What is a periodontist? Difference from a dentist, when to go

Who is a periodontist, and how are they trained?

Periodontology is the branch of dentistry concerned with the gums and the supporting tissues of the teeth. A periodontist (often called a gum specialist) is a dentist who, after dental school, has completed a specialty residency in a university department of periodontology, finishing with a thesis and a specialty examination. In Turkey, periodontology is one of the dental specialties recognised by the Ministry of Health, and entry to the residency is through the national dental specialty examination (DUS).

The residency focuses on the diagnosis and treatment of gum disease, non-surgical and surgical periodontal therapy, gum grafts, bone regeneration, implant surgery and the management of diseases around implants. Put simply, the periodontist is concerned less with the tooth itself than with the ground the tooth stands on.

The difference between a dentist and a periodontist

The general dentist is the first line of oral health care: examinations, fillings, root canal treatment, extractions, scaling and preventive care all happen there. Gingivitis, the early stage of gum disease, is usually controlled at this level with professional cleaning and adjustments to home care.

By the time a periodontist is involved, the disease has usually gone beyond the gum and reached the bone that holds the tooth. The specialist's contribution can be summarised under three headings:

• Depth of diagnosis: Pocket depth and attachment loss are measured at several points around every tooth, bone loss is assessed on radiographs, and the disease is defined by its stage and grade.
• Range of treatment: Cleaning deep pockets together with the root surface, surgical pocket therapy, bone and gum grafts, covering receded gums and crown lengthening are all part of the specialty training.
• Long-term follow-up: Periodontitis is a chronic disease. A treated patient is considered "stable" rather than "cured"; even when gum health is regained, the risk of recurrence remains increased and close monitoring is needed (Chapple 2018).

This is a division of labour, not a hierarchy. For most patients, the right arrangement is the general dentist and the periodontist working on the same file: one follows day-to-day care and restorative needs, the other follows gum and bone health.

What a periodontist treats: from gingivitis to periodontitis

Periodontal health is defined as the absence of clinically detectable inflammation, and the key criterion separating health from gingivitis is bleeding on probing (Chapple 2018). Gingivitis is the reversible inflammatory response of the gum to dental plaque; there is no bone loss, and gum health can be restored with effective cleaning.

Periodontitis is the spread of inflammation to the fibres and bone that hold the tooth; the loss that results does not come back on its own. The 2017 World Workshop merged the forms previously separated as "chronic" and "aggressive" into a single "periodontitis" category and introduced a system that defines the disease by stage and grade (Papapanou 2018). The stage (I to IV) is determined by the amount of bone loss relative to root length, tooth loss due to the disease, and factors that complicate treatment such as pocket depth, infrabony defects, furcation involvement and tooth mobility; the grade (A to C) reflects the rate of progression, and risk factors such as smoking and diabetes modify the grade (Tonetti 2018).

The disease is not rare. A systematic review pooling global burden of disease data reports that severe periodontitis was the sixth most prevalent condition in the world, with an age-standardised prevalence of 11.2 percent; prevalence rises steeply in the thirties and the rate of new cases peaks at around 38 years of age (Kassebaum 2014).

The periodontist's field also includes gum recession, gum overgrowth, the periodontal abscess, an acute lesion with rapid tissue destruction within the pocket (Papapanou 2018), and diseases around implants.

When should you see a periodontist?

Periodontitis usually progresses without pain, which is why recognising its signs matters. If any of the following apply, an assessment by a periodontist is worthwhile:

• Gums that bleed repeatedly when brushing, when flossing or on their own
• Red, swollen, shiny or tender gums
• Receding gums, teeth that look longer, sensitivity to cold on exposed roots
• New gaps opening between teeth, teeth that have shifted or feel loose
• Persistent bad breath or a constant bad taste
• Pus between gum and tooth, a swelling or abscess on the gum
• A family history of tooth loss at an early age

A periodontal assessment is also advisable for some groups even without symptoms. The relationship between diabetes and periodontitis runs in both directions: periodontitis raises the risk of dysglycaemia and insulin resistance, and periodontal therapy in people with diabetes is safe and effective and is associated with reductions in HbA1c of 0.27 to 0.48 percent after three months (Sanz 2018). Smokers, those planning a pregnancy and anyone considering implant treatment are also in this group.

What happens when you see a periodontist?

The first visit begins with diagnosis: medical history, intraoral examination, measurement and charting of the gum pockets, and radiographs. Once the disease has been defined by stage and grade, treatment is arranged in steps. The clinical practice guideline of the European Federation of Periodontology describes the treatment of stage I to III periodontitis as a sequence of steps: behaviour change, control of plaque above the gum line and management of risk factors; mechanical cleaning above and below the gum line, with adjunctive therapies where needed; different periodontal surgical interventions in sites that do not respond; and supportive periodontal care to maintain what has been gained (Sanz 2020).

The first steps are carried out under local anaesthesia, usually over several sessions. Surgery comes into consideration at sites where deep pockets persist at re-evaluation; in suitable cases, regenerative techniques that aim to rebuild lost bone can also be used. These procedures are described in detail on the periodontal surgery page. Which step is needed is decided after examination.

Implants and periodontology

The periodontist is also one of the specialists who place implants, because an implant sits in the gum and jawbone, and the health of these tissues determines how long it lasts. In patients with a history of periodontitis, implant planning waits until the disease is under control. Peri-implantitis, which presents with bleeding, swelling or bone loss around an implant, is also among the conditions a periodontist treats.

For patients looking for a periodontist in İzmir, periodontology and implant treatment are carried out under one roof at the clinic in Bornova; general information is available on the implant dentist in İzmir page.

Frequently asked questions

Do I need a referral to see a periodontist?

No, you can book an appointment directly. A referral from your general dentist is also a common route; sharing your existing radiographs and treatment history makes the first assessment easier.

How many sessions does gum treatment take?

It depends on the stage of the disease and the number of teeth affected. Cleaning below the gum line is usually completed in a few sessions, followed by a re-evaluation a few weeks later, when the need for surgery is decided. The schedule is set after examination.

Does the disease come back after treatment?

Periodontitis is a chronic disease; a treated and stable patient remains at increased risk of recurrence and must be closely monitored (Chapple 2018). That is why regular maintenance visits are an integral part of treatment.

Which treatment step is right for you is decided after a clinical examination and, where needed, three-dimensional imaging. A pre-assessment can start from an existing panoramic X-ray or CBCT; the definitive plan only emerges after the examination.