A periodontist is a dentist who specializes in the gums, bone, and other structures that support your teeth. While your general dentist handles cleanings, fillings, and crowns, a periodontist focuses specifically on preventing, diagnosing, and treating gum disease, placing dental implants, and performing surgeries to restore damaged tissue around the teeth. Think of the relationship like a family doctor and a cardiologist: one handles broad care, the other goes deep on a specific system.
Training Beyond Dental School
Every periodontist starts as a general dentist, completing four years of dental school. After that, they enter a three-year residency program focused exclusively on periodontal and dental implant therapy. During those three years, they train in both surgical and non-surgical treatments for gum disease, bone grafting, implant placement, and soft tissue reconstruction. The residency also includes research training, which means periodontists are typically well-versed in the latest evidence behind the treatments they offer.
After residency, periodontists can pursue board certification through the American Board of Periodontology. This requires passing both a written qualifying exam and an oral exam. A periodontist who earns this credential is called a Diplomate, which signals an additional level of verified expertise in periodontics and dental implant surgery. Not all practicing periodontists are board-certified, but many are.
Conditions a Periodontist Treats
The core of a periodontist’s work revolves around gum disease, which is far more common than most people realize. About 42% of U.S. adults aged 30 and older have some form of periodontitis, and that number climbs to nearly 60% among adults 65 and older, according to national survey data from the NIDCR. Roughly 8% of adults have the severe form.
Gum disease progresses through stages, and a periodontist may be involved at any point:
- Gingivitis: The mildest form. Gums become red, swollen, and bleed easily during brushing or flossing. This is usually reversible with proper care.
- Mild to moderate periodontitis: Gums start pulling away from the teeth, forming pockets. Early bone loss begins around the teeth.
- Advanced periodontitis: Significant bone and tissue destruction. Teeth may loosen, and extraction sometimes becomes necessary.
Beyond gum disease itself, periodontists also treat receding gums, correct soft tissue deformities around the teeth, and manage infections around dental implants (called peri-implant disease). They perform procedures to support orthodontic treatment, like exposing unerupted teeth or removing tissue that restricts movement. They also do crown lengthening, which reshapes gum and bone tissue to expose more of a tooth’s surface before a crown or other restoration is placed.
What Procedures Look Like
Periodontal treatment usually starts with non-surgical options. The most common is scaling and root planing, often called a “deep cleaning.” This goes below the gumline to remove plaque, hardened tartar, and bacterial toxins from the root surfaces of your teeth. It’s more thorough than a standard dental cleaning and is typically done with local anesthesia. Results are evaluated six to eight weeks later to see how well the gums have responded.
When deep cleaning isn’t enough, surgery becomes an option. Pocket reduction surgery involves lifting the gums back, removing bacteria from deep pockets, and recontouring the bone if needed so the gums can reattach more snugly to the teeth. One thing to know: pocket reduction procedures typically cause some degree of gum recession, so teeth may look slightly longer afterward.
For patients who have lost bone around their teeth, regenerative procedures can help rebuild what’s been destroyed. These involve placing bone grafts, guided tissue membranes, or biological growth factors into the defect to encourage the body to regrow bone and the connective tissue that anchors teeth in place. Not every bone defect is a good candidate for regeneration; the shape and depth of the defect matter.
Gum grafting addresses the opposite problem: lost soft tissue. If your gums have receded and exposed the roots of your teeth, a periodontist can take tissue from the roof of your mouth (or use a donor material) and attach it to the affected area. This protects exposed roots and improves appearance. Free gingival grafts can shrink up to 48% in the months after placement depending on the thickness of the harvested tissue, which is something your periodontist will account for in planning.
Laser-Assisted Treatment
Some periodontists offer a laser-based alternative to traditional gum surgery called LANAP (laser-assisted new attachment procedure). This approach uses a specific wavelength of laser energy to remove diseased tissue and bacteria from periodontal pockets while promoting regeneration of bone and connective tissue. The FDA cleared the device used in this protocol for true regeneration of the attachment structures around teeth, not just repair. Compared to conventional surgery, LANAP tends to involve less postoperative pain, less gum recession, and faster healing. It’s not appropriate for every case, but it’s an option worth discussing if surgery is recommended.
The Dental Implant Connection
Periodontists are one of the main specialists who place dental implants. Their three years of training in both hard and soft tissue makes them well-suited for the surgical side of implant work, from the initial placement of the titanium post in the jawbone to managing the gum tissue around it for a natural look.
Implant placement isn’t always straightforward. If you’ve been missing teeth for a while, the jawbone in that area may have shrunk. Periodontists perform bone-building procedures to address this. In the upper jaw, where the sinus cavity can limit available bone, a sinus augmentation raises the sinus floor and adds bone material to create a stable foundation. For areas where the jaw ridge itself has deteriorated, ridge modification fills in the missing bone before an implant can be placed. After the implant is in, your periodontist coordinates with your general dentist on the crown or prosthetic that goes on top.
Why Gum Health Affects the Rest of Your Body
Periodontal disease is a chronic bacterial infection that triggers ongoing inflammation. That inflammation doesn’t stay confined to your mouth. Research has established links between periodontal disease and several systemic conditions, most notably diabetes and cardiovascular disease. The bacteria responsible for gum disease, particularly one called Porphyromonas gingivalis, can enter the bloodstream and influence immune responses elsewhere in the body.
The connection with diabetes runs in both directions. Gum disease is associated with poorer blood sugar control, and poorly controlled diabetes makes gum disease worse. A large cross-sectional analysis found a statistically significant association between periodontitis and diabetes. Hypertension, rheumatoid arthritis, and cardiovascular disease have also been linked to chronic oral inflammation. This is part of why treating gum disease is increasingly seen as a component of overall health management, not just dental care.
Signs You May Need a Periodontist
Your general dentist may refer you to a periodontist, but it helps to know the warning signs yourself. Gums that bleed when you brush or floss are the earliest signal, and many people dismiss this as normal. It isn’t. Other symptoms to watch for: gums that are swollen, red, or tender; persistent bad breath that doesn’t improve with brushing; gums that are visibly pulling away from your teeth; new gaps or dark triangles appearing between teeth; a change in how your bite feels; pus between your teeth and gums; or teeth that feel loose. Painful chewing is another red flag.
The earlier periodontal disease is caught, the simpler and less invasive treatment tends to be. Gingivitis is fully reversible. Once bone loss starts, you’re managing the disease rather than curing it, which makes early intervention genuinely important.