A periodontist is a dentist who specializes exclusively in treating gum disease, from early-stage inflammation to advanced bone loss. They complete an additional three years of training beyond dental school focused on the tissues surrounding your teeth. While a general dentist may handle mild gum disease, a periodontist typically takes over when the disease has progressed, when initial treatment hasn’t worked, or when surgery is needed to save teeth.
How a Periodontist Evaluates Your Gums
The first visit to a periodontist centers on measuring how much damage gum disease has already caused. The key diagnostic tool is a thin probe inserted between each tooth and the surrounding gum tissue. This measures the depth of the “pockets” that form as gums pull away from teeth. Healthy gums sit tightly against the tooth with pocket depths of one to three millimeters. Deeper pockets signal active disease and bone loss.
Beyond probing, the periodontist reviews X-rays to assess how much bone has been lost around the roots of your teeth. They also look for complicating factors: teeth that have shifted or become loose, areas where the roots fork and bone loss has crept between them, and vertical bone defects that create uneven damage. All of this information feeds into a staging and grading system that determines how severe the disease is and how quickly it’s progressing. That classification drives the treatment plan and determines whether nonsurgical care is enough or surgery is warranted.
Nonsurgical Treatment: Scaling and Root Planing
For early to moderate gum disease, the first-line treatment is scaling and root planing, often called a “deep cleaning.” This is more intensive than the routine cleaning you get at a checkup. During scaling, the periodontist or hygienist removes plaque and hardened tartar from above and below the gum line. Root planing goes a step further, smoothing the root surfaces so bacteria have fewer places to attach and gum tissue can reattach more snugly to the tooth.
The procedure is typically done in sections, with local anesthetic to keep you comfortable. It’s considered the gold standard initial treatment for periodontitis. In many cases, especially when the disease is caught at an earlier stage, scaling and root planing alone can significantly reduce pocket depths and halt progression. Your periodontist will reassess your gums several weeks later to see if the pockets have improved or if more aggressive treatment is needed.
Laser-Assisted Treatment
Some periodontists offer a laser-based alternative called LANAP (Laser-Assisted New Attachment Procedure). Instead of cutting gum tissue with a scalpel, the laser targets diseased tissue and bacteria inside the pockets while leaving healthy tissue intact. It also promotes clotting and can stimulate the formation of new connective tissue attachment to the root surface.
Clinical studies show LANAP produces a greater reduction in pocket depth compared to scaling and root planing alone, along with less bleeding and lower levels of the bacteria most associated with gum disease. Patients generally tolerate it well, and it avoids the incisions and sutures of traditional surgery. However, the laser alone cannot remove hardened tartar in difficult-to-reach areas, so it’s typically used alongside mechanical cleaning rather than as a standalone procedure.
Surgical Options for Advanced Disease
When pockets remain deep after nonsurgical treatment, or when bone damage is moderate to severe, surgical intervention becomes necessary. The most common procedure is osseous (bone) surgery, sometimes called pocket reduction surgery or flap surgery.
During this procedure, the periodontist lifts the gum tissue back from the teeth to access the underlying bone. They then smooth and reshape damaged bone to eliminate the craters and irregular surfaces where bacteria thrive. Once the bone is reshaped, the gum tissue is repositioned snugly around the teeth and sutured in place. The result is shallower pockets that are far easier to keep clean with daily brushing and flossing. Osseous surgery is only recommended when the disease is too advanced for nonsurgical approaches to control.
Bone Grafts and Tissue Regeneration
When gum disease has destroyed significant bone, a periodontist can rebuild what’s been lost using bone grafting. The graft material may come from your own body, a human donor, an animal source (commonly bovine or porcine), or a synthetic material like a calcium-based ceramic. These materials act as scaffolding, giving your body a framework to grow new bone on.
In many cases, the periodontist places a small membrane over the graft site. This barrier keeps fast-growing gum tissue from invading the space before slower-growing bone has a chance to fill in. The technique is called guided tissue regeneration, and it’s one of the more specialized procedures a periodontist performs. It can mean the difference between saving and losing a tooth that has suffered major bone loss.
Gum Grafting for Recession
Gum disease frequently causes the gums to recede, exposing tooth roots and creating sensitivity. A periodontist corrects this with soft tissue grafts, and several techniques exist depending on the location and severity of the recession.
A connective tissue graft takes a small piece of tissue from beneath the roof of your mouth and stitches it over the exposed root. This is the most common approach and offers good root coverage with a natural color match. A free gingival graft takes tissue directly from the surface of the palate. It’s particularly useful in the lower front teeth, where creating a thicker band of gum tissue can stop recession from progressing, though the color match may not be as seamless. For recession near the back of the upper jaw, some periodontists use tissue from the cheek area, which has a rich blood supply and heals well. Donor tissue products are also available, eliminating the need for a second surgical site in your mouth.
What Recovery Looks Like
Recovery timelines vary by procedure. For scaling and root planing, most people experience mild soreness and sensitivity for a few days. Surgical procedures require more patience.
After gum graft surgery, for example, recovery typically takes one to two weeks. On the first day, you’ll stick to soft, cool foods like yogurt and smoothies, and use an antibacterial mouthwash instead of brushing near the surgical site. During the first week, you can gradually add soft foods like eggs, pasta, and cooked vegetables. By the second week, most people start reintroducing solid foods, though hard, crunchy, and spicy items stay off the menu until your periodontist clears you. The graft site needs to be protected from direct brushing and flossing until healing is confirmed, since disturbing it too early can cause the graft to fail. Recovery from osseous surgery follows a similar general timeline, though your periodontist will tailor instructions to the extent of your procedure.
Ongoing Maintenance After Treatment
Gum disease is a chronic condition. Even after successful treatment, the bacteria that caused it can recolonize, and pockets can deepen again without consistent follow-up. This is where periodontal maintenance appointments come in, which are distinct from a standard dental cleaning. During these visits, the periodontist or hygienist measures your pocket depths, removes any new buildup above and below the gum line, and reinforces your home hygiene routine.
The frequency of these visits matters significantly. A study comparing different maintenance schedules found that patients seen every three months had a disease recurrence rate of just 8%, compared to 12% for those seen every six months and 20% for those seen once a year. Patients on a three-month schedule had 40% less recurrence than those on the conventional six-month schedule. Most periodontists recommend starting with quarterly visits and adjusting based on how stable your gums remain over time.
When Your Dentist Refers You to a Periodontist
General dentists treat mild gum disease routinely, but several situations call for a specialist. Your dentist will typically refer you if your gum disease isn’t responding to initial treatment, if you have deep pockets or significant bone loss, if teeth are loosening, or if complex factors like furcation involvement (bone loss between the roots of a molar) are present. The current staging and grading system gives dentists clear benchmarks for when a case has moved beyond the scope of general practice. If you’re referred, it doesn’t necessarily mean surgery is inevitable. It means your case needs the diagnostic precision and treatment range that a periodontist’s additional training provides.