If one of my teeth has a perio pocket, does it mean that I have periodontal disease?

If the pocketing is isolated to one tooth, it can indicate that the tooth has a "perio involvement" but the patient may not have other teeth that are involved. This is not unusual at all, especially if the tooth has an anatomy that tends to promote pocketing. Often teeth exhibiting deep vertical cracks can develop a pocket adjacent to a crack. Similarly teeth that have a strong groove on their proximal surface often can be difficult to clean and can become periodontally involved as well. Some teeth have roots that are touching the proximal surfaces of roots of adjacent teeth (a root proximity problem) and this can also contribute to the development of pocketing.

That being the case, these patients often do not exhibit generalized periodontal disease, but instead display a more focalized type in which one,two or three teeth are involved and once these issues are taken care of their mouth is generally in a state of good periodontal health. Unfortunately, often the cure involves extraction of the involved teeth since the structural problems causing the pocketing remain until the teeth are removed, but not always.

Patients who use a Waterpik, and are taught excellent meticulous oral hygiene can do better and when they also have appropriate perio treatment may be able to maintain the involved teeth( especially if they maintain a schedule of periodontal cleaning, every three months).  In my practice, with a cooperative patient, we have been able to maintain what some dentists would term "hopeless" teeth for years. Of course this doesn't apply to every situation and patients should have a thorough evaluation before determining what treatment plan is appropriate for their particular situation.

from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2018/06/if-one-of-my-teeth-has-perio-pocket.html - http://lspindelnycdds.blogspot.com/