A periodontist is a dentist who specializes in the gums, bone, and other structures that hold your teeth in place. While a general dentist handles cleanings, fillings, and overall oral health, a periodontist focuses specifically on preventing, diagnosing, and treating gum disease, placing dental implants, and performing surgeries to restore damaged gum and bone tissue. They complete three additional years of residency training beyond dental school.
How Periodontists Differ From General Dentists
Every periodontist starts as a dentist, earning a dental degree before entering a specialized residency program. That residency lasts three years and is devoted entirely to the tissues surrounding teeth: gums, the ligaments that anchor teeth to bone, and the jawbone itself. During training, residents study advanced surgical techniques, implant placement, and the management of complex inflammatory conditions. They also take annual examinations through the American Academy of Periodontology.
Your general dentist handles most routine care and can treat mild gum problems. But when gum disease progresses, or when the situation involves significant bone loss, loose teeth, or a complicated medical history, a referral to a periodontist is common. In one study of general dentists, the most frequently referred cases were severe periodontitis and necrotizing gum diseases. About two-thirds of dentists said they factor in pocket depth, tooth mobility, and the patient’s overall medical conditions when deciding to refer.
What Happens at a Periodontal Exam
The centerpiece of a periodontal evaluation is pocket measurement. Using a small probe, the periodontist measures the tiny space between each tooth and the surrounding gum tissue, recorded in millimeters. These numbers tell a clear story:
- 0 to 3 mm with no bleeding: healthy gums, no disease.
- 1 to 3 mm with bleeding: early gum disease (gingivitis), which is reversible.
- 4 to 6 mm: periodontitis has developed. The gums are pulling away from the teeth, and some bone loss may already be present.
- 7 mm or deeper: advanced periodontitis with significant bone loss. Teeth are often loose at this stage.
The periodontist also reviews dental X-rays to assess bone levels, checks for tooth mobility, and looks at factors like gum recession and the pattern of tissue damage. All of this feeds into a treatment plan tailored to the severity of the disease.
Nonsurgical Treatments
For mild to moderate gum disease, the first line of treatment is a deep cleaning called scaling and root planing. It goes well beyond a standard dental cleaning. After numbing your gums with local anesthesia, the periodontist or hygienist uses hand instruments or ultrasonic tools to remove plaque and tartar both above and below the gumline. The root planing step smooths the tooth root surfaces, which makes it harder for bacteria to reattach and gives the gums a clean surface to heal against. In some cases, antibiotics are placed directly around the tooth roots or prescribed as pills to help control infection.
For many people, this treatment is enough to halt the progression of gum disease and allow the gum pockets to shrink back toward healthy depths. Follow-up visits track whether the pockets are improving or whether further intervention is needed.
Surgical Procedures
When deep cleaning alone isn’t sufficient, periodontists perform several types of surgery to repair damage and restore the structures around your teeth.
Gum Graft Surgery
When gums have receded and exposed the roots of your teeth, a gum graft adds tissue back to the area. The periodontist typically takes a small piece of tissue from the roof of your mouth and attaches it to the recession site. In some cases, donor tissue from a tissue bank is used instead. The procedure is done under local anesthesia, and sedation options like nitrous oxide or oral sedation are often available. Recovery generally involves some soreness at both the graft site and the palate, but the result is better root coverage and a more stable gumline.
Pocket Reduction Surgery
When gum pockets remain deep after nonsurgical treatment, the periodontist can fold back the gum tissue, clean out bacteria and damaged tissue from the pocket, and then secure the gums more snugly around the tooth. This reduces the pocket depth and makes it easier to keep the area clean at home.
Bone Grafting
Advanced gum disease destroys the bone that supports your teeth. Bone grafting places natural or synthetic bone material into the areas of loss, encouraging your body to regenerate new bone over time. This procedure is also commonly performed before dental implant placement if the jawbone has thinned too much to support an implant on its own.
Dental Implant Placement
Periodontists are one of the primary specialists who place dental implants. Their deep knowledge of jawbone structure and gum tissue makes them well suited for this work. Before placing an implant, the periodontist evaluates whether your jawbone is thick and dense enough to support the titanium post. The chewing forces your jaw handles are substantial, and if the bone is too thin or too soft, the implant can fail.
When bone is insufficient, the periodontist can perform a bone graft first and allow several months for healing before placing the implant. Once the implant is set into the jawbone, a healing period of several months follows while the bone fuses around the post. After that, a crown or other restoration is attached to complete the replacement tooth.
Signs That Point to Gum Disease
Gum disease often progresses without obvious pain, which is part of why it’s so common. According to data from the National Institute of Dental and Craniofacial Research, about 46% of adults between ages 45 and 64 have some form of periodontitis. Among adults 65 and older, that figure rises to nearly 60%. Even in the 30 to 44 age group, roughly 30% are affected.
The warning signs to watch for include gums that are red, swollen, tender, or bleed when you brush or floss. Gums that appear to be pulling away from your teeth, making the teeth look longer, are a hallmark of recession. Persistent bad breath that doesn’t go away with brushing, teeth that feel loose or have shifted position, and pain while chewing all point toward gum disease that may need specialist attention.
Why Gum Health Affects the Rest of Your Body
Gum disease isn’t just a mouth problem. The chronic inflammation it creates has been linked to a surprisingly wide range of health conditions. The connection to heart disease is one of the most studied: bacteria from infected gums can enter the bloodstream, trigger inflammation in blood vessel walls, and have even been found inside arterial plaques. The relationship between gum disease and diabetes runs in both directions, with each condition making the other harder to control.
Research has also tied periodontitis to respiratory conditions like pneumonia and COPD, rheumatoid arthritis, chronic kidney disease, and adverse pregnancy outcomes including preterm birth and low birth weight. More recently, moderate to severe periodontitis has been identified as a risk factor for dementia, with studies finding links between gum disease and the buildup of amyloid proteins in the brain regions affected by Alzheimer’s disease.
The mechanism behind these connections comes down to two pathways. Bacteria from diseased gums physically enter the bloodstream and can colonize distant tissues. At the same time, inflammatory molecules produced in the gums spill into circulation, raising the body’s overall level of inflammation. This systemic inflammatory load is what appears to drive or worsen conditions far from the mouth. It’s one of the strongest arguments for treating gum disease aggressively rather than ignoring it as a minor dental issue.