A perfect smile is about more than just teeth. The supporting structures of your teeth, including the gums, also play an essential role in your overall appearance and wellbeing. A periodontist can prevent, diagnose and treat conditions that affect these structures.

Dr. Kenneth Lee has been practicing dentistry for 44 years and is a certified specialist in periodontics and prosthodontics (aesthetic and reconstructive dentistry). In addition to running his practice, he is the director and organizer of a dental study club for dentists, holds faculty appointments at three universities — the University of Washington in Seattle, the University of British Colombia in Vancouver and McGill University in Montreal — and is invited to lecture internationally in Europe, Asia, and North America.

Dr. Michelle Lee has been practicisng dentistry for eight years and is a certified specialist in periodontics. She also has faculty appointments at the University of Washington, and teaches weekly at the University of British Colombia as a clinical assistant professor.

We spoke with the father-daughter team about their practice and what a periodontist can do for you.

Q: How did the two of you come to be working together?

KL: I currently practice with my daughter, Michelle, who is in fact a third-generation dentist in our family!  My father was also a dentist and I used to practice with him before he retired in 1977.  Some of his patients are now being treated by Michelle and I feel they are fortunate to have such excellent continuity of care.  In fact, I am very proud to say that Michelle is not the only third-generation dentist in our family. I have twin daughters, and Melissa, Michelle’s identical twin sister, is also a periodontist. Melissa, however, recently got married and has moved to Waterford, Ireland to practice with her husband.

Q: What part of the business do you each deal with?  

KL: Michelle followed the same education as I did, graduating from McGill University with her dental degree and then specializing in periodontics at the University of Washington. Because of this we have similar philosophies of treatment and Michelle and I share the care of our patients. She will be continuing the practice when I retire. We provide periodontal care and dental implant treatment to replace missing teeth.

Q: Why is it important to see a periodontist?

KL: It is important to see a periodontist in order to make sure that the teeth and gums are healthy. If the gums are not healthy, bone loss around the teeth can occur, resulting in loosening of the teeth and eventual tooth loss.

Q: Who should be concerned with gum disease?

ML: Gum disease can occur in anyone and especially in patients who have risk factors for the development of gum disease, such as those who smoke, who are diabetic, or who may have an underlying medical condition making the immune system weak. Gum disease may be localized to a small area or generalized, affecting the whole mouth.  

Q: What is periodontal therapy?

ML: Periodontal therapy is treatment aimed at improving the health of the dental supporting structures, reducing inflammed gum tissue, and reducing the bad bacteria.

Q: Who would need it?

KL: Everyone who would like to preserve their teeth and good health!  Sound dentition is required to maintain good health because people have to eat and enjoy food.

Q: What would periodontal therapy involve?

ML: Initial periodontal treatment usually involves deep cleaning, where the roots of the teeth are cleaned very well and in more involved cases, periodontal surgery would follow. Often times, people have lost teeth as a result of advanced periodontal disease or trauma and we replace these teeth with dental implants.  Because of our training and background, our practice provides treatment related to the placement of dental implants. Especially if placed in the visible front region, bone or soft tissue grafting may be required in order to achieve an ideal natural aesthetic result.

Q: How long would it take for results to be seen?

ML: Initial improvements in gum tissue health from the deep cleanings can be seen within a few weeks, but any bone healing or changes will take a few months.  

Q: Tell me about bone grafting. Why would a patient need it?

ML: A patient may need a bone graft if they have lost bone around teeth or, quite commonly, if they have lost a tooth and we are planning to place dental implants. A dental implant must be placed into bone and if there is not enough bone, we need to grow the bone first.

Q: What would the procedure be like?

ML: Bone grafting around a tooth involves cleaning the root surface well, placing the bone graft into the bony defect, covering the area with a membrane and allowing time for healing. When performing a bone graft prior to the placement of a dental implant, this would involve placing the graft material where the bony ridge is deficient, covering the graft with a membrane and closing the gum tissue back over. Bone healing would take approximately six months.

Q: What is gingival recession?

KL: Gingival recession is when the gum tissue has receded or disappeared from the tooth, exposing the root surface and making the tooth appear longer. Often times, these teeth will experience more sensitivity and be at risk for developing abrasion, cavities and further recession, not to mention it is unaesthetic. The root surface is usually darker than the crown so it is quite noticeable.

ML: [Recession is] commonly caused by aggressive toothbrushing, bite problems, having thin gum tissue, and periodontal disease.

Q: Who does it most commonly affect?

KL: It most commonly affects patients with thin gum tissue and those who brush very aggressively with medium-hard bristle toothbrushes.

Q: Tell me how dental aesthetics relates to gum health and gingival harmony.

ML: An aesthetic smile is not only related to the teeth itself, but how they fit in the mouth and the frame around it, [for example] the gum tissue. Our eyes appreciate symmetry between the right and left sides and if there is a discrepancy in gum tissue height, it will be very noticeable. For example, if one front tooth has gum recession making it look a lot longer than the other side, making a new crown for it will not change the proportion, only the colour or shape of the crown. But if a gum graft was performed to cover the exposed root surface and to restore the normal tooth proportion, it will look much more natural and will fit the smile better.

Q: Tell me about your work with trauma cases.

KL: We often see trauma cases from motor vehicle accidents, bicycle accidents or sport accidents where teeth have been knocked out or fractured. Often, these teeth will be so badly damaged that they are no longer restorable and will need to be removed and replaced with dental implants.  Because of the damage, rebuilding of the bone and soft tissue can be required prior to or at the time of dental implant placement. Because of the healing time involved, this can take several months before the final result is achieved. Dental implants are currently considered the standard of care to replace lost teeth either for cosmetic reasons or chewing purposes.

Q: What is important to look for in a good periodontist?

KL: Someone who is properly qualified, experienced, recognized by their professional peers, who is up to date in treatment and someone you feel comfortable with. •

For more information visit Dr. Kenneth Lee and Dr. Michelle Lee at vancouverperiodontics.com.