When to See a Periodontist
A periodontist is a dentist specializing in the prevention, diagnosis and treatment of infections and diseases in the soft tissues surrounding the teeth, and the jawbone to which the teeth are anchored. Periodontists have to train an additional three years beyond the four years of regular dental school, and are trained in modern techniques used to treat periodontal disease and place dental implants. Periodontists also perform a vast range of cosmetic procedures to enhance the smile to its fullest extent.
Periodontal disease begins when the toxins found in plaque start to attack the soft or gingival tissue surrounding the teeth. This bacterium embeds itself in the gum and rapidly breeds, causing a bacterial infection. As the infection progresses, it starts to burrow deeper into the tissue causing inflammation or irritation between the teeth and gums. The response of the body is to destroy the infected tissue, which is why the gums appear to recede. The resulting pockets between the teeth deepen and if no treatment is sought, the tissue which makes up the jawbone also recedes causing unstable teeth and tooth loss.
Referrals from General Dentists and Self Referral
There are several ways treatment from a periodontist may be sought. In the course of a regular dental check up, if the general dentist or hygienist finds symptoms of gingivitis or rapidly progressing periodontal disease, a consultation with a periodontist may be recommended. However, a referral is not necessary for a periodontal consultation.
If you experience any of these signs and symptoms, it is important that you schedule an appointment with a periodontist without delay:
- Bleeding while eating or brushing – Unexplained bleeding while consuming food or during the course of daily cleaning is one of the most common signs of periodontal infection.
- Bad breath – Continued halitosis (bad breath) which persists even when a rigorous oral hygiene program is in place, can be indicative of periodontitis, gingivitis or the beginnings of an infection in the gum tissues.
- Loose teeth and gum recession – Longer looking teeth can signal recession of the gums and bone loss due to periodontal disease. As this disease progresses and attacks the jawbone, (the anchor holding the teeth in place) the teeth may become loose or be lost alltogher.
- Gangrene in the tissues – Gangrene is hard to self diagnose but the general dentist and periodontist will check for its presence in the soft tissues, alveolar bone and periodontal ligament.
- Related health conditions – Heart disease, diabetes, osteopenia and osteoporosis are highly correlated with periodontitis and periodontal infections. The bacteria infection can spread through the blood stream and affect other parts of the body.
Diagnosis and Treatment
Before initiating any dental treatment, the periodontist must extensively examine the gums, jawbone and general condition of the teeth. When gingivitis or periodontal disease is officially diagnosed, the periodontist has a number of surgical and non surgical options available to treat the underlying infection, halt the recession of the soft tissue, and restructure or replace teeth which may be missing.
- Gingivitis/mild periodontal disease – When the gum pockets exceed 4mm in depth, the periodontist or hygienist may perform scaling and root planing to remove debris from the pockets and allow them to heal. Education and advice will be provided on an effective cleaning regime thereafter.
- Moderate periodontal disease – If the gum pockets reach 4-6mm in length a more extensive scaling and root planning cleaning might be required. This cleaning is usually performed under local anesthetic.
- Advanced periodontal disease – Gum pockets in excess of 6-7mm are usually accompanied by bone loss and gum recession. Scaling and root planning will always be performed as the initial nonsurgical treatment. In addition to tose nonsurgical treatments, the periodontist may recommend surgical treatment to reduce pocket depth.
- Tooth loss – Where one or several teeth are missing due to periodontal disease, dental implants are an effective option. If the bone is strong enough to provide a suitable anchor for the prosthetic tooth, the implant can be placed. However, if the bone is severely eroded, bone grafts may be performed by the periodontist to provide a suitable anchor for the new tooth/teeth.
Ask your periodontist if you have questions about periodontal disease, periodontal treatment or dental implants.
When Periodontal Care Goes Beyond a General Dentist's Office
Most adults can have their gum health managed within their regular dental practice. Routine cleanings, deep cleanings for early gum disease, and ongoing maintenance are all provided by general dentists and dental hygienists. For some patients, however, gum disease progresses to a point where care from a periodontist — a dentist with additional training and an RCDSO Certificate of Specialty in periodontics — is appropriate. Knowing when to refer is part of comprehensive general dental care.
Referral to a periodontist is generally considered when periodontal disease has reached a stage where surgical intervention may be appropriate, where the case is complex enough to need a more focused approach, or where standard non-surgical treatment has not resolved the problem. Periodontists handle gum surgery, dental implants in patients with previous gum disease, complex bone grafting, and treatment of advanced or aggressive periodontitis. They also work with patients who have rare or complicated gum conditions.
At Trillium, we provide the full range of non-surgical periodontal care directly — scaling and root planing, periodontal maintenance, treatment of early-to-moderate gum disease, and management of long-term periodontal patients. For patients who would benefit from periodontist care, we coordinate referral and continue to manage other dental care during and after periodontist treatment.
Situations Where Periodontist Referral Is Appropriate
Several specific situations typically warrant periodontist involvement:
- Stage III or IV periodontitis with significant bone loss and pocket depths of six millimetres or more across multiple teeth
- Periodontal disease that has not responded adequately to non-surgical treatment (scaling and root planing)
- Aggressive or rapidly progressive periodontitis, especially in younger patients
- Dental implant placement in patients with a history of moderate to severe periodontal disease
- Complex bone grafting or sinus lift procedures
- Gum recession requiring soft-tissue grafting
- Cosmetic gum surgery for a gummy smile or uneven gum line
- Crown lengthening before restorative work
- Treatment of failing dental implants
- Periodontal abscess that recurs despite standard treatment
- Genetic or systemic conditions affecting periodontal tissues (Down syndrome, certain immune conditions, rare genetic conditions)
- Second opinion on a complex case before major restorative work
Not every case in these categories needs periodontist referral — many can be managed in a general practice with the right approach. The decision is individualized based on what the case needs.
How a Periodontist Visit Fits Into Your Overall Care
A periodontist referral does not mean leaving your regular dental practice. We continue to manage your cleanings, exams, and other dental care while the periodontist handles their specific focus area. Information is shared between offices so both teams have a complete picture. After periodontist treatment is complete, you return to your regular maintenance schedule with us, often at three- to four-month intervals if active disease has been treated.
The first visit to a periodontist is a consultation. They review your dental history, perform their own examination, and may order additional imaging like a cone-beam CT. They explain what they would recommend, what alternatives exist, and what the cost would be. You are not committed to treatment at the consultation visit; this is the time to ask questions and decide together what the right next step is.
Treatment at a periodontist's office is typically more involved than at a general dental office because the procedures are more specialized. Surgical procedures may be staged across multiple visits with recovery time between. Sedation options are available for patients who prefer them. Recovery instructions are specific to each procedure and given in detail. Follow-up visits over the months after surgery track healing.
What This Means for Your Care at Trillium
Trillium provides direct periodontal care for most gum disease situations and refers when periodontist involvement is appropriate. Our diagnostic and non-surgical periodontal services follow the current Ontario Dental Association Suggested Fee Guide. Periodontist fees follow their own ODA-aligned schedule and are billed separately by the periodontist office.
Most private dental insurance plans cover periodontist services under specialist or surgical services categories, often at the same rate as general dental services. Some plans require pre-authorization for major procedures. CDCP coverage for specialist services depends on the specific procedure. We help coordinate referrals, share information, and discuss financial planning with you before periodontist appointments are scheduled.
Frequently Asked Questions
How do I know if I need a periodontist?
Your dentist will tell you based on your specific situation. Most patients with normal gum health or mild-to-moderate gum disease can be managed entirely within a general dental practice. Patients with advanced periodontitis, complex implant cases, or specific procedures like gum grafting or crown lengthening often benefit from periodontist involvement.
Is a periodontist more expensive than a general dentist?
Per procedure, often yes — specialist fees are typically higher than general dental fees because the procedures are more involved. Insurance usually covers periodontist services at the same percentage as general dental services. The full picture (what the procedure achieves long-term) is what matters more than visit-by-visit cost comparison.
Can I just stay with my general dentist for everything?
For most patients, yes. General dentists handle the great majority of dental care, including most gum care. Referral is reserved for situations where the patient genuinely benefits from a specialist's training. If you are managing well in general practice, no referral is needed.
How do I find a good periodontist?
Your general dentist usually has periodontists they have worked with over years and trust. Ask for a recommendation and the reason behind it. You can also verify a periodontist's RCDSO Certificate of Specialty status through the College registry.
Will the periodontist take over my care?
No. Most patients see a periodontist for a specific procedure or course of treatment, then return to their general dentist for ongoing care. Some patients with very complex situations stay under joint care for years, with the periodontist handling the gum-focused portion and the general dentist handling everything else.
What if I do not want surgery?
The decision about treatment is always yours. If a periodontist recommends surgical treatment and you would prefer not to proceed, you can decline. Non-surgical alternatives may be available with different success expectations. The periodontist and your general dentist can explain the trade-offs of each option.