"Your Smile, Our Specialty"

The motto of the American College of Prosthodontists, "Your smile, our specialty", sums up the reason to have your teeth taken care of by a prosthodontist.

Prosthodontists are committed to life-long prosthodontic care as a healthcare partner with their patients.  They believe helping people smile changes lives.  They provide comprehensive care, from diagnosis to treatment.  From a single crown to a full mouth rehabilitation, with fixed or removable prosthetics, using tooth or implant support, prosthodontists are responsible for the patient's complete and final esthetic and functional treatment outcome.

As a Fellow of the American College of Prosthodontists, and having spent more than ten years on the group's Board of Directors, Dr. Tupac ascribes to the ACP's commitment to care.

For more information:  www.gotoaPro.org

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

The Silent Infection

A Canadian study between 2009 and 2011 found that nearly 14% of people between the ages of 14 and 59 may be infected by the herpes simplex 2 virus and 1% tested positive for chlamydia.  Almost all of those affected were unaware they were infected, and that's why chlamydia is often called the silent infection.  Simple urine and blood tests can spot the infections.  Antibiotics can cure chlamydia infections, and prevent serious fertility problems, and other medical and psychological problems, too.

Source:  The Canadian Press

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

New Dentures: Get Your Smile Back

Shrinkage

When teeth are removed, our jawbone begins a continuous, lifelong process of resorption, or shrinkage.  The pressure from dentures on gum tissues also cause shrinkage, since gum tissues were never intended to withstand chewing forces.  Dentures that don't fit properly cause even greater and more rapid shrinkage.  

Replace your denture

How do you know when it is time to get a new set of dentures?  If you're like most people, you'll find a high quality set of well-fitting dentures restores your youthful appearance, allows you to eat most of the foods that you love, helps you feel better about yourself, eliminates embarrassment, enables you to speak more clearly and may even help with digestion!  A set of dentures is not meant to last forever because your denture was made to fit the original shape of your oral anatomy and that shape changes as the bone and gums underneath recede.  Often you don't notice the gradual shrinkage that causes them to loosen and become unstable, affecting you in a number of different ways.  If your denture slips and moves, if words are difficult to form, if you can't chew as easily as before, or if lack of facial support has given you the collapsed "denture look",  then it's time to get your smile back with a new set of dentures.  The new set will make you look better and feel younger, speak more clearly and enhance your chewing ability.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Surviving Allergy Season

Spring is the season that brings increased pollen levels and the symptoms of sneezing, coughing, runny nose, itchy eyes, and other things that can make you feel miserable.  What can you do to help survive allergy season?

• pollen levels are the highest in the morning and on windy days, so protect yourself at these times if possible
• keeping windows closed, especially on windy days, and changing clothes after being outdoors helps
• stay in the shade, wear sunglasses, keep eye drops handy
• wash your hands often
• Vitamin C is a natural antihistamine, so eating fruits and vegetables, or taking supplements may help minimize symptoms

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Prosthodontics

Why patients should go to a Prosthodontist

Kim was born with a cleft palate and lip. Up until she was 38 years old, she suffered from repeat infections of the sinuses, gums and tissue. It took the right team of people orchestrated by her Prosthodontist, to make all of the difference in Kim's dental health.

Kim's story is a good example of why patients go to a Prosthodontist. Prosthodontics is one of nine dental specialties recognized by the American Dental Association.

Prosthodontistics is the dental specialty

Many like to think of Prosthodontists are the "quarterback" of a dental treatment plan. They regularly lead teams of general dentists, specialist  and other health professionals to develop solutions to your dental needs. Prosthodontics is the dental specialty pertaining to the diagnosis, treatment planning, rehabilitation and maintenance of the oral function, comfort, appearance and health of patients with clinical conditions associated with missing or deficient teeth and/or oral and maxillofacial tissues using biocompatible substitutes.

According to the American College of Prosthodontists, a Prosthodontist is a dentist who Specializes in the esthetic (cosmetic) restoration and replacement of teeth. Receives three to four years of additional training after dental school. Restores optimum appearance and function to your smile. The treatment planning and restoration of implants, (TMJ and TMD), and rehabilitation of occlusion with prostheses all fall under the field of prosthodontics.

Background of Dr. Tupac

Dr. Robert G. Tupac spent ten years on the Board of Directors of the American College of Prosthodontists.  In 1981, Dr. Tupac passed the exam to become a Board Certified Prosthhodontist. To this date, there are only about three thousand Board Certified Prosthodontists in the world which gives you an idea of how important and exclusive this specialty designation is. 

For more information on Prosthodontics and to see a video of Kim's story, go to www.gotoaPro.org  

For more about Dr. Tupac, see www.drtupac.com

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

How You Present Yourself

Walking into a job interview and smiling with dark, worn teeth, and old stained fillings puts you at a disadvantage in today's job market.  Rehabilitating your smile not only improves dental health, but also adds self confidence.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Teen Prescription Drug Abuse

WebMD, from HealthDay News, reported a survey showing that 24% of high school students have abused prescription medications.  The details:

• the numbers represent a one-third increase from 2008
• 13% had experimented with either Ritalin or Adderall not prescribed for them
• 20% of teens reported their first experience before the age of 14

Helping fuel the problem is the misconception  that prescription drugs are less dangerous than street drugs.

For more: www.webmd.com

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Starting A Fitness Routine

Developing a regular fitness routine can be challenging and intimidating.  Studies show that it takes at least 21 days of repetition of an exercise program to create new habits.  You might approach a new routine this way:

• check with your physician regarding any health risks or concerns
• consider exercise as being a balanced plan of flexibility, muscle strength and endurance, as well as cardio to burn calories
• find a program, with a trainer or DVDs, tailored to your unique capabilities
• include walking as a simple way to lose weight

The best thing about it is that, if you stick with it, you can only feel better!

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Can An Implant Replace An Infected Tooth?

A report in the the Journal of Implant and Advanced Clinical Dentistry of a total of 95 patients (42 female, 53 male) age 19-75 (mean 50.5) with 97 screw type implants immediately placed in molar sites at the time of extraction shows 100% success at three years.  The key to the technique is careful extraction techniques to preserve bone and adequate implant stability upon placement due to obtaining maximum bone to implant contact.  The presence of infection in the extracted teeth was not a contraindication.  On average, the implants were restored with abutments and crowns 12-16 weeks after placement.

Source: JIACD, sept/oct2011,vol3,#6,pp37-44  More at www.drtupac.com

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

If You've Had Cancer Once...

At the annual meeting of the American Association for Cancer Research (AACR), investigators reported a study of melanoma survivors.  They found that many do not seek shade, 27% never wear sunscreen, and even 2.1% use tanning beds.  Since patients who have previously had melanoma are at greater risk than normal individuals to have a second melanoma, these statistics are alarming.  Therefore, more could be done to educate melanoma survivors on how to prevent recurrence.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

U.S. Surgeon General Endorses Water Fluoridation

U.S. Surgeon General Dr. Regina Banjamin has officially endorsed community water fluoridation as "one of the most effective choices communities can make to prevent health problems while actually improving the health of their citizens." She further stated: "Fluoridation's effectiveness in preventing tooth decay is not limited to children, but extends throughout life, resulting in fewer and less severe dental cavities.  In fact, each generation born since the implementation of water fluoridation has enjoyed better dental health than the generation that preceded it."

Every Surgeon General for the last 50 years has endorsed fluoridation of community water supplies as a safe and effective weapon in the war against tooth decay.

Source: National Oral Health Conference

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Alcohol: Low Risk vs High Risk Drinking Defined

Alcoholism

The National Institutes of Health and the National Institute on Alcohol Abuse and Alcoholism have defined drinking patterns and their accompanying risks.  A major nationwide survey of 43,000 US adults by the NIH shows that only 2 in 100 people who drink within both the single-day and weekly limits established have alcoholism or alcohol abuse:

• MEN: no more than 4 drinks on any day and no more than 14 drinks per week
• WOMEN: no more than 3 drinks on any day and no more than 7 drinks per week

Low risk

"Low risk" is defined as staying within both single-day and weekly limits.  It is not the same as no-risk.  Women's limits are lower due to lower body weight.  Alcohol is safest to avoid altogether if you are taking medications that interact with alcohol, managing certain medical conditions, underage, planning to drive a vehicle or operate machinery, or are pregnant or trying to get pregnant.

At risk 

For healthy adults in general, "at-risk" or "heavy drinking" involves drinking more than the stated limits.  It is estimated that about 1 in 4 people who exceed these limits already has alcoholism or alcohol abuse and the rest are at greater risk for developing thee and other problems.  The more drinks on any day (heavy drinking days) and the more heavy drinking days over time, the greater the risk.

Source: rethinking drinking, niaaa.nih.gov

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

What Is CAMBRA?

Risk for tooth decay

CAMBRA (the Caries Management by Risk Assessment protocol) is dentistry's current model for managing tooth decay.  It is designed to determine a patient's risk for decay and the appropriate preventive and therapeutic approaches to each individual's needs.  Your Board Certified Prosthodontist uses it as part of his treatment philosophy and practice because 70% of all dental services provided are replacements of existing restorations, with decay the most frequent reason. After reviewing dental history, saliva reducing factors (medications, disease), recall compliance, diet, and completing a detailed clinical examination, the patient's risk is considered high if there is active decay, recession with exposed roots, defective old restorations, visible heavy plaque, a visibly dry mouth, or diagnostic tests of high bacterial counts.  The presence of removable or fixed dental prostheses can increase plaque levels and decay risk.

Treatment plan

After risk assessment is complete, a patient's treatment plan can be tailored with regard to the frequency of radiographs and recall exams, saliva tests, use of antibacterials such as chlorhexidine and xylitol, in-office and daily use of fluoride, pH control, calcium phosphate topical supplements and use of sealants.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Pinning Down Prostate Cancer Risk

The British Medical Journal has recently published a controlled study of over 21,000 men between the ages of 40 and 55, to determine the association of PSA scores during that age range and subsequent risk of prostate cancer metastasis and mortality.  They found that PSA concentration can be used to predict long term (up to 25 or 30 years) risk of metastasis or death from prostate cancer.   They found that testing before the age of 45 was not diagnostic.  They found that, for those with below average PSA scores before age 55, screening was necessary only every 10 years.  They found that the group with the highest scores before age 55 required closer and more frequent screening to enable the disease to be treated as soon as possible.

Source:  www.bmj.com

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Measuring Implant Stability

Dr. Tupac published an article in the California Dental Association Journal, December, 2003, titled "When Is An Implant Ready For A Tooth?" which described the manner in which implants are tested for their readiness to support teeth.

We uncovered a Nobel Replace Select implant, submerged for four months in grafted (Bio-Oss) bone, and its OsstellISQ was 74, making it eligible for permanent restoration.  Having used the Osstell device for over eight years, we find it a consistent, reliable and objective device to measure implant stability.  

Learn more at www.drtupac.com and www.nobelbiocare.com

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

What Is Denture Stomatitis?

Denture stomatitis is a common disorder affecting denture wearers.  It is characterized as inflammation and redness of the tissues covered by the denture.  It is often asymptomatic; only a minority of sufferers experience pain, itching or burning.  It is primarily identified during a dental examination as the presence of inflammation and swelling under the denture.  It is associated with poor denture fit, increased age of the patient, increased age of the denture, continuous wearing of the denture and poor denture hygiene.  

Bacteria and fungi (primarily Candida Albicans) are likely included.  Patients can see it themselves when their tissues are fiery red under the denture and the redness follows the outline of their denture.  Not removing dentures at night while sleeping allows a biofilm of bacteria to colonize on the inside denture surface without being properly removed.  Treatment of the acute phase requires antifungal medications.  Rapid recurrence of the condition will occur unless the denture is properly disinfected and thereafter a daily denture hygiene regimen of removing the dentures and soaking them in a commercial disinfectant solution or diluted sodium hypochlorite.  Routine follow-up visits to assess that the denture maintains proper fit and function is important in reducing the risk for developing stomatitis.

Robert G. Tupac, DDS, FACP, Inc.,
Diplomate, American Board of Prosthodontics
(661) 325-1275 | www.drtupac.com
5060 California Ave., #170, Bakersfield, CA 93309

HPV and Oral Cancer

HPV can infect oral tissues.  A subgroup of oral cancer clearly is associated with HPV.  Oral HPV is transmitted sexually but also can be transmitted from mouth to mouth and vertically from an infected mother during delivery.  A detailed description of the mechanism by which an HPV lesion develops into oral cancer, with pictures, is found in JADA August 2011, 142(8), pp905, at www.jada.ada.org

Robert G. Tupac, DDS, FACP, Inc., 
Diplomate, American Board of Prosthodontics
(661) 325-1275 | www.drtupac.com
5060 California Ave., #170, Bakersfield, CA 93309

A Healthy Smile

A healthy smile creates a positive impression whenever it emerges.  It conveys self-confidence, warmth and beauty.  It can also represent good general health.  Our mission is to help patient's mouths look good and feel good. This is what four porcelain veneers look like on this lady's four front teeth. 

Robert G. Tupac, DDS, FACP, Inc.,
Diplomate, American Board of Prosthodontics
(661) 325-1275 | www.drtupac.com
5060 California Ave., #170, Bakersfield, CA 93309

Your Prosthodontist Knows About Lupus

Lupus is a chronic inflammatory disease that can affect various parts of the body, especially the skin, joints, blood and kidneys.  Approximately 95% of lupus patients suffer from some form of oral involvement.  The oral complications are either directly related to the disease or come about as a side effect of medical treatment.  Lupus patients may suffer from the following mouth symptoms: dry mouth, cracked lips, bleeding gums, sore jaws, gingivitis (gum disease), cracked or swollen tongue, lesions (ulcers) on any soft tissue surface including the cheeks, lichen planus and yeast infections. Denture wearers are more susceptible to soft tissue irritation and sore spots. Lupus patients should make sure their dentist has experience and knowledge of lupus and autoimmune diseases and takes a full medical history and updates the list of your medications regularly. 

Source:  Lupus Guide to Dental Care by HeatherGalusha-Phillips

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

The Size of Your Smile

Remaking this patient's smile was accomplished with 10 porcelain veneers on her upper teeth and 10 on her lower.

What the size of your smile says about you is explored in today's social media and healthy living literature. There is even a study of the Baseball Register in the British Medical Journal that showed people with big grins lived longer!

We all know how smiles are contagious!  :)

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Upper Teeth In A Day

Dr. Tupac has performed "Teeth In A Day" procedures over the last seven years.  In the beginning, with the 3i Implant system DIEM protocol, and presently with the NobelBiocare guide system.

NobelGuide is a treatment procedure which allows a patient to be treated from no teeth to a fixed bridge of teeth in one appointment.  Starting from wearing an upper full denture, this patient had a CT Scan of his upper jaw. By applying NobelGuide Procera software to the scan, the anatomy of his upper jawbone was visualized in three dimensions, allowing virtual placement of dental implants with a computer program. In addition to planning implant placement, the computer program facilitated creation of a clear surgical guide, to be used for "flapless" implant placement. The temporary fixed bridge was fabricated in advance of the surgery also, so the bridge was placed at the same time as the implants.  This technique is predictable because the planning has revealed the anatomy under the soft tissue.  The resulting bridge enables immediate function with a beautiful esthetic result, the patient having gone from a removable complete denture to an implant supported fixed bridge in one appointment.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Causes of Oral Cancers Changing

Oral and pharyngeal squamous cell carcinomas have been associated with alcohol and tobacco use.  Recent studies suggest cancers of the back (base) of the tongue and tonsils are associated with high-risk HPV types.  While there has been a decrease in oral cavity cancer rates due to a decrease in smoking, there has been an increase in HPV associated cancers in the back of the throat.  Transmission by skin-to-skin contact during oral sex and open-mouthed kissing is the mode of infection.

It should be noted that oral cancers due to alcohol and tobacco are steadily declining but those due to HPV are increasing dramatically. 

Details at www.jada.ada.org

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Front Tooth Extraction, Implant, and Crown

Dental Implant 

This patient's front tooth had an existing crown that was hanging down because the root was fractured.  It was not restorable.  The panoramic and individual radiographs confirmed the fracture.  The intent was to extract the tooth, place an immediate implant if possible, and if the stability of the implant was sufficient then immediately place a tooth on the implant.

Implant Procedure

We removed the crown, and then extracted the root with periotomes in order to not injure the boney socket.  After confirming the socket was intact, it was curetted, and sequential drills were used to extend and shape the site according to the anatomy as seen on the CAT Scan. The appropriate sized implant was then chosen and placed.  The Implant Stability Quotient (ISQ) was measured with the Osstell Resonance Frequency Device and it was determined that the implant was stable enough to have a tooth placed on it immediately.  An abutment was screwed onto the implant and the patient's own crown was relined to fit the abutment and placed with temporary cement.

After osseointegration of the implant is complete, a custom abutment will be placed and a new permanent crown fabricated.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Bisphosphonates Delay Healing After Extraction

Risk For BON

Patients taking certain forms of the popular bisphosphonate medications for osteoporosis are at risk for developing BP-associated osteonecrosis (BON).  BON is the presence of exposed necrotic bone for at least eight weeks anywhere in the oral cavity of a person exposed to BPs and who has not received radiation therapy to the head and neck.

Exposed To BPs

As reported in the Journal of the American Dental Association, a controlled study population in Florida, Canada and Norway, between 2007 and 2011, compared patients who were and were not exposed to BPs and needed tooth extraction.  Data was collected and analyzed. By controlling for other factors, the researchers showed that BP exposure is the main factor in delayed healing.  They found that BP exposure inhibits normal mucosal (soft tissue) healing.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Head and Neck Cancer Prevention

An amended article in Compendium, originally from the Journal of the Colorado Dental Association,  describes the need for early detection of head and neck skin cancer.

The article states that 90% of skin cancers are associated with exposure to UV rays.  Protection measures:

• avoid the sun between 10am and 4pm
• wear UV-protected sunglasses and a hat with a 2-inch brim
• wear protective clothing--long sleeves and clothing with an ultraviolet protection factor
• use sunscreen that protects from UVA and UVB rays with an SPF of at least 30
• reapply sunscreen every 2 hours on the face and lips
• wear lip balms with SPF 30

Skin cancer is largely preventable with the proper precautions.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Treating Canker Sores

What are canker sores?

Aphthous ulcers, or canker sores, are common oral health lesions.  They are single, isolated lesions that occur on cheeks, lips, or tongue and are caused by stress, trauma, or food allergies.  They are not contagious.  They are typically small, round, flat, painful sores with very defined borders.  Canker sores differ from cold sores, which are caused by the Herpes virus and are usually external and are contagious.

Canker sore treament

Treatment of canker sores involves pain relief, by applying topical solutions or corticosteroid pastes to cover the lesions and protect them from the environment, reducing pain and helping them heal faster.  Sometimes they can be cauterized, either surgically or chemically, to eliminate the nerve endings that are causing the pain, allowing the lesion to heal normally.  The normal duration of canker sore healing is 7 to 10 days.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Lower Teeth In A Day

Using a surgical guide fabricated from a virtual computer surgery done on a CAT Scan, five dental implants were placed in this lower jaw and the lower denture converted to a temporary screw-retained fixed bridge at the same appointment.  This technique is called "Teeth In A Day," and is one of many dental implant options Dr. Tupac provides his patients.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Diabetes Diagnosis in a Dental Office

The Journal of Dental Research reports that in a study of over 500 dental patients, those who had 26% or greater deep pockets and 4 or more missing teeth were correctly identified as undiagnosed diabetics or prediabetics.  If also screened for blood glucose and found to have HbA1c greater than 5.7%, then 92% were correctly identified.  Oral health professionals have the opportunity to identify undiagnosed diabetics and refer them to a physician for followup care.

JDent Res 2011, vol. 90,7:  pp. 855-860 

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Minimum Age For Dental Implant?

What is the minimum age for a dental implant?  This is especially important for boys and girls who have congenitally missing teeth.  

Dental implants should not be placed until after skeletal growth is complete.   Once placed, an implant and the bone which surrounds it do not change, so we don't want the jaws and teeth around the implants to continue to develop.  

In general, boys mature skeletally between the ages of 17 and 19, girls between 16 and 18.  

How do you really tell?  A "carpal index", or wrist film (X-ray), can be taken and evaluated by a radiologist.  The film will tell if the bones of the wrist (especially the adductor sesamoid) are completely formed (ossified), the growth (epiphyseal diaphyseal) centers of the fingers (proximal, middle and distal phalanges) are fused and the growth (epiphyseal diaphyseal) center of the radius is fused. These factors suggest completion of skeletal growth.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Update on Periodontal Disease and General Health

The American Academy of Peridontology (AAP) was recently invited to provide testimony to the Centers for Disease Controland Prevention's Division of Oral Health (CDCDOH) as part of the strategic planning process for 2011 through 2014. The goal is to develop a surveillance program to determine the incidence and prevalence of periodontal disease in the US population. An initial study indicates that the incidence of periodontal disease may be two to three times higher than previous estimates.  This is important because of the growing body of research that links periodontal disease to other disease states, such as cardiovascular disease and diabetes. The testimony recommends promoting public awareness of periodontal disease prevalence in the US and the importance of periodontal health in achieving overall health. 

Source: www.jiacd.com

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309