Periodontal Pockets: Understanding Causes & Treatment Options

Periodontal pockets (>3 mm) form when gum inflammation destroys attachment fibers and bone. Treatment is staged by severity:

1. Non-Surgical (Pockets 4–5 mm)

• Scaling and root planing (SRP): Mechanical debridement below gumline
• Adjunctive antimicrobials: Local (minocycline microspheres, chlorhexidine chips) or systemic (doxycycline, azithromycin)
• Re-evaluation at 4–6 weeks

2. Surgical (Pockets ≥6 mm or non-responsive)

• Flap surgery: Access for thorough debridement, osseous recontouring
• Regenerative procedures: Bone grafts, membranes, growth factors (GTR)
• Resective: Gingivectomy, apically positioned flap

3. Advanced/Adjunctive

• Laser therapy (LANAP): Disinfection, tissue regeneration
• Pocket irrigation: Daily home use (chlorhexidine, essential oils)

4. Maintenance (Critical)

• 3-month periodontal maintenance cleanings
• Meticulous home care (interdental cleaning essential)
• Risk factor control (smoking cessation, diabetes management)

Periodontist coordinates with general dentist for comprehensive care.