What Is a Periodontist, and When Do You Need One?

What Is a Periodontist?

A periodontist is a dentist who completed three years of additional, full-time residency after dental school, in the specialty that treats the gums, the bone that holds teeth in place, and dental implants. Periodontics is one of the twelve dental specialties recognized by the National Commission on Recognition of Dental Specialties and Certifying Boards, an agency of the American Dental Association, which defines it as the specialty covering the prevention, diagnosis, and treatment of diseases of the tissues supporting and surrounding the teeth or their substitutes. The American Academy of Periodontology describes the training as three additional years of education beyond dental school, including in-depth surgical training that most general dentists do not receive. Those three years are spent almost entirely on surgery and on the diagnosis of periodontal disease, in a hospital or university program under faculty supervision, with a research requirement; many programs award a master’s degree alongside the specialty certificate.

The difference between a periodontist and a general dentist is not permission. In most states a licensed dentist may legally perform any dental procedure, including placing implants and doing gum surgery. The difference is depth and volume. Someone finishing a periodontics residency has placed implants, grafted bone and gum tissue, treated advanced periodontal disease, and managed complications and failures hundreds of times before ever treating a patient independently. That accumulated experience is most visible not in the routine case but in the one that does not go as planned.

What Does a Periodontist Treat?

• Periodontal disease at every stage, from pockets that will not close after a deep cleaning to advanced bone loss around teeth that are becoming loose. Gum disease treatment.
• Gum recession, with grafting to cover exposed root, stop the recession from progressing, and rebuild tissue that has thinned.
• Dental implants, from a single tooth to a full arch, including the bone grafting, ridge preservation, and sinus lifts that make implant sites usable. Dental implants.
• Failing implants. Peri-implantitis is bone loss around an implant. It is the same category of problem as periodontal disease, and it is treated by the same specialty.
• Crown lengthening, which reshapes gum and bone so a dentist has enough tooth structure to restore, or so a smile shows less gum.
• Frenectomy and other soft-tissue procedures, and periodontal emergencies such as an abscess or a tooth that has suddenly loosened.

What Does Board Certification Actually Mean?

Any dentist who completes an accredited periodontics residency may use the title periodontist. Board certification is a separate, voluntary step taken afterward: a comprehensive written examination followed by an oral examination before examiners of the American Board of Periodontology, covering periodontal diagnosis, surgical treatment, and implant surgery, with candidates defending their own treated cases. Those who pass are Diplomates of the American Board of Periodontology. Only a minority of practicing periodontists hold it.

This is worth separating from a related claim patients encounter often. A dentist of any kind who takes continuing-education courses in implants and then places implants is doing the procedures; that is not the same as completing a specialty residency, and neither is the same as board certification. None of the three is a statement about any individual’s skill. They are statements about what has been formally examined and by whom. A patient comparing providers is entitled to know which of the three applies.

How Do You Verify Someone’s Board Certification?

The American Board of Periodontology maintains a public directory of current Diplomates at abperio.org, which lists board-certified periodontists in good standing with the board. Search the name; certification status appears there or it does not. The American Academy of Periodontology (perio.org) separately lists member periodontists and is a reasonable way to confirm that someone completed the specialty residency at all. The Texas State Board of Dental Examiners lists every licensed dentist in the state along with the specialties they are announced in and any disciplinary history.

Two phrases deserve a closer look wherever they appear. “Board eligible” means the examinations have not been passed, at least not yet. Certification by a board other than the American Board of Periodontology is not periodontal board certification, whatever the name of the organization suggests: the American Board of Periodontology is the certifying board for periodontics recognized by the National Commission, and it is the only one. Dr. Verrett is a Diplomate of the American Board of Periodontology and is listed in that directory. About Dr. Verrett.

Periodontist or Oral Surgeon for a Dental Implant?

The honest answer is that both specialties are trained to place dental implants, and for most single implants either is a sound choice. The emphasis of the training differs.

An oral and maxillofacial surgery residency runs four to six years, is hospital-based, and covers jaw surgery, facial trauma, pathology, wisdom teeth in volume, and the administration of general anesthesia. Implants are part of a wide scope.

A periodontics residency is narrower and concentrated on the tissue that surrounds teeth and implants: the diagnosis and surgical treatment of periodontal disease, bone and soft-tissue grafting, and the long-term maintenance of implants after they are placed. A periodontist is also the specialist who treats implants that develop problems years later.

Where that difference tends to matter: cases with thin or missing bone that must be rebuilt; sites in the front of the mouth where the gum contour around the implant determines whether it looks natural; patients whose remaining teeth have periodontal disease that has to be controlled before or alongside implant treatment; and any case where some teeth might be saved rather than replaced. Where it tends to matter less: a molar site with good bone and healthy neighbors. Full general anesthesia in a hospital setting, when a patient’s medical situation calls for it, is the oral surgeon’s territory. The more useful questions for either are how many of your particular case the surgeon does, whether a 3D scan and a surgical guide are part of the plan, and who manages the implant afterward.

Periodontist or General Dentist for Gum Treatment and Implants?

For gum treatment, the line is reasonably clear. A general dentist diagnoses periodontal disease and treats its early and moderate forms, usually with scaling and root planing. When pockets stay deep after that treatment, when bone loss is advanced or getting worse, when teeth are loose or moving, or when a graft is needed, the disease has moved past what can be reached without surgery. That is the point of referral, and it is a point most dentists recognize and act on.

For implants, general dentists vary widely. Some have substantial surgical training and place implants routinely and well. Some place a few each year. The procedure is not the hard part; site selection, bone assessment, managing soft tissue, and knowing when not to place an implant are. Anyone considering an implant with any provider can reasonably ask how many are placed each year, whether a cone-beam CT is part of planning, and what the plan is if the implant does not integrate.

What Happens to Your Relationship With Your Own Dentist?

Nothing changes about it. Dr. Verrett provides no general dentistry: no fillings, no crowns, no routine cleanings, no root canals. Referred patients are not kept. After surgical treatment is finished, patients go back to their own dentist for restorative work, including the crown that goes on an implant, and for cleanings.

Maintenance after periodontal treatment usually alternates between the two offices, typically every three to four months, so both the dentist and the periodontist examine the mouth regularly. The dentist receives a written report after every visit here: the diagnosis, what was done, the imaging, the maintenance interval, and anything else worth their attention. Patients without a general dentist are helped to find one. For referring dentists describes how that coordination works from the dentist’s side.

Do You Need a Referral to See a Periodontist?

No. A referral is not required, and most dental insurance plans do not require one to see a dental specialist, though a call to the plan settles it. Most patients here arrive with a referral, which helps because it usually arrives with X-rays and a history. But calling directly is entirely normal and no one is asked to justify it.

When Should You See a Periodontist Without Waiting?

Some situations are worth a specialist opinion before a referral is offered:

• Gums that bleed routinely when brushing or flossing, which is not normal no matter how often it is described that way.
• A tooth that has loosened, shifted, or changed how the bite feels.
• Gums that have receded, exposing root that is sensitive, notched, or getting longer year over year.
• Persistent bad breath or a bad taste that cleaning does not fix.
• A recommendation to extract a tooth, particularly several teeth or a full arch. A second opinion from a specialist whose work is saving teeth is a reasonable step before anything is removed. See replacing several teeth or a full arch and how to decide between the full-arch options.
• An existing implant that bleeds, aches, feels loose, or has gum shrinking away from it.
• A history of periodontal disease in the family, or diabetes, which both raises the risk of periodontal disease and is harder to control when the disease is active.

Waiting has a specific cost with this disease: bone that has been lost does not reliably come back. Treatment can stop the process at any stage, but it works with what is left.

What a Visit Here Looks Like

Austin Periodontal Associates is a single-doctor specialty practice in North Austin. A first visit is an examination, imaging, and a conversation, with a written plan and estimate to take home; nothing is done to the mouth that day except in an emergency. Your first visit covers it in detail, and what determines the cost of implant treatment covers the financial side. Patients who need it can be treated under nitrous oxide, oral, or IV sedation. For an appointment or a question, contact the office.