Board-certified periodontal care in Sarasota
A board-certified periodontist treats every case here, from the first deep cleaning through the maintenance visits that keep gum disease from coming back.
Understanding the stages is genuinely useful, because the stage you’re in determines the treatment and how much of it is reversible. The short version: the disease moves from inflamed tissue, to lost bone, to teeth that no longer have enough support. Each stage is treatable, and the earlier one is caught the less involved the treatment.
Gingivitis is inflammation of the gum tissue with no bone loss yet, and it's fully reversible. Plaque and tartar accumulate at and just under the gumline, the tissue responds by becoming red, puffy, and prone to bleeding, and the fix is thorough professional cleaning plus a home routine that keeps the bacteria from re-establishing. There's nothing permanent about this stage, and a patient who acts at gingivitis generally never needs anything more involved than regular cleanings afterward.
Once inflammation reaches the bone, the disease has crossed into periodontitis, and the character of it changes. The gum tissue detaches from the tooth and forms a pocket, that pocket collects bacteria your toothbrush physically cannot reach, and the bone supporting the tooth begins to resorb. Bone lost to periodontitis doesn't grow back on its own, which is the honest and important distinction between this stage and gingivitis. What treatment does at this point is stop the progression and stabilize what's there, and in selected cases regenerate some of the lost support surgically. Patients in this stage do very well, but they stay on a maintenance program afterward rather than returning to twice-yearly cleanings.
In advanced periodontitis the pockets are deep, a substantial portion of the supporting bone is gone, and teeth may be mobile. This is the stage where treatment planning gets genuinely individual: some teeth are stabilized and kept, some are better replaced, and that judgment depends on how much bone remains around each one rather than on a general rule. Being told you have advanced periodontal disease is not the same as being told you'll lose your teeth, and the evaluation exists precisely to replace that ambiguity with a specific plan for your mouth.
Most people arrive here because something small kept happening and eventually stopped feeling small, and periodontal disease treatment turns out to be the answer to a question they’d been half-ignoring for a while. The early stages are quiet by design, since the tissue and bone that anchor your teeth can lose ground before anything hurts, which is why the signs below are worth taking seriously even when they seem minor.
Bleeding is the single most common reason patients call, and it's also the sign most often dismissed, because a little pink in the sink gets written off as brushing too hard. Healthy gum tissue doesn't bleed from normal brushing or flossing. When it does, it's usually inflammation responding to periodontal disease bacteria that has settled below the gumline, and at that stage the condition is still reversible in most cases.
Healthy gum tissue is pink and firm. Gums that look red, feel swollen, or are tender to the touch are responding to bacteria at the gumline, and that inflammation is the body flagging a problem while it is still early enough to reverse.
Bad breath that survives brushing, flossing, and mouthwash usually has a bacterial source below the gumline rather than on the tongue. Further along, patients describe a change in how their bite feels: a tooth that shifted slightly, a gap that opened where there wasn't one, or a partial denture that stopped seating the way it used to. Any of those is worth an evaluation, and none of them means the outcome is already decided.
Recession shows up in a few different ways. Teeth start to look longer, a crown that always matched suddenly shows a darker line at its edge, or one tooth becomes sharply sensitive to cold in a way the others aren't. Recession matters clinically because it exposes root surface that has no enamel on it, so those areas are more vulnerable to decay and to further loss of the tissue around them.
Teeth that feel loose, have shifted position, or meet differently than they used to can signal that the bone supporting them has been affected. This is worth an evaluation sooner rather than later, because the earlier it is measured the more options there are.
Visible pus between the teeth and gums is a sign of active infection and should be looked at promptly.
A periodontal diagnosis rests on measurements rather than appearance, so the evaluation is more involved than a visual look at your gums.
We measure the pocket depth at six points around every tooth and record all of it, which produces a map of exactly where the disease is active and how far it has progressed at each site. Healthy pockets measure 1 to 3 millimeters. Anything at 4 millimeters or deeper is a site where bacteria can live beyond the reach of a toothbrush, and the pattern across your whole mouth is what determines whether periodontal disease treatment needs to be non-surgical, surgical, or a combination of both.
Pocket measurements tell us about the soft tissue; a CBCT scan tells us about the bone underneath it. We use 3D imaging to see how much supporting bone remains around each tooth, where it's been lost, and in what shape, which matters because the geometry of a bone defect determines whether it's a candidate for regeneration. Two patients with identical pocket depths can need quite different treatment for exactly this reason.
Smoking, diabetes, certain medications, a family history of periodontal disease, and clenching or grinding all affect how the disease behaves and how it responds to treatment. Smoking is the most significant of these by a wide margin, since nicotine restricts blood flow to gum tissue and measurably slows healing. We go through your history at the evaluation because two patients with the same charting can need different intervals and different approaches depending on what else is in play.
For most patients with mild to moderate periodontitis, treatment starts and often ends here. Scaling and root planing is the clinical name for what patients usually hear called a deep cleaning, and what separates it from a routine cleaning is depth rather than effort, which is also what makes it a treatment instead of a preventive visit.
Scaling removes plaque and hardened tartar from the tooth surface both above and below the gumline, reaching down into the pockets where a toothbrush can’t go. Root planing then smooths the root surface itself, because a rough, contaminated root gives bacteria somewhere to hold on and keeps the gum tissue from reattaching. Getting that surface clean and smooth is what allows the tissue to tighten back against the tooth, and a pocket that shrinks from 6 millimeters to 3 is a site that a patient can maintain at home again.
| Routine Cleaning (Prophylaxis) | Scaling and Root Planing | |
|---|---|---|
| Purpose | Prevention, for gums with no bone loss | Treatment, for gums with pockets and bone loss |
| How deep it goes | Tooth surfaces above and at the gumline | Below the gumline, into the pockets, onto the root |
| Anesthesia | None needed | Local anesthetic, so the area is numb |
| Appointments | One visit | Usually two visits, half the mouth at each |
| What comes next | Cleanings every six months | Periodontal maintenance every three to four months |
The row that surprises people most is the last one, and it’s the reason the maintenance section below exists. Once you’ve had scaling and root planing, the six-month cleaning schedule no longer applies to you.
We numb the area with local anesthetic first, so the appointment itself is comfortable rather than something to brace for. Most cases are done across two visits, treating half the mouth at each, which keeps each appointment to a reasonable length and leaves you with an unnumbed side to eat on afterward. Expect the treated gums to be tender for a day or two and the teeth to feel more sensitive to cold for a couple of weeks as the tissue tightens and slightly more root surface is briefly exposed. That sensitivity settles on its own in the large majority of cases, and we’ll tell you what to use in the meantime if it’s bothering you.
Some pockets don’t respond as completely as the rest, usually the deepest ones or those in hard-to-reach spots between molars. For those sites we place Arestin, a locally applied antibiotic delivered as microspheres directly into the pocket, where it keeps working on the bacteria for days after the appointment. It’s targeted rather than systemic, meaning the medication acts at the specific site that needs it instead of putting you on a course of oral antibiotics, and it’s used as a supplement to scaling and root planing rather than a substitute for it. We decide site by site at your re-evaluation, once we can see which pockets actually responded.
Deeper pockets and larger bone defects sometimes need more than scaling and root planing can reach, and the re-evaluation four to six weeks after your deep cleaning is where that gets decided on evidence rather than prediction. Dr. Maggie Misch-Haring performs all periodontal surgery here, so the specialist who diagnosed you is the one who treats you.
When a pocket stays deep after non-surgical treatment, pocket reduction surgery (also called osseous surgery) folds the gum tissue back to give direct access to the root and the bone, allows a thorough cleaning of surfaces that instruments couldn’t reach through a closed pocket, and reshapes the bone so the tissue can be repositioned snugly. The result is a pocket depth you can actually maintain with a brush and floss.
Selected bone defects, depending on their shape, are candidates for regeneration using grafting material and membranes that guide new bone to fill the defect. Whether a site qualifies comes down to the geometry visible on the 3D scan, which is why the imaging happens before the treatment plan. Our bone grafting page covers the materials and techniques in detail.
Where the disease has already cost you gum tissue, a graft rebuilds it, covering exposed root, reducing sensitivity, and giving the tooth a durable band of attached tissue again. Our gum grafting page explains the graft types and how each is chosen.
Here’s the part that gets explained least often and matters most. Periodontal disease is a chronic condition, which means treatment controls it rather than curing it, and the visits that keep it controlled are a different appointment from the cleaning you had before. Patients who understand this stay stable for decades. The ones who quietly drift back to twice a year, usually because nobody explained why the interval was supposed to be different, are the ones we end up seeing again with the same pockets and a little more bone loss behind them.
A maintenance visit re-measures every pocket, compares those numbers against your last visit, and cleans below the gumline at the sites that need it, which is why it takes longer and covers more ground than a routine cleaning. The measurements are the point as much as the cleaning is: a site that has gone from 3 millimeters to 5 gets addressed while it's still a small problem, and comparing your chart against itself over time is how we catch a change before you'd ever feel it. Where a site has slipped, we treat it that day or place a local antibiotic rather than waiting for the next visit.
The interval comes from how quickly the bacteria that cause periodontal disease re-establish themselves in a treated pocket, which happens faster than a six-month cleaning schedule accounts for. A three-to-four-month schedule brings you back in while that bacterial population is still below the level that restarts tissue breakdown. Your specific interval depends on your charting, whether you smoke, and how your tissue has responded to periodontal disease treatment so far, and it can lengthen over time if your numbers stay stable. Some patients earn their way back to longer intervals. That's a decision we make from your chart rather than a default.
If you have crowns, bridges, veneers, or implants, periodontal maintenance is protecting that work as much as it's protecting your natural teeth, and this is the part patients with substantial restorative history tend to appreciate immediately. Bone loss around a restored tooth undermines the foundation the restoration sits on, and margins that were sealed at the gumline become exposed as tissue recedes. Implants have their own version of this: they don't decay, but the bone around them can be lost to peri-implantitis, and an implant that loses its bone support has no natural attachment to fall back on. Keeping the tissue healthy is what makes expensive dental work last, and having the periodontist, the surgeon, and the prosthodontist who did that work in the same building means nobody is guessing about what's already in your mouth.
At most general dental offices, a periodontal diagnosis means a referral, and from there you’re managing a relationship with a second practice that doesn’t know your history and won’t be the one restoring anything afterward.
Dr. Maggie Misch-Haring is a board-certified periodontist, which means a three-year specialty residency in periodontics after dental school followed by board examination. She diagnoses and treats periodontal disease here, performs the periodontal surgery, and is a co-author on multiple peer-reviewed publications in periodontal and implant care. She’s also the specialist you see at your re-evaluation and at your maintenance visits, so nobody is reading someone else’s notes to figure out what your baseline was.
This is a family-owned practice, and it has been for 25 years with no doctor turnover, which means the people treating you now are the people who’ll be treating you in five years. Patients who’ve been coming here for a decade see the same faces, and that continuity does real clinical work on a chronic condition: the person comparing this year’s charting against 2019’s is the person who took the 2019 measurements.
When periodontal treatment affects a tooth that needs a crown, or when a tooth is better replaced than saved, the surgeon and the restorative doctor plan it together in the same building instead of trading letters. Dr. Harry Haring handles the final prosthetic and restorative work, with Dr. Katherine E. Misch, and Dr. Craig M. Misch, a board-certified oral surgeon and implantologist, handles surgical implant cases. Nothing gets lost in the handoff, because there isn’t one.
Periodontal procedures have a reputation for being uncomfortable, but they don’t have to be. With your comfort in mind, we offer sedation options and take the time to keep every appointment calm and unhurried.
The cost of periodontal disease treatment depends on how much of your mouth is involved and at what stage, so an honest number requires the evaluation first. What we can tell you before you come in is how the fees work and what drives them.
Two things, mostly. The first is how many quadrants of your mouth need treatment, since scaling and root planing is planned and fee’d by quadrant rather than as one flat procedure. The second is whether your charting and 3D imaging show that non-surgical treatment will be enough on its own or whether some sites will need surgery afterward. Your full periodontal charting is what answers both questions, and that’s why the evaluation comes before any figure does.
We’re a fee-for-service practice and we don’t participate in insurance networks, which is a deliberate choice: it keeps treatment decisions between you and your specialist rather than inside a network’s fee schedule. If you carry dental insurance and have questions about how it applies to periodontal treatment, the right time to raise them is at your evaluation, once the actual scope of what you need is on the table.
It’s natural to have questions before you start, so here are the ones patients ask us most.
Non-surgical treatment is usually two appointments about a week or two apart, then a re-evaluation four to six weeks after the second one to measure how the tissue responded. If surgery is needed, that’s scheduled after the re-evaluation and healing runs several weeks. So the active treatment phase is typically two to three months from first appointment to stable, and the maintenance phase that follows is ongoing.
Gingivitis can be fully reversed. Periodontitis can be stopped and stabilized, and in selected cases some lost bone can be regenerated surgically, though bone that’s already gone doesn’t return on its own, which is the honest line between the two stages and the reason we push hard on catching it early.
No, because the area is numbed with local anesthetic first. Afterward the gums are tender for a day or two and the teeth are often more sensitive to cold for a couple of weeks while the tissue tightens.
It’s different, and the difference is clinical rather than semantic. A routine cleaning is preventive care for gums with no bone loss, working at and above the gumline. Periodontal maintenance is ongoing treatment for gums that have had periodontal disease: every pocket is re-measured and compared against your previous charting, cleaning goes below the gumline at the sites that need it, and anything that has slipped gets treated that day. It also runs every three to four months instead of every six.
In most cases yes, in the same way a managed chronic condition needs ongoing management. The interval isn’t necessarily fixed forever, though. Patients whose charting stays stable over several years sometimes move to a longer interval, and that’s a decision made from your measurements rather than a fixed rule. What doesn’t work is returning to twice-yearly cleanings while the pockets are still there.
Most patients who get treated don’t, including many who arrive convinced they will. Tooth loss becomes a real question in advanced periodontitis where the supporting bone around a specific tooth is largely gone, and even then it’s a tooth-by-tooth assessment rather than a whole-mouth verdict. The evaluation is what replaces the worry with an actual answer, and if a tooth genuinely can’t be saved we’ll tell you plainly and walk you through what replacing it looks like.
Second opinions are one of the most common reasons patients come here, and we’re glad to give one. Bring any x-rays, charting, or treatment plan you already have. Sometimes we confirm what you were told, sometimes the staging or the recommended scope looks different to a periodontist than it did to a general dentist, and either way you’ll leave understanding what your own measurements say.
If your gums bleed, or a cleaning turned into a conversation about pockets, or you’ve been putting off a referral you got months ago, a periodontal evaluation replaces the guessing with measurements. You’ll leave knowing your stage, your charting, and what periodontal disease treatment your specific case actually needs. Second opinions welcome, and you’re seen by the board-certified periodontist who’d be treating you rather than by someone who’d hand you off.
