Periodontology: what a periodontist does and the signs that should alert you

The periodontium: gum, bone and ligament, everything that holds the tooth

A tooth is not planted in bone like a post. It hangs in its socket from a ligament made of thousands of fibres, wrapped in alveolar bone and covered by the gum (gingiva). Together these form the periodontium, from the Greek for “around the tooth”. When healthy, it shows a pink, firm gum that hugs the outline of the teeth and does not bleed when you brush.

Periodontology, also known as periodontics, is the branch of dentistry that studies these supporting tissues, their diseases and their treatment. A periodontist is a dentist who has extended their initial training with university study in periodontology and devotes all or part of their practice to this care. Dr Victor Hazout holds a CES (certificate of advanced study) in periodontology (Paris 7, 2015) and a university diploma in clinical periodontics (Paris Descartes, 2016); his practice brings together periodontology, oral surgery and implant dentistry within a global, medical approach to periodontal disease.

Gingivitis or periodontitis: two stages of the same inflammation

Gingivitis is inflammation of the gum triggered by dental plaque, the bacterial film that re-forms on the tooth surface every day. Its first signal is bleeding gums: when brushing, flossing or using interdental brushes, sometimes for no reason at all; the gum is red, slightly swollen and rarely painful. It is reversible: the gum recovers as soon as plaque is properly removed (see treating gingivitis). The 2018 international consensus describes it as a major risk factor for, and a necessary precursor of, periodontitis ^[1].

Periodontitis crosses a threshold: the inflammation gradually destroys the ligament, then the bone. Periodontal pockets open up between gum and root, beyond the reach of the toothbrush. This lost support does not come back on its own. Untreated, the disease can lead to loose teeth and, eventually, to tooth loss ^[2]. Severe periodontitis affected about 11% of the world's population in 2010, according to a large systematic review ^[3].

“Receding” and “loosening” teeth: what patients describe

“My teeth are loosening” or “my gums are receding” come up in almost every first consultation. These words are not a diagnosis but a description: the gum has pulled back, part of the root shows, the teeth look longer, sometimes dark gaps open between them or a tooth moves. Behind the same words lie two very different situations.

Gum recession: the gum slides down the root while the bone between the teeth stays intact. It often involves one or a few teeth, in people with thin gums, after heavy brushing, orthodontic treatment or because a frenum pulls on the gum. The tooth remains stable; the main complaints are sensitivity to cold and appearance. A gum graft can cover the root in a number of cases: see Gum recession and gum grafts.

Periodontitis: the gum recedes because the bone that carried it has been destroyed by inflammation. Recession is then generalised or affects several areas, and it comes with bleeding, pockets and, at an advanced stage, mobility. The priority is not to cover the roots but to halt the bone loss: see How periodontitis is treated.

When should you see a periodontist?

None of these signs amounts to a diagnosis on its own. But their presence, particularly for more than two weeks despite careful brushing, warrants a periodontal examination:

• gums that bleed when you brush or floss, or spontaneously;
• red, swollen or tender gums;
• bad breath or a bad taste that will not go away;
• receding gums, teeth that look “longer”;
• gaps opening between teeth, teeth that move or drift;
• sensitivity to cold at the neck of the teeth;
• a gum abscess (swelling, sometimes with pus).

Some situations call for an assessment even without symptoms: a close relative who lost teeth young, diabetes, smoking, or plans for implants or adult orthodontics. In a meta-analysis, smoking was associated with a roughly 85% higher risk of developing or worsening periodontitis ^[5]. Your general dentist may also refer you after spotting gum inflammation or bone loss on an X-ray.

What does the periodontist do?

The management of periodontitis follows a stepwise logic, the one set out in the European Federation of Periodontology (EFP) clinical practice guideline published in 2020 ^[4]:

Depending on the situation, other treatments come into play. Periodontal regenerative surgery can rebuild part of the lost support in some bone defects. A bonded splint stabilises teeth that stay loose once inflammation is under control. Correcting a gum line that is too visible or uneven comes under gum aesthetics.

A periodontist also works around implants: preventing and treating peri-implant mucositis and peri-implantitis (see Gum care around implants), and preparing the tissues before implant placement (see Implants).

The practice is equipped with a diode laser and an Er:YAG laser. They complement the mechanical cleaning of the roots in some situations and are used chiefly in soft-tissue surgery; they do not replace root surface debridement. Their real value, their limits and the position of the guidelines are set out on the page Diode and Er:YAG lasers in periodontology.

Prevention belongs to periodontology as much as treatment does: learning to clean between the teeth, stopping smoking, keeping diabetes in balance and understanding what diet does to inflammation (see the article Nutrition, micronutrition and periodontal inflammation).

What to expect from a first visit

The first consultation, at the Levallois-Perret practice, is first of all about understanding your background: medical history, medication, smoking, diabetes, family dental history. The periodontist then examines the gums, and reads the X-rays. You are given a clear account of the diagnosis, the options and what each one involves. What to bring and what is decided there are set out on the First visit page.

Frequently asked questions