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Periodontal pockets are spaces or openings surrounding the teeth under the gum line. These pockets can become filled with infection-causing bacteria.

Periodontal pockets are a symptom of periodontitis (gum disease), a serious oral infection.

Periodontal pockets can be treated and reversed with good oral hygiene or with dental treatment. But when left untreated, periodontal pockets can lead to tooth loss.

Read on to learn about periodontal pockets and solutions for their treatment as well as prevention and risk factors you can control.

Teeth are normally held snugly in their sockets by gum tissue and bone.

When you have gum disease, tissue erosion can occur, causing gaps known as pockets to surround teeth. These pockets can capture and hold bacteria, causing damage to the jaw bone where teeth are anchored into sockets.

Periodontal pockets are measured in millimeters (mm). A millimeter is about the width of a credit card. One inch equals 25.4 mm.

Not all pockets are immediately considered harmful.

Size and severity of periodontal pockets

  • 1 to 3 mm: normal
  • 4 to 5 mm: early or mild periodontitis; gum disease is present
  • 5 to 7 mm: moderate periodontitis
  • 7 to 12 mm: advanced periodontitis
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The periodontal pocket process starts with gingivitis, a gum infection caused by the buildup of plaque in the mouth.

Plaque is a sticky film composed of bacteria and food debris that form on teeth. Plaque can be removed by daily brushing and flossing. When it’s not removed, plaque can cause:

  • inflammation
  • infection
  • further advancement of gum disease
  • dental calculus
  • tartar

When gingivitis is left unchecked, it eventually turns into periodontal disease, which has several stages of severity. Periodontal disease in its later stages is referred to as periodontitis.

During this process, plaque continues to eat away at gum tissue and eventually bone, causing the pockets around teeth to deepen and enlarge.

If you don’t floss and brush at least twice daily, you increase your risk of periodontal disease significantly.

This may be especially true if you eat a high-sugar diet. Sugary foods and drinks can accelerate tooth decay and gingivitis.

Other risk factors include:

Your dentist will measure the size of the space between your gums and teeth with a periodontal probe.

Periodontal probes measure periodontal pockets in millimeters (mm). The depth and size of the periodontal pocket help determine what treatments are needed.

If the gap between your teeth and gums measures between 1 – 3 mm, it’s considered normal and healthy.

Since a toothbrush can’t reach easily below 3 mm, a pocket depth of 4 mm may be cause for concern.

In these cases, your dentist will assess the condition of your gums. If they bleed or look inflamed and puffy, a periodontal pocket may have formed which requires cleaning, or other treatments.

Periodontal pockets that require treatment may range anywhere from 5 to 12 mm. Pockets over 5 mm are usually too deep to be cleaned and need more aggressive procedures.

But even microscopically small pockets can hold bacteria that will grow, damaging oral health.

If a pocket is deep and bone loss may have occurred, your dentist will take an X-ray to assess how much damage was done to the tooth’s structure.

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Stages of gum disease and associated periodontal pocket depths.

Your treatment will be determined by the size and depth of the periodontal pocket and the condition of your gums and bone.

Professional cleaning

Small pockets of 4 or 5 mm may be reduced in size with professional dental cleanings along with aggressive at-home oral hygiene habits.

Your dentist will recommend you brush and floss at least twice daily. You may also be given an antibacterial mouthwash.

These practices will help remove plaque and tartar from around teeth, reducing gum inflammation.

Scaling and root planing

This non-surgical dental procedure is done with a laser or ultrasonic device. Hand instruments, like curettes and scalers, are also common.

Scaling and root planing helps remove bacteria, plaque, and tartar from around teeth. It also smooths each tooth’s root surface so that gum tissue can reattach itself to the tooth. This helps shrink the pocket.

In some instances, an antibacterial gel will also be placed directly into the pocket to attack bacteria and reduce inflammation.

Your dentist may prescribe antibiotics or an antibiotic mouthwash to reduce bacteria after this procedure.

Pocket reduction (flap) surgery

If you have a deep pocket or bone loss but the tooth may still be saved, your dentist may recommend this procedure. It’s usually done by a specialist, such as a periodontist.

Pocket reduction surgery procedure

  1. The periodontist will make small incisions in the gums that allow a portion of gum tissue to be lifted or flapped back. This exposes the tooth’s roots so that deeper scaling and root planing can take place.
  2. If bone loss has occurred, the remaining bone will be smoothed down, eliminating grooves where bacteria may thrive.
  3. The gum tissue will then be sutured back in place.
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Treatment research

A 2019 study explored the effectiveness of engineered periodontal membrane that can help regenerate of lost gum tissue in rats.

These synthetic tissues might help activate the growth of biological tissue.

While interesting, this fix for periodontal pockets is a long way off, and doesn’t take the place of good oral hygiene.

No matter what the underlying cause may be, lifestyle habits can dramatically prevent the occurrence of gum disease and periodontal pockets.

Try the following to help prevent periodontal pockets:

  • Brush at least twice daily with a soft-bristle tooth brush or an electric tooth brush.
  • Use a fluoride toothpaste.
  • Use a mouthwash that fights and dissolves plaque.
  • Floss regularly to remove bacteria and food particles from between teeth.
  • If you have dry mouth, use a mouthwash that doesn’t contain alcohol. You can also try chewing sugar-free gum, sipping water, and avoiding caffeine.
  • Stop all tobacco use.
  • Eliminate sugary foods and drinks from your diet.
  • If you eat candy, drink soda, or any other sugary substances, always rinse with water immediately afterwards.
  • Avoid junk food and eat a healthy diet that contains lots of fruits, vegetables, and other foods containing vitamin C.
  • See your dentist regularly (about once every 6 months) for a deep, professional tooth cleaning.

Periodontal pockets contain bacteria. When left untreated, this unchecked infection can continue to thrive and grow. Complications can include:

Periodontal pockets are a sign of advanced gum disease.

The size of the pocket as well as the condition of the gums and bone will determine the treatment needed to reduce pocket size. Treatments range from professional cleanings to surgical solutions.

When left untreated, severe infection, and tooth or bone loss may occur.

Periodontal pockets and periodontal disease can be avoided by practicing good oral hygiene and by seeing your dentist regularly for cleanings.