A periodontist treats gum disease through a staged approach, starting with the least invasive options and escalating to surgery only when deeper damage requires it. The specific treatment depends on how far the disease has progressed, measured largely by the depth of the pockets between your gums and teeth. Healthy gums measure 1 to 3 millimeters deep. Once pockets exceed 3 millimeters and bleed when probed, periodontal disease is underway, and a periodontist has several tools to address it.
What a Periodontist Brings to the Table
A periodontist is a dentist who completed an additional three years of residency training focused entirely on the structures that support teeth: gums, bone, and the connective tissues that anchor everything in place. That extra training covers surgical anatomy, implant placement, bone grafting, sedation techniques, and the management of complex or systemic cases that go beyond what a general dentist typically handles. Your general dentist may refer you to a periodontist when gum disease hasn’t responded to standard cleanings or when bone loss shows up on X-rays.
The Initial Assessment
Before any treatment begins, a periodontist maps the health of your entire mouth. Using a thin instrument called a periodontal probe, they measure the pocket depth around every tooth, noting where gums bleed, where pockets have deepened, and where bone has pulled away. X-rays reveal how much bone support remains. Together, these measurements determine whether you’re dealing with early-stage gingivitis, moderate periodontitis, or advanced disease with significant bone loss. That assessment shapes the entire treatment plan.
Scaling and Root Planing: The First Line of Treatment
For mild to moderate gum disease, the standard starting treatment is scaling and root planing, often called a deep cleaning. It’s similar to a routine dental cleaning but reaches much further beneath the gum line. After numbing your gums with local anesthesia, the periodontist or hygienist removes plaque and hardite tartar from both above and below your gums using specialized instruments.
The root planing step is what sets this apart from a regular cleaning. Your tooth roots, normally hidden beneath the gums, develop rough patches where bacteria and tartar cling. Planing smooths those root surfaces so bacteria have a harder time reattaching. For many patients, this is enough to halt disease progression. The gums tighten back around the teeth as inflammation subsides, and pocket depths shrink over the following weeks.
Deep cleanings are typically done in one or two visits, with each session covering one side or one quadrant of the mouth. Some tenderness and sensitivity are normal for a few days afterward.
Pocket Reduction Surgery
When pockets remain too deep after scaling and root planing, bacteria continue to thrive in spaces that no toothbrush or floss can reach. At that point, a periodontist may recommend osseous surgery, also known as pocket reduction or flap surgery.
The procedure starts with anesthesia to numb the area. Sedation is also available if you prefer it. The periodontist then makes an incision along the gum line and carefully folds back the gum tissue to expose the tooth roots and underlying bone directly. With full visibility, they clean bacterial buildup off the root surfaces far more thoroughly than a deep cleaning allows. If the bone around your teeth has developed uneven craters or defects (common in periodontitis), the periodontist reshapes it to eliminate the deep pockets where bacteria hide. The gums are then stitched back into place, now fitting more snugly against the teeth.
Recovery follows a predictable pattern. Sutures dissolve or are removed within two to four weeks. Soft tissue healing and gum strength typically improve over one to three months. During that time, you’ll eat softer foods and follow specific cleaning instructions to protect the surgical site.
Bone Grafting and Regeneration
When gum disease has destroyed bone around the teeth, a periodontist can rebuild what was lost using bone grafts. The goal is to restore enough structural support to save teeth that might otherwise need extraction, or to prepare the jaw for dental implants later.
Several graft materials are available. Autografts use your own bone, harvested from another area of the jaw, chin, or elsewhere in the body. Because it contains living cells, your own bone has the strongest potential to stimulate new growth. Allografts use processed bone from a human donor, which acts as a scaffold for your own bone to grow into. Xenografts use processed bone from an animal source (typically bovine), treated at high temperatures to prevent immune rejection, and serve a similar scaffolding function. Synthetic options also exist, including processed bone matrix available as powder, putty, or injectable gel, as well as composites that combine multiple materials with growth-promoting proteins.
Your periodontist selects the graft material based on the size and location of the bone defect, your overall health, and whether the goal is to save existing teeth or prepare for implants. When bone grafting is involved, full healing takes longer than soft tissue procedures alone, sometimes several months before the new bone is solid enough to support a tooth or implant.
Gum Grafting for Recession
Gum disease often causes the gums to pull away from the teeth, exposing sensitive root surfaces and making teeth appear longer. A periodontist addresses this with gum grafting, and the technique depends on how much tissue is available and what the goal is.
A connective tissue graft takes tissue from a deeper layer inside the roof of your mouth and transplants it to the recession site. Because it uses only the inner connective layer, the donor site heals more comfortably and the results tend to blend well with surrounding tissue. This is the most common approach for covering exposed roots.
A free gingival graft takes a piece of tissue from the surface of the roof of your mouth, including both the outer and deeper layers. It’s used primarily to thicken thin, fragile gums rather than to cover roots. A pedicle graft skips the palate entirely and instead rotates nearby gum tissue over the recession area. This works only when there’s enough healthy tissue adjacent to the affected tooth.
Laser Treatment as an Alternative
Some periodontists offer laser-assisted treatment as a less invasive alternative to traditional surgery. The most established version, called LANAP (Laser-Assisted New Attachment Procedure), uses a specialized dental laser to remove diseased tissue and bacteria from periodontal pockets without scalpel incisions or sutures. The laser energy also stimulates the remaining tissue to reattach to the tooth root.
LANAP is the only laser gum treatment that has received FDA clearance for true regeneration of bone and tissue lost to gum disease. Patients who’ve had both traditional surgery and laser treatment consistently report less pain, less gum recession, less post-operative sensitivity, and significantly less downtime with the laser approach. It’s not appropriate for every case, particularly when extensive bone reshaping is needed, but it’s a meaningful option for many patients with moderate to advanced disease.
Ongoing Periodontal Maintenance
Treating gum disease is not a one-time event. After active treatment, whether nonsurgical or surgical, you’ll shift into a maintenance phase that looks different from the twice-yearly cleanings most people are used to. Patients with periodontitis typically need periodontal maintenance every three to four months. That interval is based on how quickly harmful bacteria recolonize pockets after cleaning. At six months, bacterial levels are often back to pre-treatment levels in someone with a history of gum disease. At three to four months, your periodontist can intercept that regrowth before it causes new damage.
These maintenance visits include pocket depth measurements, targeted cleaning below the gum line, and monitoring for any signs of disease returning. Your periodontist may adjust the frequency based on how your gums respond, your overall health, and risk factors like smoking or diabetes. Skipping or stretching these intervals is one of the most common reasons gum disease comes back after successful treatment.