Figure 5 shows a radiograph of this tooth. It shows that there is a bone defect. Destruction of bone tissue radiographically manifests itself in the form of darkening (indicated by black arrows).
→ Figure 6 shows a view of a bone defect in the process of gingival detachment. The granulation tissue from the periodontal pocket has already been practically removed and hard tartar on the root surface is clearly visible, which caused the destruction of the bone and the formation of the periodontal pocket.

Surgical treatment of periodontal disease as opposed to therapeutic treatment allows:

So, when deep periodontal pockets from 3-4 mm were formed, there was a partial replacement of bone tissue with granulation tissue - the process essentially becomes irreversible, despite any local and general anti-inflammatory therapy, treatment with antibiotics, laser, removal of dental plaque, etc. d. Why?

Firstly- it is almost impossible to completely remove dental deposits from deep periodontal pockets. The fact is that the doctor inserts the ultrasonic nozzle under the gum “blindly”, i.e. he makes movements without seeing what exactly is happening in the periodontal pockets. Therefore, as a rule, a large amount of subgingival deposits remain, which continue to have a destructive effect.
In addition, the removal of subgingival dental deposits is an extremely painstaking, long process, and the patient will never know if something remains there. Therefore, in the conditions of a paid commercial reception, it is not very profitable to spend precious time looking for small subgingival pebbles.
Secondly- if deep periodontal pockets have formed, then in them, even after the removal of dental plaque and anti-inflammatory therapy, conditions are created for the development of infection and the further progression of periodontitis.
Therefore, the only way to treat periodontitis that guarantees improvement is one that will eliminate:
→ periodontal pockets,
→ remove all subgingival deposits,
→ remove the granulation tissue that replaced the resorbed bone.
This can only be done using surgical methods for the treatment of periodontitis.

Surgical methods for the treatment of periodontal diseases

There are several methods of surgical interventions for periodontitis:

curettage of periodontal pockets - "open" and "closed".
patchwork operations.

1. Closed curettage of periodontal pockets -

The purpose of the operation: to remove granulation from periodontal pockets, subgingival dental deposits. Disadvantages of the technique: curettage is carried out blindly, there is no visual review of the surface of the roots, periodontal pockets, which is why both granulation and dental deposits massively remain in their places.

Closed curettage can be more or less effective only for shallow periodontal pockets up to 3 mm, i.e. the mildest degree of periodontitis. With periodontitis of moderate and severe degree, closed curettage (due to a temporary decrease in the mass of granulations) can only temporarily improve the condition of the gums, but this phenomenon will only be short-term, and periodontitis will definitely progress further. In Fig.7 (a,b) you can see the instruments used for closed curettage.

This type of curettage is popular in dental clinics that do not have an experienced periodontist surgeon, and therefore the operation is performed by a regular dentist or even a periodontist. These specialists have neither the skills nor the experience to perform complex surgical interventions in the oral cavity, which include open curettage and patchwork operations.

2. Open curettage of periodontal pockets -

The purpose of the operation: remove all subgingival dental deposits, remove inflammatory granulation tissue from under the gums, eliminate periodontal pockets, stimulate the restoration of bone tissue with the help of "replanting" synthetic bone tissue.

Before the start of the operation must be carried out careful preparation –

After removal of granulation tissue, antiseptic treatment of the surface of the roots of the teeth and bone tissue - into deep bone pockets The synthetic bone is “planted” (Fig. 10). This is necessary for the restoration of bone tissue. Naturally, it is impossible to restore it in full, but it is quite possible to reduce bone pockets.
In Fig.11 (a,b) you can see the X-rays BEFORE and 3 months AFTER the operation. On a radiograph taken a few months after the operation (Fig. 11b), one can easily see an increase in bone mass in the periodontal pocket.
Suturing. Sutures are placed in the area of the interdental papillae (Fig. 12). At the end of the operation, a gum bandage is also applied, which will protect the area of the operation and promote faster healing. The stitches are removed 10 days after the operation.

3. Flap surgery for periodontitis -

The difference is that the incision during flap surgery is made 1-1.5 mm from the edge of the gums. This thin 1.5 mm gum line is further removed. This is done because with prolonged inflammation, the marginal gum changes in such a way that it can never fit snugly against the surface of the teeth, and therefore it must be removed. Since the mucosal flaps are mobile, at the end of the operation they are stretched to the necks of the teeth, which in most cases prevents the “dropping” of the gums.

There are methods of patchwork operations not only for generalized periodontitis, but also to, for example, close gum recession. Recession is the omission of the gums in the area of 1-2 teeth, accompanied by exposure of the roots.

Curettage of periodontal pockets: price 2019

How much does curettage of periodontal pockets cost - the price for 2019 in Moscow will be depending on the type of technique, as well as the cost of the materials used (primarily bone material).

closed curettage of periodontal pockets - the price for 1 tooth will be from 500 rubles.
open curettage of pockets - the price for 1 tooth will be from 1500 rubles.
patchwork operation - the price for 1 tooth is from 2500 rubles, and a segment of 6-8 teeth - from 10,000 rubles.

This cost, as a rule, does not include the price of bone material. Can be used as high-quality expensive bone material Bio-Oss (Switzerland) - 6500 rubles. for a package of 0.5 g, and Russian drugs such as Kolapol and Kollapan, which are several times cheaper.

Curettage, patchwork operation: reviews

Briefly summarize, patient reviews after different types interventions.

Closed curettage –
it is worth doing only with the initial form of periodontitis, when there are only shallow periodontal pockets up to 2-3 mm. With moderate and severe periodontitis, in the presence of deep periodontal pockets, it is absolutely ineffective. However, the operation takes little time, is easily tolerated, does not require a highly qualified doctor (usually dentists who do not have the skills of major operations like to do it), and is relatively inexpensive. This is the only positives.

Open curettage and flap surgery –
Pluses - these are the only techniques that allow you to eliminate periodontal pockets and achieve stabilization of periodontitis, as well as reduce the amount of bone tissue atrophy due to bone tissue grafting (which can also reduce tooth mobility). Therefore, if you want to chew with your own teeth as long as possible, then the choice of the operation method is obvious.

Minuses -

Requires a highly qualified doctor, should only be performed by dental surgeons with a specialization in periodontics.
Operations are expensive: they require not only the payment of a doctor, a nurse, but also the purchase of expensive consumables, such as synthetic bone tissue, expensive suture material (it must be monofilament), etc.
Removal of inflammatory granulation tissue and inflamed gingiva may be accompanied by gingival “drooping” (i.e. root exposure). The amount of root exposure will directly depend on the initial amount of bone tissue atrophy.
Also, after the operation, the appearance of the gingival papillae temporarily changes, which are flattened and do not occupy the entire space between the teeth. After a few months, the gingival papillae return to their normal shape and the interdental spaces are thus eliminated.
The operation is long in time: a segment of 7-8 teeth takes about 2 hours.

3,75

The depression that forms between the tooth and the gum is called a gum pocket. In the normal state, the size of the recess does not exceed three millimeters. This allows it to be cleansed of various remnants of the epithelium, food, which accumulate in the space of the formed neck around the tooth.

With inflammation of the gum pocket, treatment is carried out in different ways. Therapeutic methods are applied if the depth is not more than 4 mm. First of all, it is necessary to carry out cleaning of plaque, calculus, microbes, deposits, so that the neck closes, the attachment of the gums to the teeth is restored.

In the early stages of the development of the disease, rinsing with antiseptic solutions, medicines, and careful hygiene procedures are carried out.

In case of bleeding, you should consult a doctor. Medical procedures are carried out with the help of:

hand tools;
ultrasonic scaler;
photosensitizer;
surgery.

Photodynamic therapy - a modern method by which an advanced form of the disease is treated without surgical intervention. The principle of the method is that after brushing the teeth, a special substance consisting of concentrated chlorophyll is applied to the surface of the gums.

The principle of operation of the ultrasonic device "Vector"

It is obtained from spirullins - seaweed. In the destroyed, inflamed cells under the action of the drug, photosensitizers develop, and after that, after a certain period of time, the specialist applies a laser beam to the gums. Its light acts on photosensitizers with the release of oxygen. In this case, an active oxidative reaction occurs, as a result of which the pathogenic flora and harmful bacteria die. When the affected tissue areas in the periodontal pocket are removed, it closes completely. With the help of one procedure, you can completely cure the pocket and get rid of inflammation, bleeding. If the treatment is carried out with a laser, then a protective formation is created on the mucous membrane, which prevents microbes from entering the gums, and also helps to restore the normal state of the pocket. After carrying out procedures to remove infected gum tissue, bone tissue should be restored. Successful therapy will be in case of complete restoration of periodontal joints and gum functions.

In the case when the pocket exceeds 4 mm, a surgical operation will be required.

For this, a patchwork technique is used, in which the gums are peeled off in the area of several teeth located nearby. After opening, the pockets are cleaned manually, and then the root of the tooth is processed and the gum is sewn on.

Surgical treatment of the gingival canal

Such an operation is almost always performed with a positive effect, but the only disadvantage of the procedure may be the complexity in the psychological aspect for the patient himself. You can consider the result of the operation of the tooth pocket, the photo of which is presented above.

Many patients are interested in how to treat a pocket in the gum between the teeth with curettage technology, which is often recommended by specialists. It is considered effective and less painful. Distinguish between open and closed methods. During the procedure, gum pockets are thoroughly cleaned from deposits, tartar, and altered tissues.

The dentist prescribes a cleaning, taking into account the degree of the disease.

Closed curettage carried out by laser, ultrasound at a small depth of formation, not exceeding 5 mm.
Open curettage is a surgical operation that is performed with the use of anesthetics. In the process, an incision is made in the gums in the area of the interdental papillae, then cleaning is carried out and a means for effective healing is applied, after which the wound is sutured.

Treatment, which will be carried out under the supervision of doctors, will prevent various complications.

Preventive actions

In order to prevent re-treatment in the dental pocket, preventive measures should be taken in a timely manner. When the curettage procedure is performed, the doctor prescribes a number of preventive measures that should be performed regularly:

To prevent gum disease, visit the dentist at least twice a year.

brushing teeth;
use cleaning products, pastes with an abrasive effect, where deposits are removed with the help of solid particles and polished teeth;
use floss (dental floss) to clean between teeth;
a visit to the dental clinic for prevention at least twice a year;
compliance with additional recommendations of the doctor will reduce the growth of pockets, prevent complications of a different nature.

Treatment with folk remedies

Patients, when contacting a dentist, often ask if the dental pocket can be treated at home.

Experts say that it is quite possible to carry out treatment with folk remedies if the disease does not have serious complications.

In this case, antiseptic solutions, decoctions from medicinal plants with a wound healing effect can effectively help. Several recipes can be found below.

Walnut. The recipe uses green peel. Grind a tablespoon of peel and pour olive oil in a warm state - 0.25 ml. Pour the product into a jar and close tightly, then refrigerate for a week with occasional shaking. After infusion, the resulting solution is filtered and the gums are lubricated five times during the day.
Plantain. Boiled water - 0.25 ml pour 20 grams of crushed plantain leaves and insist for at least an hour. They rinse the mouth four times throughout the day. In the summer, plantain juice helps a lot, for which the leaves are crushed in a blender and the juice is squeezed out with gauze. You can see the result of treatment with juice of gum pockets, the photo of which is presented below. A positive effect is achieved on the third day.
Psyllium juice is often used to treat a gum pocket.
Eucalyptus oil. In 200 ml of boiled water, add 2 teaspoons of oil, stir, then rinse at least three times a day for seven days. The tool is excellent for strengthening the gums.
Hydrogen peroxide. 1 teaspoon of peroxide is added to 100 ml of water. The mouth must be rinsed twice a day for a week.
Sugar beet. Grate the beets and wrap the resulting slurry in the amount of one teaspoon in cheesecloth, do not squeeze the juice. The remedy is applied for fifteen minutes to the inflamed areas. The procedure is carried out at least three times a day with a new compress. The expected result can come after two days of regular treatment.
Highlander kidney. With this tool, treatment is carried out for a week. A spoonful of highlander is poured with 0.25 ml of boiled water, then infused for 25 minutes. It is necessary to moisten a piece of cotton wool in the resulting tincture, apply to the inflamed area, hold for 10 minutes. The agent is applied twice a day. The infusion is applied hot, but not boiled.
Leaves and stems of golden mustache. The leaves of the plant are applied to the places of inflammation, and rinse the mouth with a tincture of the stems. One spoonful of the plant is brewed with half a liter of boiling water and infused for 30 minutes. Rinse is carried out at least three times a day.
Lemon peels. Brew chopped lemon peel with a glass of boiling water, leave for half an hour and rinse your mouth three times a day for ten days.
F5 Infusion of lemon peels - a folk way to treat a gum pocket
Air, propolis. The resulting remedy is effective for inflammation, as an anesthetic, wound healing. Preparation is carried out in advance with the addition of vodka. This will require one liter of vodka of the best quality, grind the root in an amount of 250 gr., And propolis - 20 gr. Each component is taken separately, poured with five hundred milliliters of vodka and infused for ten days with daily shaking. After preparation, proceed to treatment. The treatment is carried out over four weeks. To do this, mix calamus tincture with propolis tincture in a teaspoon.

In conclusion, it should be noted that self-treatment of gum disease without the advice of specialists is not recommended. It is desirable to perform medical procedures in combination with traditional methods with traditional medicine.

Diseases of the gums and oral mucosa are not uncommon these days. A pocket in the gum between the teeth serves as a signal of serious problems, how to treat it and where it came from - we will consider in this article.

First you need to have some understanding of what a periodontium is. The periodontium is all the tissues that surround the tooth. This includes bone, ligaments, root cement, gums. The root of each tooth is located in the socket allotted to it inside the jawbone, to which it is attached with the help of strong and elastic ligaments, which are called periodontium. These ligaments prevent the tooth from falling out of the hole, as well as turning around its axis and tilting. They provide very little movement, called physiological mobility. Such mobility is normal and almost imperceptible in everyday life. Periodontal ligaments also transfer chewing pressure from the tooth to the bone, acting as a shock absorber. In general, the function of these ligaments is extremely important.

At advanced diseases periodontal gum becomes inflamed from the constant exposure to microbes and begins to decrease, exposing the root. Periodontal ligaments are also destroyed. The process passes to the bone, its height becomes smaller, the teeth loosen and fall out. So gingivitis (inflammation of the gums) turns into periodontitis (inflammation of the periodontium, accompanied by loss of bone tissue).

Classification of gum pockets

Normally, the gum fits snugly to the teeth throughout. In the region of the neck of the tooth, the gum lies somewhat looser, slightly behind the tooth, forming a normal gingival sulcus. Its depth should not be more than 3 mm. Depth is measured using a special tool - a probe with a blunt end, which is carefully immersed in the gap between the gum and the tooth.

In the event that in the area of the neck of the tooth long time soft and hard plaque accumulates, harmful bacteria cause inflammation of the gums, which can later lead to the formation of a pocket.

Table. Varieties of pathological pockets in the area of the teeth.

False pockets	true pockets
A false gum pocket is actually a swollen gum. Increasing in volume and height due to inflammation or hypertrophy, it creates the illusion of a real pocket and the measurement really shows an increase in the depth of the gingival sulcus. However, the difference is that in the false pocket, the attachment of the gum to the tooth is not broken and it still fits snugly to the root throughout.	Periodontal, bone or true pocket is formed when the ligaments that attach the tooth to the bone are destroyed.
	Supraalvelar pockets (periosteal) appear with a horizontal direction of bone destruction	Intraalveolar pockets (intraosseous) appear with the vertical direction of bone destruction

Risk Factors for Gingival Pocketing

Smoking. Surely you have seen the terrible warnings on cigarette packs more than once about the dangers of smoking for teeth and gums. The horrific photographs of unhealthy mouths are placed there for a reason. A combination of poor dental care and chemical compounds from tobacco smoke- a direct road to severe inflammation of the periodontium and loss of teeth. Cigarette abuse also drastically reduces the effectiveness of the treatment by maintaining inflammation and preventing tissue regeneration.

Poor quality and irregular brushing of teeth. This is the main factor leading to the formation of gum pockets, which must be eliminated first.
Hormonal changes in adolescents and women. During periods of restructuring of the endocrine system, the body is most sensitive to any infections, including those in the oral cavity.
External factors. Working in difficult conditions, exposure to chemicals, and severe stress can affect not only health in general, but also the gums in particular.
Diseases of the digestive, cardiovascular, immune and other systems. The overall endurance of the body will undoubtedly affect the resistance of the periodontium to microbial factors.
Diabetes. This disease should be singled out separately, since it almost always manifests itself on the oral mucosa. Diabetes treatment is usually long and multi-stage, so to maintain healthy gums, it is necessary to at least stabilize the process.
Regular medication. An impressive number of drugs for a variety of diseases has side effect, which reduces the immunity of the oral cavity, in particular, reduces the secretion of saliva. It is saliva that contains important protective elements that prevent the development of gingivitis, periodontitis and caries. Other drugs can cause gums to grow abnormally, making it difficult to brush your teeth.
genetic predisposition. Some people from birth are prone to various pathologies in periodontal tissues - from minor features to severe forms of disease.

Who can get a gum pocket?

Usually people do not pay too much attention to the condition of their gums until the disease becomes quite severe. Most often this occurs at the age of 30-40 years. Men are more prone to periodontitis, which, in particular, is associated with the predominance of men among smokers, as well as with difficult working conditions. In adolescents, gum disease and false pockets are more common than bone destruction. However, there are separate forms of periodontal disease that develop at a young age and are extremely difficult, so when the first symptoms appear, you should consult a doctor for diagnosis. In general, gum disease can appear at any age if personal oral hygiene is not given due attention.

How do I know if I have pockets in my gums?

There are a number of signs by which you can suspect the presence of pockets in the gum:

bad breath that does not disappear despite the hygiene products used;
red, swollen gums, sometimes of an unusual shape;
sensitive and bleeding gums;
pain when chewing and eating;
mobile teeth;
too much sensitive teeth feeling of pain when taking cold or hot food or drinks;
gum loss, exposure of the roots of the teeth.

Each of these signs is a signal of serious problems in the oral cavity. If you have found at least one of the symptoms, you should consult a dentist to determine the cause. If periodontal disease is suspected, diagnosis usually consists of the following:

questioning the patient about the development of the disease, existing risk factors, previous treatment;
examination and instrumental examination of teeth and gums to identify signs of inflammation;
measurement of the depth of gum pockets with a thin probe with a rounded tip (most often painless);
taking an x-ray of the upper/lower jaw to determine the presence of bone loss, its depth and extent.

How to treat pockets in the gum?

The main goal of periodontitis treatment is to eliminate the infection. The types and number of procedures vary greatly and are determined by the form and severity of the disease. At the same time, not only the manipulations and prescriptions of the doctor are important, but also the careful implementation of all recommendations by the patient at home. The doctor will also advise you to get rid of bad habits and treat other diseases (for example, diabetes).

Professional teeth cleaning and closed curettage

The first procedure that is prescribed for the formation of gum pockets is a thorough cleaning of the teeth in dental office. Only a doctor can carry out such cleaning, as it is very different from home cleaning with a toothbrush. Here, special techniques are used to clean all surfaces of the teeth from soft and hard plaque, manual or ultrasonic scalers are used, as well as curettes that carefully scrape and separate the accumulated tartar from the surface of the crown and tooth root. Despite the aggressiveness of these tools to plaque, they do not damage the surface of the root itself.

After cleaning with scalers and curettes, the surface of the tooth is polished so that less plaque accumulates on it. This can be achieved by means of apparatuses supplying a polishing dispersion, either manually or with a laser.

Medicines for the treatment of gum pockets

After professional hygiene oral cavity in the presence of pockets in the gum, as a rule, prescribe drugs.

Mouthwashes. For periodontal diseases, rinses are recommended that have an antibacterial effect, for example, those containing chlorhexidine. It is worth remembering that medicinal rinses not suitable for long term use.

Antimicrobial gels and ointments. They are also prescribed to fight infection and reduce inflammation. They are usually applied about twice a day for a strictly limited period.
Anti-inflammatory drugs. May be in the form of tablets or ointments. Contribute to the subsidence of symptoms of acute infection.
Healing preparations. Usually in the form of an ointment or oil. May contain vitamins A, D, E. Often have a plant base. Helps oral tissues and gums to recover.
Antibiotics. Most often prescribed in tablets during an exacerbation of the disease. The time of admission is strictly limited, almost always taking antibiotics is incompatible with drinking alcohol due to severe complications up to death.

All these drugs only supplement the main treatment and cannot be used without professional hygiene. They will also not replace surgical interventions prescribed for moderate and severe forms periodontitis.

Surgical methods for the treatment of gum pockets

First option surgical treatment periodontitis and gum pockets is open curettage. The objective of the method is to clean out plaque and microbial residues, as well as the affected tissues in the area of the roots of the teeth. At the same time, a section of the gum limited in height is separated from the teeth and bone after incisions are made, and thus the doctor can visually control the course of cleaning the teeth and tissues. The operation is carried out under local anesthesia. Upon completion of the cleaning, the gums are sewn into place and an anti-inflammatory agent is applied to better heal the gums and reduce the risk of complications.

With a significant loss of bone, a flap operation is performed, which differs from open curettage in that the gum exfoliates from the bone completely for its entire length, until it passes into the mucous membrane of the lips and cheeks. Often lost bone tissue is also replaced with grafts.

However, even such serious and time-consuming operations do not permanently prevent re-development periodontitis and its exacerbation. All therapeutic measures should be used in combination, the loss of at least one link significantly reduces the effectiveness of treatment in the future.

How to care for teeth and gums if there are already gum pockets?

When gum pockets appear, you will have to fight against pathogenic bacteria, including at home. After the treatment, a clear implementation of all the recommendations of the dentist is required. Personal oral hygiene should be especially thorough and at least twice a day.

It is advisable to periodically use antiseptic rinses, but strictly according to the doctor's prescription. Also on the market are special pastes for people prone to inflammation of the gums and periodontium. It is strongly recommended to purchase an irrigator - a special device that allows you to increase the degree of cleaning your teeth. It also massages the gums, helps blood circulation, healing and regeneration after surgery and curettage. As a liquid for irrigation, the dentist will advise the use of medicinal solutions and decoctions of medicinal herbs.

How to prevent the appearance of pockets in the gum?

Follow personal hygiene teeth, massage the gums with a brush or irrigator.
Don't forget to clean your interdental spaces.
Visit the dentist at least once every six months or more often if necessary.
Maintain general health body, do not start the course of major diseases.
Give up bad habits - smoking, alcohol.

What happens if gum pockets are not treated?

At further development periodontitis, the depth of gum pockets is rapidly increasing, plaque continues to accumulate, affecting an increasing number of tissues. Further, the ligament holding the tooth is destroyed to such an extent that it becomes mobile, which will eventually lead to tooth loss. In addition, increasing inflammation will cause more and more inconvenience, extremely bad breath will appear, the gums will hurt more and bleed, preventing normal food intake.

In addition, microbes will continue to multiply in the thickness of plaque, their toxins will gradually enter the bloodstream. Ultimately, this may lead to serious illness heart, when the harmful influence of bacteria spreads beyond the oral cavity.

Therefore, the treatment of periodontal disease should not be postponed, and if you suspect the presence of gum pockets, consult a dentist.

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What is a gum pocket?

Gingival pockets, as seen in the photo below, are a depression between the tooth root and the gum that covers it. In these recesses, the bone tissue was destroyed, and granulation tissue formed in its place. Gingival pockets are also called periodontal, dental and periodontal pockets. The “contents” of the pockets are represented by microbial plaque, tartar and pus. Pockets tend to increase rapidly.

How are pockets formed?

In a healthy person, the gum fits snugly against the tooth, but it is considered normal if there is a slight detachment of soft tissues from the tooth surface. Permissible is the depth of detachment of the gums in 1-2 millimeters. In this condition, the area under the gum has the ability to self-clean, and subject to careful hygiene, food residues and bacteria do not linger in it.

However, in conditions of poor hygienic care, the periodontal pocket increases, deepens, and plaque accumulates in it, which, when hardened, turns into stone. It is impossible to remove plaque from the recesses with a toothbrush. Pathogenic microorganisms that live in dental deposits secrete enzymes that destroy bone and periodontal ligaments, thanks to which teeth are held in their sockets.

Note: the rate of pocket formation and the progression of periodontitis are affected by: negative factors like smoking, lack of vitamins, unbalanced diet, the use of unsuitable hygiene products (paste, brushes).

Symptoms of periodontal pockets

Pocketing is the main symptom of this dangerous disease like periodontitis. The disease has inflammatory character and is expressed in the following terms:

the appearance of bleeding gums;
unpleasant, purulent smell from the mouth;
swelling, redness of the periodontal tissues;
gum pain during surgery hygiene procedures and eating;
the presence of dental deposits.

In advanced cases, the patient has suppuration from under the gums, exposure of the tooth necks and roots, loosening of the teeth. It is important to note that the development of periodontitis and the formation of periodontal pockets is always preceded by a disease such as gingivitis. That is, periodontitis does not develop at once, it is a rather long process, which is impossible not to notice. Therefore, it is very important to pass preventive examinations at the dentist every six months in order to be able to carry out conservative treatment of gingivitis when the first signs of inflammation are detected. If gingivitis develops into periodontitis, in which gum pockets form, treatment will have to be carried out with surgical methods.

Read: how stomatitis in cats is treated and what factors contribute to the development of this disease in pets.

Treatment Methods

We recommend you to as soon as possible contact a dentist-therapist or periodontist, having found a pocket in the gum between the teeth, as to treat it at home using various pastes, rinses and folk remedies not only inefficient, but also dangerous. All these methods will be powerless, a much more serious approach will be required here. Trying to cope with the problem on your own, you will lose time, and the disease will only get worse.

Treatment of periodontal pockets is a multi-stage process. As a rule, it includes:

examination of the oral cavity;
diagnostic manipulations: this can be probing the canals with a periodontal probe or panoramic shot teeth, which shows the depth of tissue damage;
cleansing pockets of dental deposits;
prescription of anti-inflammatory therapy.

Surgical methods

The main therapeutic measure should be the cleaning of pockets from dental plaque and granulation tissue. Surgical methods are used for this: open and closed curettage of pockets, patchwork operations.

Note: Dental deposits from the surface of the teeth and gum line are removed using an ultrasonic scaler. In the case of formation of gum pockets, this method will be ineffective, since, by inserting the scaler tip under the gum, the dentist has to work “blindly”. It is impossible to remove all dental deposits in this way. If the cleaning is carried out poorly, the tartar remaining in the pockets will cause the progression of the disease.

Closed curettage

One of the methods for treating a gum pocket is closed curettage. This is a procedure for cleaning pockets with special instruments - curettes or ultrasound without violating the integrity of the gums, that is, without dissecting it.

Closed curettage is effective on early stages diseases, when the depression between the soft tissues and the tooth is no more than 4 millimeters. In more complex cases, the technique will be ineffective, since with closed curettage, the doctor does not have the ability to visually control the process of cleaning the pockets.

The procedure is carried out under local anesthesia. Dental instruments are inserted into the periodontal recess, with the help of which subgingival deposits are first removed, and then the bottom of the pocket is processed. Next, the dentist scrapes granulation tissue from the bottom and walls of the pocket, and the treated area is washed with sodium chloride solution. In conclusion, a protective bandage is applied to the gum, the patient is told how to care for the oral cavity in the postoperative period.

Important: after closed curettage, the patient is scheduled for a second appointment with a periodontist in a month. During this time, the dimensions of the recesses should decrease, and shallow pockets should disappear altogether. At the second appointment, the doctor measures the pockets with a periodontal probe and, if the operation is ineffective, directs the patient to open curettage.

Open curettage

Open curettage involves cleaning pockets after gaining access to them through a gum incision. Peeling off the gum allows the dentist to get to the very bottom of the recess with the tool, and therefore to conduct a more thorough cleaning. The surgeon gets access to the roots of the tooth and bone tissue, visually controls the process of removing dental deposits and granulations.

The operation is performed using local anesthesia. In one session, processing of 7-8 teeth is possible.

The procedure begins with a gum incision in the area of the neck of the tooth and its exfoliation. Cleaning of the pocket in the gum between the teeth, as well as with closed curettage, is carried out with manual curettes and ultrasound. Next, an antiseptic treatment of tissues is carried out, and to reduce the volume of periodontal recesses, bone grafting is performed. Finally, the detached gum flap is returned to its place, the gum is sutured in the region of the gingival papillae. Sutures are removed after 10 days. For guard postoperative wound a special bandage is applied to the incision site.

Flap operation

Flap surgery has the same goals as open curettage. When it is carried out, dental deposits and granulation tissue are removed, synthetic bone tissue is planted to replace the atrophied bone.

The difference of the method from the one described above is that in the case of patchwork surgery, the gum is cut along the line 1-1.5 mm below the gingival margin. At the next stage, the cut off gum strip will be removed, because due to the inflammatory process in the tissues, it has undergone modifications and is no longer able to fit snugly against the tooth surface. The remaining gum after cleaning the pockets will be stretched higher - to the tooth necks - and sutured. This will prevent the necks from being exposed in the future.

The cost of surgical treatment

Treatment and cleansing of gum pockets are complex and therefore costly processes. Closed curettage of one site costs around 900-1500 rubles. If it is necessary to carry out open curettage, the patient will have to pay about 1500-3000 rubles for cleaning one pocket. The cost of flap surgery is even higher - from 3 thousand rubles per tooth.

Medical treatment

After the surgical stage, drug treatment is carried out with the help of antiseptic and anti-inflammatory drugs. It can be carried out at home. The doctor prescribes to the patient special solutions for rinsing, gels and ointments for applications.

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Treatment

In case of bleeding, you should consult a doctor. Medical procedures are carried out with the help of:

hand tools;
ultrasonic scaler;
photosensitizer;
surgery.

It is obtained from spirullins - seaweed. In the destroyed, inflamed cells under the action of the drug, photosensitizers develop, and after that, after a certain period of time, the specialist applies a laser beam to the gums. Its light acts on photosensitizers with the release of oxygen. In this case, an active oxidative reaction occurs, as a result of which the pathogenic flora and harmful bacteria die. When the affected tissue areas in the periodontal pocket are removed, it closes completely. With the help of one procedure, you can completely cure the pocket and get rid of inflammation, bleeding. If the treatment is carried out with a laser, then a protective formation is created on the mucous membrane, which prevents microbes from entering the gums, and also helps to restore the normal state of the pocket. After carrying out procedures to remove infected gum tissue, bone tissue should be restored. Successful therapy will be in case of complete restoration of periodontal joints and gum functions.

Many patients are interested in how to treat a pocket in the gum between the teeth with curettage technology, which is often recommended by specialists. It is considered effective and less painful. Distinguish between open and closed methods. During the procedure, gum pockets are thoroughly cleaned from deposits, tartar, and altered tissues.

The dentist prescribes a cleaning, taking into account the degree of the disease.

Closed curettage carried out by laser, ultrasound at a small depth of formation, not exceeding 5 mm.
Open curettage is a surgical operation that is performed with the use of anesthetics. In the process, an incision is made in the gums in the area of the interdental papillae, then cleaning is carried out and a means for effective healing is applied, after which the wound is sutured.

Preventive actions

brushing teeth;
use cleaning products, pastes with an abrasive effect, where deposits are removed with the help of solid particles and polished teeth;
use floss (dental floss) to clean between teeth;
a visit to the dental clinic for prevention at least twice a year;
compliance with additional recommendations of the doctor will reduce the growth of pockets, prevent complications of a different nature.

Treatment with folk remedies

Patients, when contacting a dentist, often ask if the dental pocket can be treated at home.

In this case, antiseptic solutions, decoctions from medicinal plants with a wound healing effect can effectively help. Several recipes can be found below.

Walnut. The recipe uses green peel. Grind a tablespoon of peel and pour olive oil in a warm state - 0.25 ml. Pour the product into a jar and close tightly, then refrigerate for a week with occasional shaking. After infusion, the resulting solution is filtered and the gums are lubricated five times during the day.
Plantain. Boiled water - 0.25 ml pour 20 grams of crushed plantain leaves and insist for at least an hour. They rinse the mouth four times throughout the day. In the summer, plantain juice helps a lot, for which the leaves are crushed in a blender and the juice is squeezed out with gauze. You can see the result of treatment with juice of gum pockets, the photo of which is presented below. A positive effect is achieved on the third day.
Eucalyptus oil. In 200 ml of boiled water, add 2 teaspoons of oil, stir, then rinse at least three times a day for seven days. The tool is excellent for strengthening the gums.
Hydrogen peroxide. 1 teaspoon of peroxide is added to 100 ml of water. The mouth must be rinsed twice a day for a week.
Sugar beet. Grate the beets and wrap the resulting slurry in the amount of one teaspoon in cheesecloth, do not squeeze the juice. The remedy is applied for fifteen minutes to the inflamed areas. The procedure is carried out at least three times a day with a new compress. The expected result can come after two days of regular treatment.
Highlander kidney. With this tool, treatment is carried out for a week. A spoonful of highlander is poured with 0.25 ml of boiled water, then infused for 25 minutes. It is necessary to moisten a piece of cotton wool in the resulting tincture, apply to the inflamed area, hold for 10 minutes. The agent is applied twice a day. The infusion is applied hot, but not boiled.
Leaves and stems of golden mustache. The leaves of the plant are applied to the places of inflammation, and rinse the mouth with a tincture of the stems. One spoonful of the plant is brewed with half a liter of boiling water and infused for 30 minutes. Rinse is carried out at least three times a day.
Lemon peels. Brew chopped lemon peel with a glass of boiling water, leave for half an hour and rinse your mouth three times a day for ten days.
Air, propolis. The resulting remedy is effective for inflammation, as an anesthetic, wound healing. Preparation is carried out in advance with the addition of vodka. This will require one liter of vodka of the best quality, grind the root in an amount of 250 gr., And propolis - 20 gr. Each component is taken separately, poured with five hundred milliliters of vodka and infused for ten days with daily shaking. After preparation, proceed to treatment. The treatment is carried out over four weeks. To do this, mix calamus tincture with propolis tincture in a teaspoon.

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The structure of periodontal pockets and the stage of the disease

Only periodontitis is accompanied by both infectious inflammation and tooth mobility. With periodontal disease, the destruction of connective tissues occurs without the formation of pus, and with gingivitis, the integrity of the dentition is preserved.

Periodontitis creates an ideal environment for the reproduction of microbes and bacteria. The bottom is filled with food particles, plaque and pus. The patient cannot fully clean the pocket on his own. Over time, the process is aggravated: the space is filled deeper and deeper with solid deposits, and the granulation tissue and alveolar processes atrophy.

Important! The main methods for examining gum pockets are radiography and probing. The picture clearly shows dark areas in the place where the soft tissues move away from the tooth.

There are three stages of the disease:

Light. The pocket depth is up to 3.5 mm.
Average. Destruction reaches 4 mm.
Heavy. Lesions exceed 5 mm.

Causes and symptoms

Poor or improper oral hygiene.
Eating a large amount of soft and carbohydrate foods: sweets, pastries, fast foods.
Lack of solid vegetables and fruits in the diet: hard food helps to get rid of plaque, promotes proper blood supply to the gums and teeth strength.
Bite defects: crowding, curvature of teeth.
Diabetes.
Hormonal disbalance.
Immunodeficiency.
Poor-quality or incorrectly made fillings, crowns, bridges, prostheses.

Important! Smokers are the most susceptible to plaque formation on their teeth. Nicotine resins cover the surface of the enamel, especially from the inside. For patients with addiction, professional cleaning is mandatory to avoid the risk of developing periodontitis.

The formation of periodontal pockets is accompanied by:

Itching in the gums.
Bleeding under mechanical impact.
Bad breath that does not disappear even after brushing and rinsing with solutions.
Separation of purulent contents when pressed.
Reaction to cold, hot, sour, sweet.
Discomfort while eating.
Visual enlargement of the tooth due to periodontal dystrophy.
Mobility and loosening of teeth - in a severe stage.

Treatment

Treatment of periodontal pockets is carried out in several ways. Which technique will be chosen depends on the depth of the lesion and the stage of the disease.

Laser cleaning

Important! Laser cleaning is usually performed without anesthesia. The procedure is painless, some discomfort is possible. Anesthesia is resorted to if the patient is hypersensitive or very afraid.

Photodynamic therapy

When exposed to a laser beam, an oxidative reaction begins with the release of oxygen. Microbes and bacteria die, and a protective layer forms on the mucosa. At the end of the procedure, the gum pockets are closed. Further therapy is aimed at restoring bone and granulation tissues.

curettage

The most common treatment. There are two types of procedure:

Open. It is carried out when the depth of the pockets does not exceed 5 mm.
Closed. It is used in the third stage of the lesion.

The general principle of both closed and open curettage is the same. The only difference is the excision of soft tissues. It is carried out with the second type of method.

The procedure consists of several stages:

Treatment of the oral cavity with antiseptic solutions: Chlorhexidine, Miramistin.
Anesthesia.
Mechanical removal of plaque, deposits, pus. If necessary, excision of the affected tissues.
Re-disinfection of mucous membranes.
The application of drugs that promote osseointegration - the growth of bone cells and the healing of gums.
Suturing (if there are incisions), applying a protective bandage.

Important! Usually they prefer to carry out an open type of curettage. It is more efficient and gives full access to gum pockets.

After the procedure, the recovery period begins. It lasts from 14 to 21 days. By the end of the third week, the connective tissues are completely restored.

Flap operation

Procedure steps:

Anesthesia.
Vertical excision of the gums in two places.
Exfoliation of the periosteal flap.
Mechanical removal of affected tissues, dental deposits, pus.
Antiseptic treatment and application of wound healing drugs that stimulate the growth of new cells.
Suturing.

Important! As the anesthesia wears off, patients begin to feel pain. Therefore, after the operation, it is recommended to take painkillers.

During the rehabilitation period, wound healing gels and antiseptic solutions for rinsing are prescribed. Most often, Asepta, Metrogil Denta, Solcoseryl, Actovegin are prescribed. If the disease is accompanied by an extensive inflammatory and purulent process, antibiotics are indicated.

Prices

The cost of treating periodontal pockets depends on the type of procedure and the amount of treated area. Average prices for therapy:

- Processing with the “Vector” apparatus – 2,500 per jaw,
- Closed curettage - 1,400 per tooth,
- Open curettage - 2,700 per tooth,
- Flap surgery – From 2,500 to 3,500 depending on the number of roots in the tooth,
- PDT — 1,500 for one gingival pocket.

Periodontal pocket appears with the development of periodontitis. The disease is accompanied by pain, bleeding, and in advanced cases - a violation of interdental bonds and adentia. Treatment is carried out with the help of laser devices, mechanical cleaning and surgical excision.

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The structure of the periodontal pocket

The periodontal pocket is the space freed as a result of the destruction of the periodontium. The inflammatory process violates the integrity of the periodontal joints, atrophy (resorption) of the alveolar bone begins. There is an area where there is no attachment of the gum to the surface of the tooth root.

Let us explain that the periodontium includes the periodontal tissues:

circular ligament of the tooth;
cement covering the root;
alveolar processes (the part that bears the teeth).

The bottom of the pocket is usually filled with granulation (connective) tissue, plaque and pus. There is a large number of destroyed leukocytes, which indicates a protracted inflammatory process. Particles of food constantly fall into the hole.

The defect is clearly visible in x-ray, it appears as a dark area between the teeth. For diagnostics, the probing method with hand instruments is also used.

Reasons for education

The main reason for the formation of periodontal pockets is poor oral hygiene, the accumulation of bacterial plaque and hard tartar.

Factors accelerating the formation of a defect:

the use of exclusively soft food - it is known that hard vegetables and fruits (carrots, apples, cabbage) help to clean teeth from plaque;
improper installation of a dental filling - the sharp edges of the filling can injure the gums;
malocclusion - leads to increased stress in certain areas of the periodontium;
some chronic diseases, such as diabetes;
hormonal imbalance;
immunodeficiency states.

Symptoms of inflammation

Putrid odor from the mouth that does not go away even after brushing your teeth;
bleeding gums, which increases with any mechanical impact;
pain and itching during meals, especially hard ones;
reaction to cold and hot;
release of purulent exudate;
visual lengthening of the tooth crown by lowering the gums;
on the late stage- loosening and displacement of teeth.

Depth measurement of periodontal pockets

Normally, the space between the neck of the tooth and the gingival margin should not exceed 1-2 mm. With a mild degree of periodontitis, a gingival pocket with a depth of 3.5 mm is formed.

The average severity of the inflammatory process is characterized by pockets with a depth of 4 mm. At the same time, a bone defect and destruction of the interdental septa already appear on the x-ray. At a late stage, the depth of the fossa exceeds 5 mm.

Treatment of periodontal pockets and periodontal disease

Periodontitis (inflammation) and periodontal disease (destructive process) should be treated in a complex manner. First stage - ultrasonic cleaning periodontal pockets, then carried out drug treatment. In the most advanced cases, surgical intervention is prescribed.

Ultrasonic cleaning

It is carried out by the apparatus "Vector". A special scaler nozzle generates ultrasonic vibrations that destroy hard dental plaques, including deep pockets. All pathogenic microflora is destroyed due to the antibacterial effect of ultrasound.

curettage

Open and closed curettage is the mechanical cleaning of pockets using hand instruments (scalers and curettes). Applicable when the pocket depth exceeds 3mm.

It is performed under local anesthesia and includes the following steps:

Antiseptic treatment of the entire oral cavity (rinsing with a solution of chlorhexidine or miramistin).
Scraping of softened tissues and purulent exudate at the bottom of the pocket, removal of bacterial deposits on the entire surface of the tooth, including the roots.
Washing the cleaned cavity with an antiseptic solution.
The imposition of a protective bandage on the gum.

The recovery period lasts 2-3 weeks. During this time, a new scar-connective tissue is formed.

Flap operation

The doctor makes 2 vertical incisions with a scalpel and peels off the mucoperiosteal flap. Then the standard mechanical cleaning of the pocket and polishing of the tooth surface is carried out.

At the end of the procedure, an osteogenic medicine is applied to the affected area (restores bone tissue), and the gum is sutured. The operation lasts about 40 minutes and, of course, includes local anesthesia.

For drug therapy prescribe healing solutions and gels for external use (drug cryogel, Furacilin, etc.). It is also recommended to use ointments that stimulate the epithelization of the gums (Actovegin, Solcoseryl). The doctor may prescribe a course of antibiotics.

The consequences of the formation of pockets in the gum

With the formation of periodontal pockets, the ligaments that hold the tooth in the alveolus (hole) are destroyed, the tooth roots are exposed, and the crown loses its natural support. As a result of this pathological process there is mobility of healthy teeth, bite is disturbed.

In this state, it is difficult for a person to chew even soft food. Ultimately, the interdental spaces increase more and more, and the loose teeth begin to fall out one by one.

Therefore, if you notice that the gum has moved away from the tooth, do not postpone a visit to the periodontist. It is not difficult to find such a specialist. Just use the search bar on our website.