A periodontist is a dental specialist focused on the prevention, diagnosis, and treatment of diseases affecting the supporting structures of the teeth. This specialized field, known as periodontics, centers on the health of the gums, ligaments, and the underlying jawbone. Periodontists receive three additional years of focused training beyond dental school, making them experts in managing complex tissue conditions. Referral typically occurs when a patient’s condition requires advanced surgical skill or complex treatment planning outside the scope of routine general dentistry.
Signs That Indicate Advanced Disease Progression
The most common reason for referral is established periodontitis, an advanced form of gum disease characterized by progressive destruction of the tooth-supporting apparatus. A primary clinical indicator is the existence of persistent deep periodontal pockets, typically measuring 5 millimeters or more, which have not responded adequately to initial non-surgical cleaning procedures. These deep spaces below the gumline harbor bacteria, making professional intervention necessary to reduce the pocket depth.
Radiographic evidence of bone loss is a significant factor, especially when X-rays show a vertical or angular pattern of bone destruction rather than a simple horizontal loss. This type of defect is likely to progress rapidly and is often associated with a poor prognosis without specialized treatment. Noticeable tooth mobility is another severe sign, indicating that a significant amount of the surrounding bone structure has been lost. The presence of localized abscesses, which are acute infections within the gum tissue, also signals the need for immediate specialized care.
When Surgical and Regenerative Procedures Are Necessary
Referral is necessary when standard non-surgical treatments, such as scaling and root planing, are insufficient to halt disease progression. When deep pockets remain after initial deep cleaning, a periodontist may need to perform gingival flap surgery, also known as pocket reduction surgery. This procedure involves lifting the gum tissue to gain direct access to the root surfaces and bone defects, allowing for thorough removal of disease-causing bacteria and calculus.
The specialist may also perform osseous surgery to reshape bone that has been damaged and made irregular by the infection. Smoothing the uneven bone surfaces helps eliminate areas where bacteria can hide, promoting better reattachment of the gum tissue. For specific types of bone defects, a periodontist may use regenerative procedures, employing bone grafts, membranes, or tissue-stimulating proteins to encourage the natural regrowth of lost bone and ligament tissue. These surgical requirements require specialized training to perform successfully.
Reconstructive Needs for Gum and Bone Structure
Beyond treating active infection, periodontists are involved in the reconstruction and repair of tissues lost to disease or trauma. Soft tissue grafting is often necessary when gum recession has occurred, exposing the tooth root surface and causing sensitivity or cosmetic concerns. The periodontist can perform procedures like a connective tissue graft, taking tissue from another area, such as the palate, to cover the exposed root and create a healthier, thicker gum line.
For patients planning to receive dental implants, a referral is required to ensure the underlying jawbone is adequate to support the artificial root. If periodontitis has caused significant bone loss, the periodontist will perform a bone grafting procedure to augment the jawbone, increasing its density and volume for secure implant placement. Their expertise in managing hard tissue (bone) and soft tissue (gums) makes them the appropriate specialist for implant placement and ongoing maintenance.
Managing Complex Patient Health Factors
A patient’s overall systemic health can significantly complicate periodontal treatment, necessitating a specialist referral even if the local disease severity is moderate. Patients with poorly controlled diabetes are highly susceptible to severe periodontitis because high blood sugar levels impair the body’s ability to fight infection and heal. Managing these individuals requires a specialized treatment plan and careful coordination with their physician to ensure successful outcomes.
Patients undergoing cancer treatment, particularly those receiving chemotherapy or radiation, often experience compromised immune systems, making them vulnerable to aggressive oral infections. A referral is also essential for patients who are taking complex medications like bisphosphonates, which are used to treat osteoporosis or certain cancers. These drugs carry a risk of medication-related osteonecrosis of the jaw, and any necessary dental surgery must be managed by a periodontist expert in mitigating this severe complication.