Pocket reduction "gum" surgery (also known as osseous surgery and flap surgery) is a collective term for a series of several different surgeries aimed at gaining access to the roots of the teeth in order to remove bacteria and tartar (calculus). Ideally Drs. Dennis Nishimine, Dee Nishimine, & Sophia Tseng, would like the pocket depths to be less than 3mm in depth upon probing. The shallow pocket is cleansible and maintainable by your daily brushing and flossing. Pocket depths greater than 5 mm are not maintainable and we would like to reduce them for you with pocket reduction surgery.
The human mouth contains thousands of different bacteria at any given time. The bacteria found in Bacterial Plaque (the sticky substance on teeth) produce acids that lead to demineralization of the tooth surface, and ultimately contribute to periodontal disease, increase in pocket depth, and bone loss.
Periodontal infections cause a chronic inflammatory response in the body that literally destroys bone and gum tissues once they invade the subgingival area (below the gum line). Gum pockets form and deepen between the gums and teeth as the tissue continues to be destroyed.
Periodontal disease is a progressive condition which, if left untreated, causes massive bacteria colonization in gum pockets can eventually lead to teeth falling out. Pocket reduction surgery is an attempt to alleviate this destructive cycle, and reduce the depth of the bacteria-harboring pockets.
Reasons for the pocket reduction surgery
Pocket reduction surgery is a common periodontal procedure which has been proven effective at eliminating bacteria, reducing inflammation and saving teeth. The goals of pocket reduction surgery are:
Reducing bacterial spread – Oral bacteria has been connected to many other serious conditions such as diabetes, heart disease and stroke. Oral bacteria can travel to various parts of the body from inside the bloodstream and begin to colonize. It is important to decrease bacteria in the mouth in order to reduce the risk of secondary infection. If there are few to no bacteria there will be little to no infection.
Halting bone loss – The chronic inflammatory response induced by oral bacteria leads the body to destroy bone tissue. As the jawbone becomes affected by periodontal disease, the teeth lose their rigid anchor. When the teeth become too loose, they may require extraction.
Facilitate home care – As the gum pockets become progressively deeper, they become incredibly difficult to clean by the patient. The toothbrush and dental floss cannot reach to the bottom of the pockets, increasing the risk of further periodontal infections.
Goal of pocket reduction surgery- We would like to reduce the pocket depth so that you can then maintain them on a daily basis with your Brushing and Flossing. We want you to brush 4-5 times per day and floss 2x per day.
Enhancing the smile – An oral cavity that is affected by periodontal disease is not attractive to the eye. In fact, smiles may be marred by brown gums, rotting teeth and ridge indentations. Pocket reduction surgery halts the progression of gum disease and improves the aesthetics of the smile.
What does pocket reduction surgery involve?
Before recommending treatment or performing any procedure, Drs. Dennis Nishimine, Dee Nishimine, & Sophia Tseng will perform a thorough visual and x-ray examinations in order to assess the condition of the teeth, gums and underlying bone. Pocket reduction surgery may be performed under local or with sedation depending on the preferences of the patient.
The gums will be gently reflected back from the teeth and bacteria and calculus (tartar) will be eliminated. Scaling and root planing will generally be required to fully remove the calculus (tartar) from the surfaces of the roots. If the root is not completely smooth, root planing procedure will be performed to ensure that when the gums do heal, and re-attach. The gums will not reattach to rough, infected, or diseased roots.
The gums are then sutured back together with tiny stitches that are left in place for 7-20 days.
Though the gums will be more sensitive immediately following the procedure, there will be a significant reduction in pocket depth and a vast improvement in the condition of the teeth and gums.
In summary: "The gums are reflected back and all of the diseased bark is taken off of the tree and smoothed out. The gums are brought back together with sutures that will then melt away in 7-20 days."
If you have any questions about pocket reduction surgery or treatment for periodontal disease, please ask our Periodontal Team Members.