Bone and gum tissue should fit snugly around your teeth like a turtleneck around your neck. When you have periodontal disease, this supporting tissue and bone is destroyed, forming "pockets" around the teeth.
Over time, these pockets become deeper, providing a larger space for bacteria to live. As bacteria develop around the teeth, they can accumulate and advance under the gum tissue. These deep pockets collect even more bacteria, resulting in further bone and tissue loss. Eventually, if too much bone is lost, the teeth will need to be extracted.
Pocket reduction or flap surgery may be recommended if you have pockets that are too deep to clean with daily at-home oral hygiene. During this procedure, the periodontist separates the gum from the tooth, folds the flap of gum tissue back, removes the disease-causing bacteria, and then sutures the tissue into a new position. In some cases, irregular surfaces of the damaged bone are smoothed to limit areas where disease-causing bacteria can hide. This allows the gum tissue to better reattach to healthy bone. After healing, stitches dissolve or are removed.