If you are referred to a periodontist, your first visit will be for an evaluation. This typically involves a review of your dental, medical and social histories. If you have any medical problems, it is crucial that you describe them to the periodontist because so many systemic diseases can affect your mouth and the health of your gums. He or she also will want to know about any medications you are taking, since these also can affect your gums.

If you smoke, your periodontist will ask you to make an earnest effort to quit whatever the condition of your gums. This is especially important before a surgical procedure. Smoking increases the risk of periodontal disease, makes the disease worse once you have it, and decreases the effectiveness of periodontal treatment by affecting your body's ability to heal properly.

The first visit always includes an examination of your head, neck and jaw joints (temporomandibular joints, or TMJs); a general oral examination of all of the structures in your mouth and throat (tongue, tonsils, cheeks, etc.); evaluation of your teeth; and a full examination of the health of your gums, called a periodontal examination.

In addition to the examination, your periodontist also will need X-rays of your teeth. A type of X-ray called a periapical X-ray helps the dentist or periodontist determine 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, known as a panoramic radiograph. This type of picture provides information about other important structures in your skull, such as the maxillary sinuses and jaw joints.

Once the examination is done, your periodontist will develop a plan to treat your periodontal problems. Since people have different wants and needs, there is no single treatment that is best. Some people want state-of-the-art treatment, regardless of cost. Other people may be constrained by insurance and other financial issues. Still others may want the treatment that takes the least amount of time.

In addition, you may find that periodontists differ in their treatment philosophies. Some periodontists believe in attacking the disease aggressively with surgical treatment, while others believe in more conservative, nonsurgical approaches. It's important that you understand why your periodontist is recommending a particular form of therapy and that you feel comfortable with the proposed treatment plan.

Regardless of the specific type of treatment, all patients will be placed in a maintenance program in which they will be asked to come in for regular follow-up examinations and cleanings. These cleanings and checkups are critical to maintain the health of your mouth and gums, and to help to prevent the disease from worsening again in the future. For someone who has gingivitis and no other problems, most periodontists will recommend twice-yearly visits. For people with more significant periodontal problems, the schedule might be once every three months.