Gum disease is the leading cause of tooth loss in adults in the UK, yet it remains one of the most under-treated conditions in dentistry. For the majority of patients, gum disease can be managed effectively by a general dentist and hygienist working together. But there are cases — more common than many patients realise — where the complexity of the condition, or the structures involved, warrant the involvement of a specialist periodontist.
This article explains what a specialist periodontist does, which conditions benefit most from specialist care, and how the periodontal service at The Briars Dental Centre works — both for patients who come to us directly and for dental professionals considering a referral.
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A specialist periodontist is a dentist who has completed additional postgraduate training — typically at master’s level — specifically in the prevention, diagnosis, and treatment of diseases affecting the gums and supporting structures of the teeth. In the UK, specialist periodontists are registered on the GDC Specialist List, a distinction that reflects both the depth of their training and their scope of clinical practice.
The difference between a specialist periodontist and a general dentist with an interest in periodontics is significant. A specialist has dedicated their entire clinical career to this area, managing cases of a complexity and severity that fall outside the scope of general dental practice. At The Briars, our specialist periodontist is Sharmila Khopade, who sees both patients referred from within the practice and those referred by dental professionals from across the region.
For most patients with early to moderate gum disease, a structured course of treatment with a hygienist – including personalised oral hygiene instruction, professional cleaning, and regular monitoring – will achieve good disease control. But some cases don’t respond as expected, or present at a level of severity that requires a different clinical approach from the outset.
A specialist periodontist is the appropriate next step when gum disease is advanced, when pocketing is deep and persistent despite initial treatment, when bone loss is significant, or when the pattern of disease suggests something beyond straightforward plaque-induced periodontitis. Sharmila uses a combination of thorough clinical assessment, detailed pocket charting, and targeted treatment – both non-surgical and surgical – to bring active disease under control in cases where general dental management has reached its limits.
Early referral to a specialist periodontist in complex cases generally leads to better long-term outcomes. The longer aggressive periodontal disease is left inadequately treated, the greater the risk of irreversible bone loss and eventual tooth loss.
Dental implants don’t develop decay, but they are not immune to gum disease. Peri-implantitis — infection and inflammation of the tissues surrounding a dental implant — is a growing clinical challenge as implant placement becomes more widespread. Approximately one in five patients with a history of gum disease will develop peri-implantitis, and the condition can progress more rapidly around implants than around natural teeth.
Early peri-implantitis can often be managed non-surgically, but more established cases – particularly those with bone loss around the implant — frequently require surgical intervention. The first step in treating peri-implantitis is professional non-surgical therapy to reduce bacterial deposits, followed by reassessment at around six weeks to evaluate the response. Where disease persists or bone loss is ongoing, a specialist periodontist is well placed to determine the most appropriate surgical strategy.
At The Briars, the periodontal and implant teams work in close collaboration. Patients with existing implants who develop signs of peri-implantitis can be assessed and treated by Sharmila, often working alongside Dr French or Dr Lilleker where surgical management of the implant site is required. This integrated approach – with both clinicians under the same roof – avoids the fragmented care that can occur when implant and periodontal management happen at separate practices.
For patients who have not yet had implants but have a history of periodontal disease, it is essential that gum health is optimised and stable before implant placement begins. Our article on implants after gum disease explains this process in more detail.
Gum recession – where the gum tissue pulls back from the tooth surface, exposing the root – is one of the more common reasons patients are referred to a specialist periodontist. It can be caused by periodontal disease, over zealous tooth brushing, tooth position, or a combination of factors, and it tends to progress gradually, which means many patients aren’t aware of the extent of the problem until it is pointed out at a check-up.
Beyond the aesthetic concern of teeth appearing longer than they should, recession has clinical consequences. Exposed root surfaces are more vulnerable to sensitivity and decay, and recession in certain areas can compromise the long-term prognosis of a tooth if left untreated. Surgical techniques to address recession – including soft tissue grafting – fall within the specialist periodontist’s scope of practice and can achieve meaningful improvement in both function and appearance.
Not all periodontal treatment is driven by disease. Sharmila is frequently involved in aesthetic cases at The Briars — particularly those involving Digital Smile Design planning, implant restorations, and veneer or composite work where the gum architecture is a significant factor in the final result.
Gum recontouring — reshaping the gumline to achieve symmetry, correct a gummy smile, or create the right proportions for a cosmetic restoration — is a procedure that benefits greatly from specialist involvement, particularly in complex cases or where precision is critical to the aesthetic outcome. Collaborating with the broader clinical team at The Briars, Sharmila ensures that the soft tissue framework is in the right position before final restorations are placed, which produces results that are both more predictable and more durable.
The Briars uses Waterlase — an advanced laser system — as part of its periodontal treatment toolkit. In the right cases, laser-assisted treatment offers meaningful advantages over conventional approaches: reduced bleeding, faster healing, and the ability to target diseased tissue with a precision that traditional instruments cannot always achieve.
Waterlase has applications across a number of the conditions Sharmila treats, including active periodontal disease, peri-implantitis, and soft tissue procedures such as gum recontouring and crown lengthening. It is not a replacement for clinical judgement or thorough assessment, but it is a genuinely useful adjunct that expands the range of treatment options available to patients at The Briars. Our dedicated Waterlase article explains the technology in more detail for patients who want to understand how it works.
Sharmila Khopade accepts referrals from dental professionals across the region for the full range of periodontal conditions — including active periodontitis, peri-implantitis, recession, and aesthetic gum surgery. Referrals are welcome from general dental practitioners, specialist colleagues, and multidisciplinary teams.
The Briars operates as a specialist referral practice as well as a patient-facing private practice, and we understand the importance of clear communication between referring clinician and specialist. Referring dentists receive a full written report following assessment and at key stages of treatment, and we are committed to returning patients to their referring practice for ongoing care once specialist treatment is complete.
Where cases require a multidisciplinary approach — for example, a patient needing both periodontal treatment and implant placement — the benefit of referring to The Briars is that both elements of care can be managed within the same practice, with the clinical teams working in direct collaboration. This avoids the delays and communication challenges that can arise when specialist care is split across multiple locations.
To discuss a referral or request further information, please contact the practice, or check out our online referrals portal here. Our team will ensure your patient is seen promptly and that you are kept informed throughout their care.
Patients do not need a referral from their own dentist to access Sharmila’s services at The Briars — self-referral is welcome. If you have been told you have gum disease that requires specialist attention, if you are concerned about recession, or if you have implants and have noticed any changes around them, you are welcome to contact us directly to arrange a consultation.
For patients already registered with The Briars, internal referral to Sharmila from your treating clinician is straightforward — one of the genuine advantages of a multidisciplinary practice is that specialist input is accessible without needing to travel to a different location or navigate a separate referral pathway.
The British Society of Periodontology is an excellent independent resource for patients wanting to understand more about gum disease and what specialist periodontal care involves. The European Federation of Periodontology also provides clear patient-facing information on periodontal conditions and their treatment.
If you have concerns about your gum health – or if you are a dental professional looking to refer a patient – we’d be delighted to hear from you.
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