A periodontist is a dentist who specializes in the structures that support your teeth: your gums, the ligaments that anchor teeth in place, and the surrounding jawbone. While general dentists handle routine care, periodontists complete three additional years of residency training focused specifically on preventing, diagnosing, and treating gum disease, placing dental implants, and performing surgical procedures to restore damaged tissue and bone.
What a Periodontist Treats
The word “periodontics” comes from the Greek words for “around” and “tooth,” which captures the specialty well. A periodontist treats conditions affecting everything surrounding your teeth, not the teeth themselves. That includes four key structures: the gums, the connective tissue fibers that attach teeth to bone, the hard layer covering tooth roots, and the section of jawbone that holds tooth sockets.
The primary condition periodontists manage is periodontitis, commonly called gum disease. This is a chronic infection that destroys gum tissue and bone over time, eventually loosening teeth if left untreated. Periodontists also treat gum recession (where the gum line pulls away from the tooth), bone loss in the jaw, and infections around dental implants.
Non-Surgical Treatments
The first line of treatment for gum disease is almost always non-surgical. Scaling and root planing, often called a “deep cleaning,” is considered the gold standard of periodontal therapy. During this procedure, the periodontist cleans below the gum line to remove hardened plaque (calcite deposits called calculus) from the root surfaces of your teeth. This allows the gum tissue to heal and reattach more tightly to the tooth.
Deep cleaning is especially effective for moderately deep gum pockets in the 4 to 6 millimeter range. For context, healthy gums typically measure 1 to 3 millimeters deep when probed. The results of non-surgical treatment determine what happens next. If pockets shrink and bleeding stops, you may only need regular maintenance visits. If deep pockets persist, surgery becomes the next step.
Surgical Procedures
When gum disease is advanced, periodontists turn to surgical options. These fall into three main categories.
Flap surgery involves lifting the gum tissue back to access and clean the root surfaces underneath deep pockets (6 millimeters or more). This is more effective than non-surgical cleaning for severe pockets because it gives the periodontist direct visibility and access to the affected bone and roots.
Resective surgery reshapes or removes damaged bone and tissue to eliminate deep pockets entirely. The trade-off is that it can increase gum recession, sometimes causing tooth sensitivity or cosmetic changes. Periodontists weigh these factors when recommending it.
Regenerative surgery takes the opposite approach, using grafting materials or specialized membranes to encourage your body to rebuild lost bone and tissue. This is particularly useful when bone loss has created deep craters around a tooth that could otherwise be saved.
Gum Grafting for Recession
Gum recession exposes tooth roots, which can cause sensitivity, increase the risk of root decay, and change the appearance of your smile. Periodontists correct this with gum graft surgery. The most common technique involves taking a small piece of tissue from the roof of your mouth and stitching it over the exposed root area. In some cases, periodontists use donor tissue from a licensed tissue bank instead, which means no second surgical site in your mouth and a more comfortable recovery.
Dental Implant Placement
Periodontists are one of the specialists most commonly trained to place dental implants. Their expertise in bone and gum tissue makes them well suited for this work, since a successful implant depends entirely on the health of the surrounding structures.
Their implant-related services go well beyond simply placing the post. If your jawbone is too thin or has lost volume after tooth loss, a periodontist can perform bone grafting or a sinus lift to rebuild the foundation before placing an implant. They also reshape gum tissue around implants to create a natural-looking appearance and make the area easier to keep clean.
Once implants are in place, periodontists monitor for a condition called peri-implantitis, an infection that causes bone loss around the implant. This is essentially gum disease for implants, and periodontists treat it with deep cleaning, surgery, or regenerative procedures to save the implant when possible.
Laser Therapy
Many periodontists now use laser technology alongside or instead of traditional surgical tools. Laser therapy targets diseased tissue and bacteria within gum pockets while leaving healthy tissue largely intact. Patients who undergo laser treatment typically report less pain, less swelling, and faster healing compared to conventional surgery. The reduced noise and vibration also make the experience more comfortable than mechanical instruments.
Research shows that combining laser therapy with traditional deep cleaning can be more effective than deep cleaning alone, particularly for managing deeper pockets and more severe gum disease. The laser helps reduce pocket depth, improve tissue attachment, and decrease bleeding.
How Periodontal Exams Work
During a periodontal exam, the periodontist uses a small instrument called a periodontal probe, essentially a tiny ruler, to measure the depth of the space between your gums and each tooth. Six measurements are taken around every tooth. Healthy readings fall between 1 and 3 millimeters. Pockets of 4 millimeters or deeper indicate tissue attachment loss and possible bone damage.
The periodontist also checks for bleeding when the probe touches the gum (a sign of active inflammation), records any gum recession, and evaluates whether bone loss has reached the area where tooth roots branch apart. Combined with X-rays, these measurements let them classify your condition as mild, moderate, or severe and build a treatment plan accordingly.
Ongoing Maintenance After Treatment
Gum disease is a chronic condition. Even after successful treatment, the bacteria responsible can recolonize within a few months. That’s why periodontal maintenance visits are scheduled every 3 to 4 months rather than the standard 6-month interval used for routine dental cleanings.
These visits are also different in scope. A regular cleaning is preventive, removing plaque above the gum line and polishing teeth. Periodontal maintenance is therapeutic. It targets areas below the gum line that regular cleaning can’t reach, monitors pocket depths for any signs of disease returning, and adjusts frequency based on how your body responds over time.
Why Gum Health Affects the Rest of Your Body
Periodontists increasingly consider the connection between gum disease and overall health. Severe periodontitis is associated with a 25 to 90 percent increased risk of cardiovascular disease, even after adjusting for other risk factors. One study found that 91 percent of patients with cardiovascular disease had moderate to severe gum disease, compared to 66 percent of heart-healthy patients.
The relationship between gum disease and diabetes runs in both directions. Diabetes increases your risk of developing periodontitis, and active gum infection makes blood sugar harder to control. There are also documented links between periodontal disease and preterm low-birth-weight babies, as well as osteoporosis, since both conditions involve progressive bone loss.
Signs You May Need a Periodontist
Your general dentist should refer you to a periodontist if your gum disease is anything beyond mild. Common symptoms that prompt a referral include bleeding gums, persistent bad breath, gum recession, loose teeth, pain when chewing, pus along the gum line, and gums that look red, swollen, or purplish. Changes in how your bite fits together can also signal advancing bone loss. Severe periodontitis typically requires surgical treatment that falls outside the scope of general dentistry.
Training Beyond Dental School
All periodontists first complete dental school to earn a general dentistry degree. They then enter a periodontics residency program lasting a minimum of 30 months across three consecutive academic years. During this residency, they receive intensive training in gum and bone surgery, implant placement, tissue regeneration, and the management of complex cases involving multiple systemic health conditions. This additional training is what distinguishes them from general dentists who may offer some periodontal services but lack the specialized surgical expertise.