For periodontal disease, there are two basic criteria. First is pocket depth. Generally, up to 4 mm is normal. You can properly clean pockets up to 4 mm. 4 - 6 mm is deeper and usually will require scaling and root planing in order to get them clean and attempt to shrink the pockets down to an acceptable level. Often, an antimicrobial agent is placed. Greater than 6-8 mm requires periodontal surgert to reduce the pocketting level. 8+ mm usually means a hopeless tooth requiring extraction.
There are a number of factors that can influence the treatment planning decision of your dentist. A 3-4 mm pocket that bleeds indicates inflammation (a sign of onfection) and gingivitis. Treatment is indicated. A 4-5 mm (and sometimes even 6 mm) pocket that does not bleed may require no treatment since there is no inflammation present. Mobility of the teeth plays a factor in treatment options. A tooth with a 7-8mm pocket that is firm may respond favorably to treatment while one that is very mobile (with the same pocket depth) may require extraction.
Other factors play a role as well. If the patient is a smoker, then theyare more likely to develop periodontal disease and will not respond as favorably to treatment as a non--smoker. Same with uncontrolled diabetics.
Periodontal disease is a bacterial infection. (Oral antibiotics will not cure periodontal disease since the medication will not get to the site of infetion.) The bacteria are normally present in the mouth and do not cause problems unless they are allowed to organize themselves. Organization occurs by allowing a particular tooth surface to go unclean. Not flossing is the number one reason, not brushung properly (allowing some areas to go uncleaned) is another, and pocket depth beyond 4 mm is a third. If you want to see the effectiveness of your oral hygiene routine, get some disclosing tablets and after you finish, use them. If red still appears on any surface of your teeth, you've missed that spot.
With periodontal probing the numbers are telling you how healthy your bone is. The healthy numbers are 1, 2, 3. Usually 4's arent to much to worry about because it ususally just means that your gums are a little inflammed. I really wouldnt worry to much unless you are getting a TON of 4's or any larger numbers than that.
With a conservative approach teeth with pockets above 8 do not necessarily need to be removed. I was told 9+ by one dentist but i refused to have all my teeth pulled. I had mostly 9-14's. After scaling and root planing, the largest I had was a 9, but many of my large numbers had been reduced to 5's and 6's and even a few 4's.. I am now post flap surgery and do not yet know the final outcome of my teeth but I am confident that I and my periodontist have saved many of my teeth. I have an appt soon to probe the areas which had surgery and see how they are doing. Some of my teeth were also mobile and I have some significant bone loss so the situation was pretty bad..but I feel my teeth are very strong and am unwilling to give up on them.
some people may not want to go thru all I have to save teeth, but i personally feel it is well worth it.
Those of you reading this with deep pockets, if you feel you would like to try to save your teeth, seek another opinion. Not every dentist agrees on how to handle these situations. Many of them do not want to take the time to try to save the teeth and feel implants or dentures are so much easier. Others will work with you to try to save them where ever possible.
i have medium to somewhat bad gingivitis. pockets are around 2 to 3....with a few spots at 4. had scaling done 2 weeks ago. REALLY helped. gums got pink and firm in a matter of days. still some redness is present at times, but im working to reduce that.
I just had my last flap surgery a few days ago. It has been almost 6 mos since the first quad was done so my dentist is waiting to do probing until 6 months but she said based on what she can see so far she thinks I will be able to keep the rest of my teeth but i will have to do 3 cleanings a year to make sure to keep any further infection away...As I said, the other 3 dentists i met with before going with this one wanted immediately to pull about 14 teeth.
From what i have read since getting this disease, 4 pockets should not be a problem as long as you keep up your flossing and regular dental cleanings. I have bone loss so whether the bone matter she placed under my gums stimulates new bone growth will be a big factor in how long i can keep the rest of my teeth, but meanwhile they all feel strong to me(and always have!!!this is a very silent disease in my case).