Who should you see for gum problems, and when is specialist care necessary?
One of the most common questions my patients ask me is: What is the difference between a periodontist and a dental hygienist?
In short, a dental hygienist tends to and helps you maintain your oral health, while a periodontist diagnoses gum disease and treats the complications that arise from it.
Both roles are essential, but they are not interchangeable. Understanding the distinction between them can make a significant difference in knowing who to visit to help preserve your oral health over time.
What Is the Difference Between a Periodontist and a Dental Hygienist?
The main difference between dental hygienists and periodontists is their area of focus. A dental hygienist focuses on prevention and maintenance, whereas a periodontist is a specialist who is trained to diagnose and treat periodontal (gum) disease.
You’re likely familiar with the professional cleanings and oral hygiene support that hygienists provide. A periodontist’s responsibilities include:
- Diagnosing gum disease
- Assessing bone loss
- Identifying risk factors
- Developing and carrying out specialised treatment plans
For those with healthy gums, regular care from a hygienist may be sufficient. However, if gum disease is present, intervention by a specialist like a periodontist is often required.
The Role of a Dental Hygienist
Dental hygienists are highly trained professionals who have earned a university degree after three years of education. A visit with them is often the first stop in preventing oral disease, and their role is fundamental to maintaining oral health and stability.
During a dental hygiene appointment, hygienists remove plaque and tartar using ultrasonic tools, airflow technology, and handheld instruments. They polish teeth and assess gum health. You can also expect hygienists to provide tailored oral hygiene and dietary advice, particularly when a tooth’s enamel shows signs of wear caused by acidic exposure.
For patients with healthy gums, I generally recommend appointments with a hygienist every six months. However, when there is a history of periodontal disease, visits often need to take place more frequently: every three to four months is recommended in order to reduce the risk of recurrence, as bacteria in periodontal pockets can repopulate within this time frame.
Hygienists are essential in maintaining oral health. Their role is primarily preventive and supportive, rather than diagnostic.
When Gum Disease Requires Specialist Care
Periodontal disease is a chronic inflammatory condition that permanently alters the way that gums attach to teeth. Over time, it leads to the destruction of connective tissue fibres, and in many cases, the supporting bone around the teeth.
This is not simply a matter of plaque build-up. Once bone loss begins, the disease process becomes more complex.
In my clinical practice, I frequently see patients who have been attending regular hygiene appointments for years and maintaining good at-home care, yet their periodontal disease has quietly progressed. Often, this happens because a specialist diagnosis was never made and the underlying risk factors were not fully assessed.
Routine cleaning alone cannot control established periodontal disease. It must first be properly diagnosed and treated.
What I Do as a Periodontist
After qualifying as a dentist, I completed additional specialist training at New York University that was focused exclusively on periodontal disease. Now, my role is to take responsibility for diagnosing and managing complex gum conditions, including deep gum pockets.
My first step is always determining an accurate diagnosis. To get there, I assess medical history, medications, genetic predispositions, hormonal influences, stress levels, and anatomical factors that may contribute to disease progression.
When it looks like periodontal disease may be present, I take and carefully analyse radiographs that evaluate the pattern and extent of bone loss. A comprehensive periodontal examination follows. Here, I measure pocket depths, attachment levels, and bleeding upon probing, as bleeding combined with deep pockets is a significant indicator of active disease and a risk factor for further bone loss.
Clinical photographs are also taken so that I can track and monitor subtle changes in tooth position over time. This structured diagnostic process allows me to develop a tailored treatment plan based on your specific clinical presentation.
My clinical approach is informed by the interconnection between my specialist periodontal training, my PhD in Oral Medicine, and research that has deepened my understanding of the systemic and biological factors that drive disease progression. Together, this background shapes the way I approach complex cases, particularly when medical history, medication, or systemic conditions intersect with periodontal health.
Why Maintenance Alone May Not Be Enough
In some settings, particularly within the NHS, hygienists may carry greater responsibility for managing gum health. While they are highly skilled professionals, periodontal disease management ultimately requires specialist-level assessment.
When patients come to see me after years of maintenance-only care, they are often surprised to learn that bone loss has progressed despite regular cleaning. This does not reflect a lack of effort on their part. Rather, it reflects the importance of accurate diagnosis and appropriate specialist intervention.
Hygienists maintain health. Periodontists treat disease. Both roles are vital in the different purposes they serve. This distinction is especially relevant if you’re considering orthodontic treatment such as Invisalign with a history of gum disease, knowing which specialist to see first can protect your results long-term.
When Should You Consider Seeing a Periodontist?
If you have noticed any of the following symptoms, an assessment by a periodontal specialist could be beneficial:
- Persistent bleeding gums
- Gum recession
- Deep pockets around the teeth
- Loose teeth
- Bone loss identified on x-rays
Early intervention significantly improves long-term outcomes and can help prevent the need for more complex treatment in the future.
A Final Thought
My role is to diagnose and control periodontal disease. Once the condition is treated and stabilised, it is essential to regularly visit a hygienist for help with maintaining gum health and preserving the results we’ve achieved together.
If you are unsure whether your gum health requires specialist input, a structured periodontal assessment can provide you with clarity and peace of mind.
If you have concerns about bleeding gums, bone loss, or recurring gum problems, I encourage you to book a periodontal consultation. An early and accurate diagnosis is the most important step in protecting your long-term oral health.
Dr Leticia Casanova
Co-Founder & Periodontist
GDC number: 182582
Leticia Casanova
Co-Founder & Periodontist
GDC number: 182582
Dr Casanova graduated in dentistry from the University of Oviedo, Spain in 2006. Following a period of work in private practice she moved to New York where she completed 2 years full-time training in Periodontology at New York University College of Dentistry. She completed her PhD in Medicine in 2012, where she investigated the links between Periodontal disease and systemic diseases such as Diabetes.
Since arriving in the UK in 2009 Dr Casanova has restricted her practice to periodontology and implant dentistry offering a full range of periodontal treatments including regenerative and cosmetic procedures, microsurgical periodontal plastic surgery (gum surgery), implant dentistry and bone augmentation procedures. She is a Specialist Clinical Teacher at KCL Guy’s Hospital.
Dr Casanova is a member of the British Society of Periodontology, American Academy of Periodontology, Royal Society of Medicine and the Association of Dental Implantology UK. She regularly attends National and International conferences and publishes and presents her work in peer reviewed dental journals and dental meetings.