A periodontist is a dental specialist who focuses on the prevention, diagnosis, and treatment of periodontal (gum) disease and the placement of dental implants. These specialists undergo an additional 2-3 years of specialized training beyond dental school, making them experts in treating inflammation, addressing gum recession, managing bone loss, and performing complex surgical procedures to restore oral health. Periodontists are essentially the architects of a healthy foundation for your teeth.
At Dental Specialties Northwest, our periodontal team specializes in both surgical and non-surgical techniques to treat gum disease, place dental implants, and perform regenerative procedures that help rebuild tissue damaged by periodontal disease. Understanding the role of a periodontist is crucial because healthy gums are the foundation of a healthy mouth – when your gums thrive, your overall dental health follows.
What Is a Periodontist and What Do They Do?
A periodontist is a dentist who specializes in the prevention, diagnosis, and treatment of periodontal disease and other conditions affecting the gums and supporting structures of the teeth. Periodontists are experts in managing inflammation, performing periodontal surgeries, and placing dental implants to replace missing teeth. They focus primarily on preserving the foundational tissues that support your teeth, including the gums, periodontal ligament, and alveolar bone.
When general dentistry isn’t enough to address complex gum issues, periodontists provide specialized care for moderate to severe gum disease that requires surgical intervention, significant bone or tissue loss cases, and complicated dental implant placements. They are trained to perform advanced procedures including tissue grafts, regenerative treatments, and specialized cleaning techniques that go beyond the capabilities of general dentistry.
Specialized Training Beyond General Dentistry
Periodontists undergo extensive additional education after completing their four-year dental school program. This specialized training includes:
- A rigorous 2-3 year accredited residency program focused specifically on periodontal disease and its treatments
- Advanced surgical training for tissue grafting, bone regeneration, and implant placement
- Specialized coursework in periodontology, immunology, and oral pathology
- Training in sedation techniques to ensure patient comfort during complex procedures
- Experience with the latest technological advances in periodontal care
This advanced training prepares periodontists to tackle the most complicated cases of gum disease and oral reconstruction. Many periodontists, like Dr. Thomas Sweeney at Dental Specialties Northwest, also pursue board certification through the American Board of Periodontology, demonstrating their commitment to the highest standards of care through ongoing education and clinical evaluation.
Core Areas of Periodontal Specialization
Periodontists focus on several key areas that distinguish their expertise from general dentistry:
Periodontal Disease Management: Periodontists are the primary specialists for treating all stages of gum disease, from early gingivitis to advanced periodontitis. They address infection beneath the gum line using specialized cleaning techniques like scaling and root planing, as well as more advanced surgical interventions when necessary.
Dental Implant Procedures: Periodontists excel in the surgical placement of dental implants, including complex cases requiring bone grafting or sinus augmentations. They evaluate bone quality, determine optimal implant positioning, and ensure long-term implant success through careful treatment planning.
Regenerative Procedures: These specialists perform techniques to regenerate lost bone and tissue, including guided tissue regeneration, bone grafting, and growth factor therapies that stimulate the body’s natural ability to rebuild supporting structures.
Periodontal Plastic Surgery: Procedures to enhance both function and aesthetics fall under this category, including gum grafting for recession, crown lengthening to expose more tooth structure, and aesthetic gum recontouring to improve smile appearance.
Management of Oral Inflammation: Beyond tooth-supporting structures, periodontists also address inflammation throughout the mouth and its connection to systemic health conditions like diabetes and heart disease.
Common Periodontal Treatments and Procedures
Periodontists offer a comprehensive range of treatments designed to address various stages of gum disease and related conditions. The appropriate treatment depends on the severity of the condition, the patient’s overall health, and specific oral health goals. Modern periodontal care ranges from minimally invasive non-surgical approaches to advanced surgical interventions, all aimed at controlling infection, halting disease progression, and restoring oral health.
At Dental Specialties Northwest, we provide the full spectrum of periodontal treatments, from deep cleaning procedures to advanced regenerative therapies. Our approach emphasizes preserving natural teeth whenever possible while offering state-of-the-art solutions when replacement becomes necessary. The goal of any periodontal treatment is to stabilize your oral health, eliminate active infection, and create a sustainable environment for long-term dental wellness.
Non-Surgical Periodontal Therapy
Non-surgical treatments are typically the first line of defense against periodontal disease and often sufficient for managing mild to moderate cases:
Scaling and Root Planing: This deep cleaning procedure removes plaque and tartar from below the gum line (scaling) and smooths the root surfaces to remove bacterial toxins (root planing). This treatment can effectively address pocket depths up to 5mm and is usually performed under local anesthesia for comfort. Treatment typically requires 1-4 sessions depending on the extent of disease.
Antibiotic Therapy: Local or systemic antibiotics may be used as adjuncts to scaling and root planing. Local options include antibiotic fibers or microspheres placed directly into periodontal pockets, while oral antibiotics help control bacterial infection throughout the mouth. These treatments target specific bacteria that cause gum disease.
Laser Therapy: Advanced laser treatments can selectively remove infected gum tissue while leaving healthy tissue intact. The LANAP® (Laser Assisted New Attachment Procedure) protocol uses laser energy to target bacteria and diseased tissue with minimal discomfort and faster healing times than traditional surgery.
Host Modulation: Medications that modify the body’s inflammatory response may be prescribed to help manage periodontal disease, particularly in patients with risk factors that enhance susceptibility to gum inflammation.
Non-surgical treatments are often highly effective, with success rates of 80-90% for early to moderate periodontal disease when combined with diligent home care and regular maintenance visits.
Advanced Surgical Procedures
When non-surgical therapies aren’t sufficient to manage periodontal disease, surgical interventions become necessary:
Flap Surgery (Pocket Reduction): For persistent deep pockets (≥6mm), the gums are temporarily folded back to allow thorough removal of calculus and smoothing of damaged bone. This helps the gum tissue reattach to healthy bone and reduces pocket depth to make home care more effective.
Osseous Surgery: This procedure reshapes deformities in the bone caused by periodontal disease. After folding back the gum tissue, irregular surfaces of damaged bone are smoothed to eliminate bacterial hiding places and create a better environment for gum reattachment.
Regenerative Procedures: For cases with significant bone loss, periodontists employ techniques to stimulate new bone growth:
- Bone grafting using synthetic materials, donated bone, or your own bone
- Guided tissue regeneration using special membranes that encourage bone regeneration
- Growth factors and tissue-stimulating proteins that encourage your body’s natural ability to regenerate bone and tissue
Gum Grafting: This addresses gum recession by taking tissue from another area (typically the palate) or using donor tissue to cover exposed root surfaces. Benefits include reduced sensitivity, protection against further recession, and improved aesthetics.
Crown Lengthening: This procedure removes excess gum and bone tissue to expose more of the natural tooth, making it possible to restore broken teeth or improve a “gummy smile.”
Dental Implant Placement and Restoration
Periodontists are recognized experts in the placement and maintenance of dental implants:
Comprehensive Implant Assessment: Before placement, periodontists evaluate bone density, volume, and quality to determine if additional procedures like bone grafting are needed to support implants. They also assess your overall oral health to ensure long-term implant success.
Sinus Augmentation: When the upper posterior jaw lacks sufficient bone height, this procedure adds bone between your jaw and sinuses to allow for implant placement. This specialized technique requires the precise awareness of anatomy that periodontists possess.
Ridge Modification: For patients with deformities in the upper or lower jaw, periodontal procedures can reshape the ridge to create a better foundation for implants or improve appearance.
Implant Placement: Using precise surgical techniques, periodontists place titanium implant posts into the jawbone, carefully positioning them for optimal function and aesthetics. Advanced 3D imaging ensures accurate placement.
Immediate Implants: In certain cases, implants can be placed immediately following tooth extraction, minimizing the number of surgical procedures required. Periodontists can evaluate whether this approach is suitable for individual cases.
The success rate for dental implants placed by specialists typically exceeds 95% over a ten-year period, making them one of the most reliable tooth replacement options available.
Periodontist vs General Dentist: Key Differences
Understanding the distinction between a periodontist and a general dentist helps patients recognize when specialized care is beneficial. While both professionals focus on oral health, their training, expertise, and the scope of treatments they provide differ significantly. General dentists offer comprehensive routine care, while periodontists provide specialized treatment for gum disease and related conditions.
The relationship between these professionals is complementary rather than competitive. General dentists often work closely with periodontists, referring patients when specialized care is needed while continuing to provide ongoing general dental care. This collaborative approach ensures patients receive optimal treatment at every stage of their oral health journey.
Training and Expertise Differences
The educational paths and expertise of general dentists and periodontists diverge after dental school:
General dentists are trained to identify periodontal issues and provide treatment for mild cases, including regular cleanings and scaling and root planing. However, their expertise typically doesn’t extend to advanced surgical interventions or complex implant cases.
Periodontists devote their practices entirely to periodontal health and implant dentistry. Their specialized training allows them to diagnose subtle periodontal conditions, provide comprehensive treatment options, and manage complex cases that require surgical intervention or specialized techniques.
When Your General Dentist Refers You to a Periodontist
General dentists typically refer patients to a periodontist when they identify conditions that would benefit from specialized care:
Persistent Gum Disease: If you’ve received treatment for gum disease from your general dentist but continue to experience inflammation, bleeding, or deepening pockets, a referral to a periodontist is appropriate for more intensive intervention.
Advanced Periodontal Disease: Periodontitis that has progressed beyond early stages, especially when pocket depths exceed 5mm or bone loss is detected on X-rays, often requires specialized periodontal treatment.
Complex Dental Implant Needs: Cases requiring bone grafting before implant placement, multiple implants, or implants in areas with limited bone volume benefit from a periodontist’s expertise.
Gum Recession: Significant gum recession that exposes tooth roots and creates sensitivity or aesthetic concerns may require gum grafting procedures performed by a periodontist.
Crown Lengthening Requirements: When a tooth needs to be restored but there isn’t enough exposed structure to support a restoration, a periodontist can perform crown lengthening to expose more of the natural tooth.
Specialized Cosmetic Procedures: Uneven gum lines or excessive gum tissue creating a “gummy smile” can be addressed through periodontal plastic surgery.
Complicated Medical History: Patients with conditions like diabetes, heart disease, or those taking medications that affect oral health often benefit from a periodontist’s specialized knowledge in managing complex medical-dental interactions.
When you receive a referral, your general dentist will typically share your dental records, X-rays, and treatment history with the periodontist to ensure continuity of care. After periodontal treatment, you’ll return to your general dentist for ongoing maintenance and regular dental care, with the periodontist remaining available for specialized periodontal maintenance as needed.
When Should You See a Periodontist?
You should see a periodontist when you notice persistent signs of gum disease that haven’t responded to regular dental care, or when your general dentist recommends specialized treatment. Early intervention by a periodontist can prevent minor gum issues from progressing to serious conditions that threaten your oral health and potentially lead to tooth loss.
At Dental Specialties Northwest, we recommend scheduling a periodontal evaluation if you’re experiencing any symptoms of gum disease or if you have risk factors that make you more susceptible to periodontal problems. Catching gum disease early significantly improves treatment outcomes and reduces the need for more invasive procedures.
Warning Signs of Gum Disease
Be alert for these symptoms that indicate you may need periodontal care:
Bleeding Gums: If your gums bleed during brushing, flossing, or even spontaneously, this is often the first sign of gingivitis. Healthy gums should not bleed, even with robust brushing and flossing.
Red, Swollen, or Tender Gums: Inflamed gum tissue appears red rather than pink, feels puffy or swollen, and may be sensitive to touch or temperature changes. This inflammation indicates an active bacterial infection.
Persistent Bad Breath: Chronic halitosis that doesn’t resolve with brushing, flossing, or mouthwash may be caused by bacteria harbored in periodontal pockets. The waste products of these bacteria create unpleasant odors.
Receding Gums: When gums pull away from teeth, making teeth appear longer than normal, this recession exposes root surfaces, increases sensitivity, and creates spaces where bacteria can thrive.
Loose or Shifting Teeth: As periodontal disease destroys the supporting bone and ligaments, teeth may become mobile or shift position. Spaces may appear between teeth that weren’t there before.
Pus Between Teeth and Gums: Periodontal abscesses can form when infection becomes trapped in a pocket. These may drain pus when pressure is applied to the gum.
Changes in Bite or Fit of Partial Dentures: As teeth shift due to bone loss, you may notice changes in how your teeth come together when you bite or how removable appliances fit.
Pain While Chewing: Discomfort during eating, especially with harder foods, can indicate advanced periodontal disease affecting the supporting structures around teeth.
If you experience several of these symptoms or if any single symptom is severe or persistent, scheduling an evaluation with a periodontist is strongly recommended. Many patients are unaware that their condition requires specialized care until symptoms become advanced.
How Gum Disease Progresses Without Treatment
Understanding how periodontal disease develops highlights the importance of early intervention:
Stage 1: Gingivitis (Reversible)
- Characterized by inflammation without bone or attachment loss
- Caused by plaque buildup at the gumline
- Signs include redness, swelling, and bleeding during brushing
- Completely reversible with improved oral hygiene and professional cleaning
- No permanent damage occurs at this stage
Stage 2: Early Periodontitis
- Inflammation begins to cause destruction of supporting tissues
- Pocket depths increase to 3-5mm
- Up to 15% bone loss may be detected on X-rays
- Bacteria move below the gumline where home care cannot reach
- Professional intervention required to halt progression
- Some attachment loss occurs but is typically minimal
Stage 3: Moderate Periodontitis
- Significant bone loss (15-30%)
- Pocket depths of 5-7mm
- Teeth may begin to feel loose
- Root surfaces become exposed, increasing sensitivity
- Recession becomes more noticeable
- Bacterial infection deepens and becomes more resistant to treatment
- Surgical intervention often becomes necessary at this stage
Stage 4: Advanced Periodontitis
- Severe bone loss (>30%)
- Deep pockets exceeding 7mm
- Significant tooth mobility
- Teeth may shift or fall out
- Abscesses may form
- Chewing becomes painful
- Systemic health issues may be worsened by chronic oral infection
- Extensive treatment required to save remaining teeth
Without treatment, periodontal disease continuously progresses through these stages, though the speed varies among individuals based on genetic factors, oral hygiene habits, and other risk factors such as smoking and diabetes. What begins as simple gum inflammation ultimately leads to irreversible bone and tooth loss if left untreated.
The progressive nature of periodontal disease emphasizes why early intervention is critical. Treatment at earlier stages is less invasive, less expensive, and more predictable than attempting to manage advanced disease. Once bone loss occurs, complete regeneration is challenging, making prevention and early treatment the preferred approach.
Common Questions About Periodontists
Patients often have concerns and questions when referred to a periodontist for specialized care. Understanding what to expect can help ease anxiety and prepare you for treatment. Here, we address the most common questions patients have about seeing a periodontist and undergoing periodontal procedures.
How Long Do Periodontal Treatments Take?
Treatment duration varies based on the procedure and condition severity:
Initial Evaluation: Your first visit typically takes 60-90 minutes for a comprehensive assessment, including examination, X-rays, and discussion of treatment options.
Non-Surgical Treatments:
- Scaling and root planing generally requires 1-2 visits of 1-2 hours each, often completed by quadrant (quarter of the mouth)
- Full-mouth debridement is usually completed in a single 1-hour appointment
- Laser bacterial reduction is a quick procedure that adds 15-20 minutes to other treatments
Surgical Procedures:
- Pocket reduction surgery takes 1-3 hours per quadrant
- Grafting procedures typically require 30-90 minutes per site
- Dental implant placement averages 1-2 hours per implant for straightforward cases
- More complex cases may require staged procedures over 3-12 months
Healing Times:
- Non-surgical treatments: 1-2 weeks for gum tissue to heal and inflammation to subside
- Surgical procedures: 2-4 weeks for initial healing, with complete tissue maturation taking up to 6 months
- Dental implants: 3-6 months for osseointegration (bone fusion to implant) before final restoration
Overall Treatment Timeline:
- Mild to moderate periodontal disease: 3-6 months from diagnosis to stabilization
- Advanced periodontal disease: 9-18 months for complete treatment, including surgical phases
- Implant procedures: 3-12 months from extraction to final restoration, depending on whether bone grafting is needed
Each patient’s treatment timeline is individualized based on their specific condition, healing capacity, and treatment response. Your periodontist will provide a detailed estimate of your expected treatment duration during your consultation.
Are Periodontal Procedures Painful?
Modern periodontal care emphasizes patient comfort:
During Treatment:
- Local anesthesia ensures you feel no pain during procedures
- For anxious patients, additional options include:- Nitrous oxide (laughing gas) for mild anxiety- Oral sedation for moderate anxiety- IV sedation for significant anxiety or lengthy procedures
- Advanced techniques like LANAP laser therapy often result in less discomfort than traditional surgery
- At Dental Specialties Northwest, we prioritize comfort with amenities like massage chairs, noise-canceling headphones, and warm blankets during treatment
After Treatment:
- Non-surgical procedures typically cause minimal discomfort, easily managed with over-the-counter pain relievers
- Surgical procedures may cause moderate discomfort for 24-72 hours, which can be managed with prescribed medications
- Swelling generally peaks at 48 hours and resolves within a week
- Cold compresses applied intermittently (20 minutes on, 20 minutes off) help reduce swelling
- Soft diet recommendations reduce discomfort while eating during the healing phase
- Follow-up appointments allow your periodontist to monitor healing and address any concerns
Pain Management Approaches:
- Precise surgical techniques minimize tissue trauma
- Pre-emptive pain medication before anesthesia wears off
- Detailed post-operative instructions to optimize healing
- 24-hour access to your provider for unexpected concerns
Most patients report that periodontal procedures are much more comfortable than they anticipated. The temporary discomfort of treatment is far less severe than the pain of untreated advanced periodontal disease or tooth loss. With proper pain management protocols, most patients return to normal activities within 24-48 hours after treatment.
Contact Dental Specialties Northwest for Expert Periodontal Care
Throughout this guide, we’ve explored the vital role periodontists play in maintaining your oral health, from treating gum disease to placing dental implants and performing regenerative procedures. Periodontal health forms the foundation of a healthy smile, and addressing gum issues promptly can prevent more serious complications down the road.
At Dental Specialties Northwest, our team provides comprehensive periodontal care in a comfortable, state-of-the-art environment in downtown Seattle. Led by Dr. Thomas Sweeney, our periodontal specialists combine years of advanced training with cutting-edge technology to deliver exceptional results. What makes our practice unique is our integrated approach, where multiple dental specialists collaborate under one roof to address even the most complex cases without the need for referrals to different practices. Whether you’re experiencing symptoms of gum disease or need advanced implant treatment, we invite you to experience the difference specialized periodontal care can make. Contact Dental Specialties Northwest today at 206-682-8200 or visit our website to schedule your comprehensive periodontal evaluation.
