Keeping 5mm pocket clean-Question for Docs

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BobKK47 - 25 Dec 2006 22:14 GMT

A few years ago, I had pocket surgery on the buccal side of #15. It's
located right in the middle of the tooth, not between the teeth. The
pocket was 9mm and after the surgery, it was reduced to 5mm, which is
what it is currently.

Both my periodontist and my general dentist tell my I'm doing a good
job keeping the pocket clean. I brush, floss and use a standard
rubber-tip device, to clean the pocket, every night. My periodontist
told me that the most important thing is to use the rubber tip to get
into the pocket to remove as much debris etc. as possible.

I asked my periodontist about another surgery in order to get the
pocket down to 2 or 3mm, as I've always heard that anything over 3mm is
impossible to clean well with normal home hygiene. He said that it
would not be necessary. I should also note that I get a professional
cleaning every 4 months.

I would prefer not to get another surgery done for obvious reasons.
Does the above advice sound reasonable and can I "live" with a 5mm
pocket? Thanks.

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Alexander Vasserman DDS - 26 Dec 2006 00:54 GMT

if you are able to keep it at 5mm. A time will come when you will not
be able to do that anymore.
if it is possible to get that pocket down more than it might be worth a
shot.
hard to say without knowing what was done.

> A few years ago, I had pocket surgery on the buccal side of #15. It's
> located right in the middle of the tooth, not between the teeth. The
[quoted text clipped - 16 lines]
> Does the above advice sound reasonable and can I "live" with a 5mm
> pocket? Thanks.

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Steven Bornfeld - 26 Dec 2006 02:27 GMT

    If the pocket is monitored I don't see any real danger. Surgery can
always be done later if things head south.
    Tough to make specific recommendations, but most upper molars have two
buccal roots, and the pocket may well be into the furcation (separation)
between the roots if they are separated. Furcations are tough to
maintain, hence your periodontist's emphasis on this area (though I
would guess most wouldn't recommend the rubber tip for this purpose).
It may well be that the prognosis of the tooth is not great, and if the
pocket deteriorates (surgery or no) the tooth may be questionable enough
not to warrant surgery.
    In any case, there is no need to worry about that now, though it may be
in your periodontist's mind that this may not be worth the effort.

Steve

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BobKK47 - 27 Dec 2006 21:16 GMT

> If the pocket is monitored I don't see any real danger. Surgery can
> always be done later if things head south.
[quoted text clipped - 10 lines]
>
> Steve

Steve,

Thanks for the feedback. The RDH who I saw the last time I had a
cleaning did mention the term "Bi-Furcation" when taking about the
pocket. Regarding use of the rubber tip, you indicated that most
periodontists would not recommend this. Is this because I could
possibly injure the gum, and should I refrain from using this? What
other way would there be to keep it as clean as possible? What about a
waterpik? Thanks again.

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Mark & Steven Bornfeld - 27 Dec 2006 22:02 GMT

>> If the pocket is monitored I don't see any real danger. Surgery can
>>always be done later if things head south.
[quoted text clipped - 20 lines]
> other way would there be to keep it as clean as possible? What about a
> waterpik? Thanks again.

I did not mean to contradict what you were told. The rubber tip can be
effective, and is handy to use in the handle of the brush. I prefer the
Perio Aid, which uses a toothpick in a holder, but it means you need
another instrument, and simpler is better.
Historically, the rubber tip is a relic of the days when it was thought
that gum disease was caused by venous stasis in the gingivae, and the
aim was to massage the gums. It can be abused, and I've seen
significant gum recession from its misuse. However, used correctly it
does a pretty good job of cleaning the furca. I'd avoid using the
Waterpik, esp. using the stream into the pocket--that can cause gum
abscesses.

Steve

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Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

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