A periodontist is a dentist who specializes in the gums, the bone that supports your teeth, and dental implants. After completing four years of dental school, periodontists train for an additional three years in a residency focused entirely on preventing, diagnosing, and treating gum disease, as well as placing implants and performing surgery on the soft and hard tissues around your teeth.
How They Differ From General Dentists
Your general dentist handles routine cleanings, fillings, crowns, and overall oral health. When gum problems go beyond what a general dentist typically manages, a periodontist steps in. That extra three-year residency (a minimum of 30 months of instruction, per accreditation standards) covers nonsurgical gum therapies, multiple types of gum and bone surgery, implant placement, and the connection between gum health and conditions like diabetes and heart disease. Think of a periodontist the way you’d think of a cardiologist compared to your primary care doctor: same foundational training, but a much deeper focus on one system.
Most people see a periodontist after a referral from their general dentist, usually because their gum pockets are too deep, they’re losing bone around their teeth, or they need implants. You can also see one on your own if you notice persistent gum bleeding, recession, or loose teeth.
Deep Cleanings and Nonsurgical Treatment
The most common starting point is a procedure called scaling and root planing, often referred to as a “deep cleaning.” A regular dental cleaning removes plaque and tartar around and just below the gum line. Scaling and root planing goes further, mechanically removing buildup all the way down to the roots of affected teeth. It’s considered the gold standard first treatment for periodontitis.
During the procedure, the periodontist may numb the area, then use hand instruments or ultrasonic tools to scrape away hardened deposits from root surfaces beneath the gums. Smoothing those root surfaces helps the gum tissue reattach more tightly to the tooth. In some cases, they’ll also prescribe a local antibiotic placed directly into deep gum pockets, or a short course of oral antibiotics, to knock back bacteria that mechanical cleaning alone can’t reach.
For many patients with early to moderate gum disease, this nonsurgical approach is enough to stabilize things. The periodontist will then monitor your progress and decide whether surgery is needed based on how your gums respond.
Gum Surgery
When deep pockets persist or tissue damage is too advanced for cleaning alone, periodontists perform several types of surgery. The specifics depend on what’s happening in your mouth, but the most common procedures fall into a few categories.
Pocket Reduction (Flap Surgery)
The periodontist folds back the gum tissue, removes bacteria and damaged tissue from around the tooth roots, then repositions the gums snugly against the teeth. This shrinks the pockets where bacteria thrive and makes future cleaning easier, both for you at home and at professional visits.
Gum Grafting
When gums recede and expose tooth roots, you’re at higher risk for sensitivity, decay, and continued bone loss. A gum graft adds tissue to the thinned or receded area. Periodontists commonly take tissue from the roof of your mouth and move it to the recession site. In some cases, they use donor tissue from a licensed tissue bank instead, which avoids a second surgical site in your mouth. Recovery typically involves a week or two of soft foods and mild discomfort.
Laser Gum Treatment
Some periodontists offer laser-assisted procedures as an alternative to traditional flap surgery. One well-known protocol uses a specialized laser fiber inserted into the gum pocket to selectively remove diseased tissue while leaving healthy tissue intact. The laser also helps form a stable blood clot that seals the pocket and promotes healing from the inside out. Patients who undergo laser treatment generally experience less bleeding, less swelling, less post-operative pain, and faster recovery compared to conventional surgery. The gums are also less likely to recede afterward.
Bone Grafting and Regeneration
Advanced gum disease destroys the bone that holds your teeth in place. Once bone is lost, teeth become loose and may eventually fall out. Periodontists can rebuild some of that lost bone using grafting procedures.
The graft material acts as a scaffold, giving your body a framework to grow new bone on. Several types of material are used. Bone taken from another site in your own body is considered the gold standard because it contains living cells that actively build new bone. Donor bone from a tissue bank is another common option. Animal-derived materials (most often from bovine or porcine sources) and synthetic materials like calcium-based cements and bioactive glasses are also widely used, especially for smaller defects. Your periodontist will choose the material based on the size and location of the bone loss.
Bone grafts are also used outside of gum disease treatment. If you’ve had a tooth extracted and the surrounding bone has shrunk, a graft can rebuild the ridge so the area is ready for an implant later.
Dental Implant Placement
Periodontists are one of the main specialists who place dental implants. Their training in bone and soft tissue makes them well suited for both the surgical placement of the implant post and the preparation of the site when bone or gum tissue is lacking.
Before placing an implant, the periodontist evaluates whether you have enough bone to support it. If not, they may perform a bone graft, a sinus lift (raising the sinus floor to create room for bone in the upper jaw), or a ridge modification to fill in areas where bone has resorbed. Once the site is ready, the titanium implant post is placed into the jawbone. Over the following months, the bone fuses with the implant in a process that creates a stable anchor. Your periodontist will create a treatment plan tailored to your specific anatomy and needs, coordinating with a restorative dentist or prosthodontist who builds the final crown or bridge on top.
The Conditions They Treat
Periodontists primarily treat gum disease, which exists on a spectrum. Gingivitis is the mildest form: red, swollen gums that bleed when you brush. It’s reversible with proper care. Periodontitis is what happens when gingivitis goes untreated and the infection spreads below the gum line, destroying bone and the fibers that attach your teeth to that bone.
Periodontitis is classified into four stages based on severity. Stage I involves minor attachment loss and shallow pockets, with no teeth lost. Stage II is moderate, with slightly deeper pockets and up to 15 to 33 percent bone loss in the affected area. Stage III means significant bone loss extending into the middle third of the tooth root or beyond, deeper pockets of 6 millimeters or more, and potentially five or more teeth already lost. Stage IV is the most severe, with the same level of destruction plus functional problems like drifting teeth, bite collapse, or so few remaining teeth that complex reconstruction is needed.
Periodontists also treat gum recession that isn’t caused by active disease (sometimes from aggressive brushing or thin tissue), infections around implants (peri-implantitis), and cosmetic concerns like an uneven gum line or a “gummy smile.”
Gum Disease and Overall Health
Part of what periodontists manage extends beyond the mouth. The relationship between gum disease and diabetes is well established and runs in both directions: poorly controlled blood sugar increases the risk and severity of gum disease, while active gum disease makes blood sugar harder to control. Multiple clinical trials have shown that treating periodontitis in diabetic patients reduces a key blood sugar marker by roughly 0.3 to 0.4 percent within three to four months, a meaningful improvement.
There’s also a growing body of evidence linking gum disease to cardiovascular problems. Bacteria from infected gums can enter the bloodstream and have been found inside arterial plaques. The chronic inflammation from periodontitis raises levels of inflammatory proteins in the blood, which contributes to arterial damage. Gum bleeding from periodontal inflammation is consistently associated with higher blood pressure and an increased risk of developing hypertension. Periodontists are trained in these connections and may coordinate with your physician when managing your care.
What Happens After Treatment
Gum disease is a chronic condition. Even after successful treatment, the bacteria that cause it never fully disappear, and they can repopulate within months. That’s why periodontists place patients on a maintenance schedule, typically every three to four months rather than the standard six-month interval most people follow for routine dental cleanings. These maintenance visits include measuring your gum pockets, removing any new buildup below the gum line, and catching early signs of recurrence before real damage happens. Sticking to this schedule is one of the most important things you can do to protect the results of your treatment.