If you are referred to a periodontist, your first visit will be for an evaluation. Among other things, you will be asked about your medical and dental history.

Tell your dentist about any medical conditions that you have. Many diseases of the body can affect your mouth and gums. Examples include diabetes, osteoporosis and rheumatoid arthritis.

Your periodontist will also ask you if other members of your family (parents, siblings or children) have gum problems. This is important because some forms of severe gum disease run in families. You should also list any medicines that you take. Some medicines can affect your gums.

If you smoke, your periodontist will ask you to try to quit. This is especially important before you have gum surgery. Smoking increases the risk of periodontal disease. It also makes the disease worse once you have it. Finally, smoking hinders healing. This can make your treatment less effective.

The first visit always includes examination of the following:

• Your head, neck and jaw joints (temporomandibular joints, or TMJs)
• Your mouth and throat (tongue, tonsils, cheeks etc.)
• Your teeth
• Your gums (periodontal examination)

Your periodontist will also need X-rays of your teeth. A periapical X-ray helps to show the extent and pattern of bone loss around each tooth. These X-rays show the entire tooth, from the crown (top) to the end of the root, which anchors the tooth in your jaw. You also may need an X-ray of your entire mouth. This is called a panoramic radiograph. This type of image shows other important structures in your skull. They include the maxillary sinuses and jaw joints.

After the exam, your periodontist will determine what type of gum disease you have and develop a plan to treat it. People have different wants and needs. No single treatment is best. Periodontists also differ in their treatment philosophies. Some believe in attacking the disease aggressively with surgery. Others prefer treatments that don't require surgery. Make sure you understand why your periodontist recommends a particular form of treatment. It's important that you feel comfortable with the plan.

Whatever treatment you receive, you will be placed in a maintenance program. This will include regular follow-up exams and cleanings. These visits help to keep your mouth and gums healthy. They also can help to prevent the disease from getting worse again. For someone who has only gingivitis, most periodontists will recommend twice-yearly visits. For people with more significant problems, the schedule might be once every three months.