A periodontist is a dental specialist with an additional two to three years of focused residency training after dental school, concentrating exclusively on the supporting structures of the teeth. Receding gums, known clinically as gingival recession, is the loss of gum tissue that exposes the tooth root surface, often leading to sensitivity and a higher risk of decay. While a general dentist handles mild gum issues, a periodontist is the specialist required when recession is severe, actively progressing, or when advanced surgical correction is necessary to restore lost tissue. Their role is to diagnose the underlying cause and provide the specialized treatments needed to stabilize the gum line and prevent further damage.
Diagnosing Recession and Initial Steps
The periodontist’s first step involves a comprehensive diagnostic examination to determine the extent of the recession and its primary cause. A periodontal probe is used to precisely measure the distance between the cementoenamel junction—where the enamel meets the root—and the current gum margin, quantifying the tissue loss. They also measure periodontal pocket depths to assess for active gum disease, which is a common contributor to recession.
Identifying the root cause is a significant part of the diagnosis, often including aggressive horizontal tooth brushing, untreated periodontitis, or genetic predisposition. If the underlying cause is periodontitis, the periodontist will first attempt non-surgical therapy. This involves a deep cleaning procedure called scaling and root planing, which meticulously removes calculus and bacterial toxins from the tooth root surfaces below the gum line. This initial treatment is designed to eliminate inflammation and halt the progression of the disease before considering surgical intervention.
Specialized Gum Grafting Procedures
When non-surgical efforts are insufficient to cover the exposed root or when the recession is severe from the outset, the periodontist utilizes specialized surgical techniques collectively known as gum grafting.
The most common and predictable method for achieving root coverage is the Connective Tissue Graft (CTG). This involves creating a flap on the roof of the mouth and harvesting the sub-epithelial connective tissue from underneath, leaving the outer layer intact. This tissue is then placed over the exposed root and secured with sutures, acting as a scaffold to promote the growth of new gum tissue that blends naturally with the existing gum line.
Another option is the Free Gingival Graft (FGG), which is often chosen when the goal is to reinforce a thin band of gum tissue rather than purely aesthetic root coverage. The FGG involves taking a small piece of tissue that includes both the outer epithelial layer and the underlying connective tissue directly from the palate. While highly effective at creating a thicker, more robust band of attached gum, the FGG may sometimes result in a slight color or texture difference compared to the surrounding gum tissue.
For localized recession where sufficient healthy gum tissue exists adjacent to the exposed root, the periodontist may perform a Pedicle Graft. This technique involves partially cutting a flap of gum tissue next to the recession site, keeping one edge attached to maintain its original blood supply. The flap is then rotated or slid over the exposed root and sutured into its new position, which often leads to faster healing due to the preserved circulation.
A modern, less invasive alternative is the Pinhole Surgical Technique (PST). Instead of harvesting tissue, this method uses specialized instruments inserted through a tiny pinhole to gently loosen and reposition the patient’s existing gum tissue over the recession. Collagen strips are often placed underneath the repositioned tissue for stabilization, making it a suture-free procedure that typically results in a quicker recovery time.
Ensuring Long-Term Gum Health
Following any gum grafting procedure, the periodontist guides the patient through a specific post-operative care protocol to ensure the graft’s success. Patients are instructed to avoid brushing or disturbing the surgical site and to adhere to a soft, cool diet to prevent trauma. They must also refrain from strenuous activity and avoid actions that create suction, such as using a straw, which could dislodge the healing tissue.
Long-term success depends heavily on the patient modifying the habits that initially caused the recession. The periodontist provides instruction on proper oral hygiene, often recommending a switch to a soft-bristled toothbrush and demonstrating a gentler brushing technique to prevent future mechanical wear. The patient then enters a specialized maintenance phase involving regular periodontal maintenance appointments, often three to four times a year. These visits allow the periodontist to monitor the health of the graft, measure pocket depths, and perform meticulous cleanings.