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Periodontists perform thorough clinical examinations, using calibrated periodontal probes to measure periodontal pocket depths and the "attachment level" of periodontal tissues. They check for gingival bleeding, evaluate the amount of plaque and calculus, and assess tooth stability. They also take X-rays to see if the patient has bone loss from past periodontal disease. Periodontists may do tests to find out which types of bacteria are involved.
Meticulous removal of calculus below the gum line, or scaling, remains an important part of treatment. Root planing is a more intensive form of scaling that involves removing infected cementum from root surfaces. When their periodontal disease has been stabilized, patients enter the maintenance phase of treatment and return every few months for scaling and root planing.
Periodontists also prescribe antibiotics to eliminate bacteria in the periodontal pockets. Increasingly, antibiotics are placed directly in the pocket in the form of fibers, gels, or chips.
Periodontists also can surgically insert bone-regenerating materials into areas with bone loss to grow new bone. This process is known as guided tissue regeneration.
When periodontal disease is left untreated or treatment fails, tooth bone loss may occur. Periodontists and other dentists can replace lost teeth with dental implants, which are metal or ceramic-metal devices surgically inserted into the jawbone. Artificial teeth or dentures are attached to the implants to restore normal function.
Periodontists may also perform gum grafts in patients whose gums have receded, leaving the bone less protected. In this procedure, tissue is harvested from the roof of the patients mouth and then stitched onto the receded region, in the hopes that the "graph" will take hold as new tissue.
Those who manage their own practices must hire, train, and supervise employees, including office staff and dental hygienists.