A periodontist is a dental specialist who focuses on the supporting structures of the teeth: the gums, alveolar bone, and the ligaments that hold the teeth in place. They receive extensive training beyond general dental school, completing an additional two to three years of specialized residency. This training masters the prevention, diagnosis, and treatment of periodontal disease. While a general dentist provides routine care, they often refer patients to a periodontist when conditions affecting the gums and bone become complex or severe, especially for managing advanced infections or performing intricate surgical procedures.
Conditions Requiring a Periodontist
The primary reason a patient is referred to a periodontist is the presence of periodontal disease, which progresses through distinct stages. The initial stage is gingivitis, characterized by inflammation of the gums, often causing redness, swelling, and bleeding. Gingivitis is typically reversible with improved oral hygiene and professional cleaning, as the infection has not yet damaged the underlying bone.
If gingivitis remains untreated, the condition advances to periodontitis. This stage is marked by the destruction of the soft tissue and bone that anchor the teeth. This deeper infection causes the gums to pull away from the tooth, forming spaces known as periodontal pockets where plaque and calculus accumulate below the gum line.
Signs requiring intervention include persistent bad breath, visibly receding gums, and a chronic bad taste. During an examination, a periodontist uses a probe to measure the depth of the gum pockets. Measurements beyond 4 to 5 millimeters indicate significant disease progression and bone loss. The destruction of the supporting bone can lead to loose or shifting teeth, requiring the periodontist’s role in stabilization and tissue regeneration.
Non-Surgical Treatments for Periodontal Disease
The initial approach to treating established periodontitis begins with non-surgical procedures designed to halt disease progression. The foundation of this therapy is Scaling and Root Planing (SRP), commonly referred to as a deep cleaning. This procedure is distinct from a routine cleaning because it targets the areas below the gumline and within the periodontal pockets.
The scaling phase involves meticulously removing dental plaque and hardened calculus (tartar) from the tooth surface and the root below the gum tissue. Specialized instruments, including ultrasonic devices, are used to reach deep into the pockets to eliminate these bacterial deposits.
The second phase, root planing, focuses on smoothing the exposed root surfaces. Smoothing the surface removes residual toxins and contaminated cementum, creating a clean surface that discourages bacteria from recolonizing. This action promotes the reattachment of the gum tissue to the tooth root. Following SRP, periodontists may also place antimicrobial agents directly into the deep pockets to reduce the bacterial load and aid healing.
Advanced Surgical and Restorative Procedures
When non-surgical treatments prove insufficient to control the infection or when advanced bone and tissue damage has occurred, the periodontist implements various surgical and regenerative techniques.
Flap and Osseous Surgery
One common procedure is flap surgery, also known as pocket reduction surgery. The periodontist gently lifts the gum tissue away from the tooth, providing direct visibility and access to the deep pockets and underlying bone. This allows for thorough cleaning and removal of diseased tissue and calculus.
Once the area is clean, the periodontist may perform osseous surgery, which involves reshaping or smoothing the bone damaged by the infection. The goal of this bone correction is to eliminate irregular defects and reduce the size of the pocket, making the area easier for the patient to keep clean afterward. The gum tissue is then sutured back into a position that fits more snugly around the tooth.
Regenerative Procedures
For patients who have experienced significant tissue loss, regenerative procedures rebuild the mouth’s supporting structures. Bone grafting is used to reverse bone loss by placing natural or synthetic material in the area of the defect. This graft material acts as a scaffold, stimulating the body to regenerate new bone tissue to stabilize the tooth.
Gum grafting, or soft tissue grafts, is a technique used to treat receding gums that expose the vulnerable tooth root. Tissue is typically harvested from the roof of the mouth or a donor source and then carefully stitched onto the area of recession. This procedure improves aesthetics and protects the root from sensitivity and decay.
Dental Implants
Beyond treating disease, periodontists are specialists in the placement, maintenance, and repair of dental implants, which serve as artificial tooth roots. They evaluate the underlying jawbone and perform necessary procedures like bone augmentation or sinus lifts to ensure adequate bone volume. They then surgically place the titanium implant. This training ensures the long-term stability and health of the implant within the supporting bone and gum tissue.