How to Choose a Periodontist

Periodontists are dentists who specialize in the prevention, diagnosis and treatment (non-surgical and surgical) of periodontal diseases and the placement of tooth implants. They also perform cosmetic oral plastic surgical procedures.

It is especially important to see a periodontist if you experience any of the symptoms of gum disease, but regular periodontal examinations should be part of everyone’s routine oral health care regimen. An evaluation sometimes may be the only way to detect gum disease. You should also visit the periodontist regularly if you have diabetes, heart or respiratory disease, osteoporosis, malnutrition, or smoke or use tobacco; all have been linked to periodontal disease.

Education and Certification

Periodontists must complete a four-year undergraduate college degree, then graduate from an accredited dental school with a Doctor of Dental Surgery (DDS) or Doctor of Medical Dentistry (DMD) degree. In addition, a periodontist must complete three to seven years of formal training in an American Dental Association (ADA)-accredited periodontology residency program.

After successful completion of an ADA-accredited residency training program in periodontics, dentists may earn national board certification by the American Board of Periodontology (ABP) by passing comprehensive written and oral examinations covering all phases of periodontal disease and its treatment, as well as presenting detailed reports on a range of treatments personally provided by the periodontist.

Periodontists must be recertified every six years. Recertification requires fulfillment of continuing education requirements and other professional activities that demonstrate current knowledge and competence in periodontics. Board-certified periodontists are diplomates of the ABP. Periodontists can work in dental schools, hospitals, the business sector, and state, national and international agencies. They also can focus on research opportunities, such as testing emerging therapies and studying the interrelationships between periodontal and systemic diseases.

Types of Periodontal Procedures

Non-surgical Periodontal Treatment. In the early stages of gum disease, most treatments include deep cleanings, scaling and root planing (a professional cleaning of the root surfaces to remove plaque and calculus/tartar from periodontal pockets, and to smooth the tooth root to remove bacterial toxins), followed by adjunctive therapy, such as antibiotics and antimicrobials. In most cases of gingivitis, scaling and root planing – and proper daily brushing and flossing – will produce a healthy result.

Dental Implant Placement. During a dental implant procedure, an artificial tooth root is placed into your jaw, where it binds with the jawbone through a process called osseointegration. After a healing period, an artificial tooth is attached to the implant post.

Periodontal Surgery Procedures, such as:

Regeneration, in which your periodontist folds back gum tissue to remove bacteria. Membranes (filters), bone grafts or tissue-stimulating proteins are used to encourage your body’s natural ability to regenerate bone and tissue.
Pocket reduction, in which your periodontist folds back gum tissue to remove disease-causing bacteria before securing the tissue into place. In certain cases, irregular surfaces of damaged bone are smoothed to minimize areas where bacteria can hide, allowing gum tissue to better reattach to healthy bone.
Gingivectomy, in which excess tissue is removed under local anesthesia. The gums usually heal within eight days, and teeth contours are restored.

Periodontal Plastic Surgery, such as:

Gingival Sculpting (Crown lengthening), in which excess gum and bone tissue is reshaped to expose more of the natural tooth. This can be performed on one tooth to even your gum line, or several teeth to expose a broader smile.
Soft tissue grafting, in which your periodontist takes gum tissue from your palate (or another source) to cover an exposed root. This can be performed on one tooth or several teeth to even your gum line and reduce sensitivity.
Ridge augmentation, used to correct gum and jawbone indentations, recaptures the natural contour of your gums and jaws, making an artificial tooth appear to be growing naturally out of the gum tissue.

What to Expect During Periodontal Visits

Your first periodontal visit will consist of an evaluation. You will be asked about your dental/medical history. If you have medical problems, advise your periodontist, since many diseases can affect your mouth and gums.You also should list any medicines you take, including oral contraceptives, because certain medications can adversely affect your gums or have contraindications for antibiotics. Antihypertensive medication can often cause xerostomia (dry mouth) that can accelerate decay and periodontal breakdown.If you smoke, you will be advised to quit, particularly if you are undergoing gum surgery. Smoking, which increases the risk of periodontal disease, also worsens the disease if you already have it. It can also impair the healing process.Your periodontist also will examine:

Your head, neck and jaw joints (temporomandibular joints, or TMJ)
Your mouth and throat
Your teeth and gums

X-rays will be taken. A periapical X-ray – which reveals the entire tooth from crown (top) to the end of the root in your jaw – shows the amount and pattern of bone loss around each tooth. A panoramic radiograph – an X-ray of your entire mouth – shows other important skull structures, including the jaw joints.Once the examination is complete, your periodontist will develop a treatment plan based on your individual wants and needs. Typically, following treatment you will be placed on a periodontal maintenance program.In addition to a proper oral hygiene regimen of daily at-home brushing and flossing, this treatment plan will include regular follow-up examinations and cleanings, which are essential for the continued health of your mouth and gums. If you have gingivitis, many periodontists recommend visits every six months for a deep cleaning. More serious conditions may require visits every three months.

Things to Consider

An excellent way to find a qualified periodontist is to request a referral from your general dentist. Additionally, there are several points to consider when selecting a periodontist, including:

How long has the periodontist been in practice?
What continuing education and/or recertification courses has the periodontist taken? How recently have they been completed?
What is the periodontist’s diagnosis and proposed treatment plan? Ask about all the options for your periodontal condition, as well as the pros and cons of each. Periodontists have different treatment philosophies. While some focus on treating the disease aggressively with surgery, others prefer more conservative non-surgical alternatives. Make sure you fully understand why your periodontist recommends a particular treatment and that you feel comfortable with the proposed plan.
What is the periodontist’s training/clinical experience in performing the specific procedure(s) you need?
What are the estimated costs of the proposed treatments? Does your periodontist accept your insurance? In cases where dental insurance does not cover treatment costs, does the periodontist offer third party and/or in-house financing?
What types of dental technology/equipment does the periodontist’s practice provide?
What medication and pain-relief options are offered?
Does the periodontist have a pleasant chairside manner, and is the staff accommodating and professional?
Does the periodontist practice alone, or is he/she part of a multi-specialty dental group that can provide you with the one-stop oral health care? It is important to note that while these multi-specialty practices may offer convenience, they may not provide the finest specialists for the specific procedures you need, or give referrals outside of the practice.
Who is part of your periodontist’s referral network? If your periodontist works in collaboration with other dental/medical professionals on your case, you must have the same level of confidence in their professional expertise as you do in those of your periodontist. You also need to determine whether these dental/medical professionals accept your insurance, and whether the specific treatments they will perform are covered under your insurance plan. If laboratory-fabricated restorations are involved, is your periodontist satisfied with the work quality of the laboratory and/or technician?
Are the office hours and location convenient for you?
What type of emergency care is available?