By Cynthia Marshall Schuman

Dr. Kenneth Abe uses a surgical microscope to make dental work less painful

With its serene rice-paper screens, gracefully displayed antique obi and lustrous blond-wood floor, this office doesn’t look as though it belongs to someone who practices perhaps the bloodiest of dental specialties: a periodontist.

Dr. Kenneth Abe has practiced his trade in this office at 843 Altos Oaks in Los Altos for 22 years. His office, decorated with traditional Japanese objects, contrasts sharply with his cutting-edge approach to periodontics.

Abe is a periodontal microsurgeon. Like a regular periodontist, he works on restoring bone and gums that have been lost to infection. But unlike his more conventional counterparts, Abe conducts his procedures with the aid of a surgical microscope 11 to 17 times stronger than the naked eye. This extra seeing power allows him to repair irregularities in the roots and gums that his peers can’t even see.

“I’ve found that a lot of defects and a lot of gum problems are due to problems that we normally can’t see with the naked eye, so (microsurgery) has dramatically changed the way I practice,” Abe said. Since he learned the approach half a dozen years ago, he has changed his practice and now uses microsurgical techniques exclusively.

The instruments he uses are roughly half the size of standard periodontal tools, and both the tools and the techniques borrow from minimally invasive treatments such as arthroscopy, vascular surgery and radial keratotomy.

Because Abe works on a smaller scale, his work is more precise and less painful.

“The smaller the wound that is created to accomplish the surgery, the less pain,” said Dr. Dennis Shanelec, a Santa Barbara-based periodontist.

Shanelec was one of the first to use microscopes in his practice, beginning in the mid-1980s. He trained Abe, as well as roughly 600 other periodontists around the country, in the technique.

The ultimate test of microsurgery’s pain-sparing effects is what patients experience.

Rose Balanga, a computer specialist at National Semiconductor in Santa Clara, was very pleased with the experience she had at Abe’s office.

Balanga said that during the procedure, she didn’t feel any pain. “(Afterward) he gave me a painkiller, but I didn’t need to take it at all. He’s great,” she said.

This confirms Abe’s own observation from a sampling of his patients. “I’ve been actually keeping track of it, and I’ve found that about 80 percent of my patients either don’t take pain pills or take one pain pill post-surgically, and everybody goes to work the next day,” he said.

With even the slightest promise of producing less pain for their patients, Shanelec wonders why more dental professionals don’t use microsurgery. “I would say that about 4 or 5 percent of the doctors utilize a microscope in their practice and truly practice microsurgery,” Shanelec said.

He feels that the profession is ripe for this kind of change but that, like anything, it will take time. “The kind of gross, crude surgery that is the standard of care now will be replaced. I think that in another decade, (microsurgery) will be the standard of care, but it’s not going to happen overnight,” Shanelec said.

In the meantime, periodontal disease continues to infect people in epidemic proportions. Up to 80 percent of American adults are thought to have the disease. Unfortunately, it frequently has no detectable symptoms until its advanced stages and no one is immune from it. (There may be a genetic component, however, that ups the odds of some people getting it.)

Periodontal disease is thought to be caused by a buildup of plaque, the sticky film that adheres to the teeth. Plaque contains as many as several hundred different bacteria, some of which can break down the gums and underlying bone. As this foundation deteriorates, the teeth separate from the gums and loosen. Loose teeth can fall out, which is why periodontal disease is a leading cause of tooth loss.

Keeping the mouth meticulously clean - by regularly brushing and flossing - is the best way to prevent periodontal disease.