In my last column, I spent time hopefully giving a clear understanding about periodontal disease and how it occurs.

As a quick overview, periodontal disease is an infection of the gums in which the supporting bone around the tooth is affected by a bacterial invasion. These bacteria come primarily from plaque and not removing it from the teeth. There are a number of secondary factors which can make it difficult to remove the plaque. Things like crowded teeth, consistency of saliva, kind of bacteria that normally live in your mouth, poorly contoured fillings or crowns and heredity are all examples of secondary factors which may make plaque removal more difficult.

That is a quick overview of how the infection occurs.

Let's assume that you are one of the 50 to 80 percent of the American population that has some area in their mouth that has some form of gum disease.

I have also explained in previous articles how the gum disease affects the health of the rest of your body.

So here you are sitting with your dentist discussing this disease and the extent that you have it.

What now?

How can this disease be helped and the bacterial infection be eliminated?

I would like to discuss the steps that are taken in treating the disease.

Periodontal disease is classified depending upon the depth of the pockets that are around the tooth.

Think of a shirt with a collar that you are wearing. The distance from the top of the collar down to the shoulder is like the distance from the top of the gum to the bone.

Once this distance gets past 3 millimeters, many studies have shown that regular brushing and flossing can't clean off the bacteria filled plaque. Plaque hardens into tartar after 24 hours and now you need help from the dental team.

Step one is to get off the tartar and plaque and make a clean root surface for healing to occur. Years ago, the treatment for periodontal disease was to get rid of the deep pockets by cutting the gum down so the depth of the pocket would be less. This is a rare procedure these days. The main focus on treatment is non surgical.

Think of the root of a tooth as a tree branch that you have cut and are holding in your hand. The bark of the tree is all rough and jagged. The perfect breeding ground for bacteria.

The first step is to remove all of the built up tartar on the tooth, or to remove the bark from the tree.

So translating that to the mouth, a section of the mouth is made numb and then either the dentist or the hygienist will gently removed the rough tartar from the teeth. We irrigate the pockets as we go along to flush out the debris that has been removed. A combination of hand instruments and ultrasonic instruments are used to get the root surface as smooth as possible.

The goal here is to allow the gum tissue to grow new fibers to the tooth to make the pocket less deep so that the patient can keep the plaque off their teeth. As previously mentioned, this means that the goal is to make the pockets to be less than 3 millimeters in depth.

It looks like this topic will be continued because there are several important points that still need to be made.

Also, I will discuss other ways of eliminating those deep pockets to allow for health of the gums.

Dr. Michael K. Keating, DDS, is a dentist in Auburn and can be reached at 252-7278 or e-mail him at DrMike@FingerLakesSmiles.com