A periodontist is a dental specialist focused on the supporting structures of the teeth, collectively known as the periodontium. These structures include the gums, the periodontal ligament, and the jaw bone. Periodontists are experts in the prevention, diagnosis, and treatment of conditions affecting these tissues, managing the full spectrum of gum health. This specialized focus ensures patients with complex needs receive the advanced care necessary to preserve natural teeth and overall oral function.
Specialized Training and Scope of Practice
Becoming a periodontist requires advanced education beyond general dentistry. After completing four years of dental school (DDS or DMD), the specialist must complete an additional three years of intensive residency training. This specialized program focuses entirely on periodontology and related surgical techniques, providing a deep understanding of tissue biology and disease progression.
This extended training differentiates a periodontist from a general dentist, whose primary focus is routine maintenance. The periodontist’s scope of practice centers on managing inflammatory diseases of the gums and placing dental implants. They are experts in both the soft tissues (gums) and the hard tissues (bone) that anchor the teeth, enabling them to handle complex cases involving significant bone loss or surgical intervention.
Core Conditions Managed by a Periodontist
Periodontists manage the progression of periodontal disease, which begins with the reversible stage known as gingivitis. Gingivitis is characterized by inflammation and bleeding of the gums, often caused by the accumulation of bacterial plaque along the gum line. If this irritation is not managed, it can progress to the more destructive and irreversible condition called periodontitis.
Periodontitis involves the destruction of soft tissue and the alveolar bone that hold the teeth in place. The bacteria trigger a host immune response that damages the supporting structures of the teeth. This destruction leads to the formation of deep spaces, known as periodontal pockets, between the teeth and gums. As the disease advances, the loss of attachment and bone resorption increases significantly.
Another common condition treated is gum recession, where the gum tissue pulls away from the tooth surface, exposing the root. This exposure can lead to increased tooth sensitivity and a higher risk of root decay. The periodontist’s role is to halt the progression of these conditions and, where possible, regenerate the lost tissue and bone.
Advanced Treatment Procedures
When non-surgical methods are insufficient, periodontists employ advanced procedures to manage disease and restore oral health. The initial non-surgical treatment for moderate disease is Scaling and Root Planing, a deep cleaning procedure to remove plaque and hardened calculus (tartar) from the tooth surfaces below the gum line. Following the removal of irritants, the periodontist smooths the root surfaces to encourage gum tissue reattachment.
For advanced cases involving deep pockets, flap surgery, or pocket reduction surgery, may be necessary. During this procedure, the periodontist folds back the gum tissue to gain direct access to thoroughly clean the root surfaces and remove diseased tissue. The gums are then repositioned and secured around the tooth, reducing the depth of the periodontal pocket.
To address irreversible damage, regenerative procedures are often performed. These include bone grafting to repair bone structure lost to disease and soft tissue grafting to cover exposed roots resulting from gum recession. Additionally, periodontists are surgically trained to place dental implants, acting as the foundation for replacement teeth when a tooth cannot be saved.
Recognizing the Need for Specialized Care
Patients should consult a periodontist if they notice certain persistent symptoms. One of the most common signs is bleeding gums, especially when brushing or flossing, or gums that appear red, swollen, or tender. Persistent bad breath (halitosis) that cannot be resolved with routine hygiene may also indicate a bacterial infection below the gum line.
Observable physical changes, such as gums visibly pulling away from the teeth, making them appear longer, suggest gum recession. More serious indicators include teeth that feel loose, changes in how the upper and lower teeth fit together when biting, or the presence of pus between the gums and teeth. While a general dentist may treat mild gum conditions, these advanced signs warrant the specialized knowledge of a periodontist to prevent further destruction and save teeth.