Exercise Enhances Brain Power

Even for older people, physical exercise has been shown to actually increase activity in areas of the brain, and helps ward off a host of cognitive impairments and enhances brainpower all life long.  Michelle Voss, Assy. Prof. of Psychology, Univ. of Iowa, and her team examined more than 100 studies on the topic.  They found that aerobic exercise improves ability to coordinate multiple things, long term planning and the ability to stay on task for extended periods.  Resistance training, such as lifting weights, improves the ability to focus amid distracters.  MRIs of people in their 60s showed increases in gray and white matter just after six months of exercise.  This happens in the prefrontal and temporal lobes, sites that usually diminish with age.  With exercise, they grow.  Voss also explained that the hippocampus area of the brain, key for memory formation, shrinks 1% to 2% per year over the age of 60.  But if the same people begin fitness regimens, it grows by 1% to 2% instead.  Beyond growing one's brain, exercise improves the ability of different parts of the brain to work together.  Benefits can be had by simple brisk walking for 45 minutes three times per week.  

Source: Los Angeles Times  

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

Bisphosphonate-Related Osteonecrosis in Cancer Patients

As reported in the American Dental Association Journal, the prevalence of bisphosphonate-related osteonecrosis in patients with cancer could be as high as 13.3%, which is more common than previously thought.  Bisphosphonates are the group of medications commonly used to treat bone weakening in older patients.  An important side effect is the risk, though small, of bone necrosis in sites that are surgically exposed, as in dental extractions or dental implant placement.  The authors examined studies in this area and separated out those with documented follow-up (those in which dental experts participated) and found the rate, in cancer patients, to be 13.3% instead of the previous reported average of 6.1%.  For patients without cancer, the prevalence of BON (bisphosphonate-related osteonecrosis) for patients receiving oral bisphosphonates is 0.10%.  The implications of this new information for the dental practice are: the possibility of deferring oral surgery and considering non-surgical approaches such as root canal therapy, fixed bridgework or removable partial dentures for patients who are receiving antiresorptive therapy.  JADA 2/2012

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

Sense of Smell Decreases with Age

People 60 years and older may be less able than young people to distinguish between odors. Researchers from several institutions assigned 440 participants to one of two groups according to age: younger than 45 and 60 and older.  They tested 621 olfactory sensory neurons from participants for responses to two odorant mixtures and individual odors.  

Results showed older participants had as many neurons as younger participants, but the older group could not differentiate between two odors, blending them together.  Younger people responded to one or the other.  Lead researcher, Dr. Diego Restrepo, Univ. of Colorado, suggested that changes in the nose and brain contribute to a declining sense of smell in the elderly. 

Source:  Neurobiology and Aging

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 Right For You?

I met a new patient this morning.  She is 65 years old, and has extensive bridgework in her mouth.  It all started when she lost one front tooth when she was a teenager and got her first bridge... then had decay, got a new (bigger) bridge, etc... a sequence repeated a number of times during her life.  Add to that various toothaches, root canals, extractions, more dental visits and expense than she can remember, and now she is "done with it."  Instead of having it all done over--again!--with the expectation that five years from now she'd be back in the same place, she decided she wants dentures with implants.  She asked if this was the right thing?  And, after discussing it at length, it is the right thing: for her.  She had done her homework, understood the process, knew the pros and cons and was willing to make what would be a life change for her.  We talked for a long time and one of the sad things that came out was that she was never happy with the outcomes of the previous bridgework, either because it didn't match or new problems quickly cropped up.  We took time to meet her mind as well as her mouth.  She said:  "I am the kind of person who is organized, is neat; I put things in their place.  My teeth have never been like that.  I want them to be like me!" She would rather have dental work than plastic surgery.  We will fabricate for her the teeth she wants.  She will see them in advance and we will not finish them until she approves.  This is what we do.  We recognize that she deserves to be happy with her new teeth, with the way they look and the way they work.  

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

Dentures: "When I'm Sad, My Teeth Are Sad"--Stay Happy!

One of my all time memories in treating prosthodontic patients came from a complete denture patient 30 years ago.  We had made a new set of dentures for a lady and, from my perspective, she was coming along just fine.  However, some weeks she had no complaints  and at other times nothing was right.  We talked about it at length and finally she said: "When I'm happy, my teeth are happy.  When I'm sad, my teeth are sad."  My reply: "Then look at the good things in your life and be grateful for them every day."  A good prosthodontist always correlates the problems observed in a patient's mouth with the patient's complaints.  If correction of the problems from a technical dental standpoint will satisfy the complaints, then treatment most often goes smoothly. When complaints go beyond the observed problems, then there is another component that has to be discovered and dealt with if treatment is to succeed.  Learning to ask open ended questions and being a good listener is a skill developed over time and with experience.  

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

Implants Keep Bone Loss from Occurring and Altering How You Look

We stress implants for a very good reason:  it's the only way to prevent bone loss in your jaw when teeth are missing.  Over time, bone loss distorts your appearance, which is obviously something you don't want and we don't want.  Implants are the best way to keep bone loss from occurring and altering how you look. 

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

Melanoma Survivors Must Remain Vigilant

A new study finds that cancer survivors are at increased risk for cutaneous melanoma, one of the most aggressive forms of skin cancer.  Cutaneous melanoma is the 5th most diagnosed cancer in US men and 7th most commonly diagnosed in women.  Overall incidence is increasing; death rates have decreased little, despite survival gains for other types of cancer.  Ultraviolet radiation exposure is the greatest risk factor for cutaneous melanoma.  Researchers analyzed data from US patients with melanoma as a first primary cancer and patients who were diagnosed with melanoma after surviving a previous cancer.  Among patients age 45 or older at first cancer diagnosis, the risk of developing cutaneous melanoma was much higher among those previously diagnosed with melanoma or other skin cancers, ocular melanoma, breast cancer or lymphoma.  Results suggest the need for continues skin surveillance in melanoma survivors as the risk remains elevated for over 15 years.


Source: Archives of Dermatology

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

Satisfied Implant Patient

Congenitally missing upper right and left lateral incisors... onlay grafts before placement of Nobel 3.0mm Active implants... then restored with angled abutments and porcelain crowns.

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

Breast Cancer Prevention: Recommendations

The United States Preventive Services Task Force (USPSTF) has published draft recommendations for preventive therapy in women with high risk of breast cancer.  Risk assessment is based on the National Cancer Institute (NCI) Breast Cancer Risk Assessment Tool, which predicts 5-year cancer risk based on an individual's age, family history, ethnicity, age at first menstruation, age at first live childbirth, and personal history of ductal carcinoma, lobular carcinoma, or breast biopsies.

The recommendations are for women between the ages of 40 and 70, who have no prior diagnosis of invasive breast cancer, ductal cancer, lobular cancer, and no history of blood clots or stroke.  Preventive therapy using tamoxifen or raloxifene in this group was shown to reduce the risk of invasive breast cancer by 30-56%.

For greater detail, go to: www.chemotherapyadvisor.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

From a Memorial: What Cancer Cannot Do

We went to a beautiful memorial for a dear neighbor--a good man--who passed away recently.  In the program was the following poem:

Cancer is so limited.....

It cannot cripple love.

It cannot shatter hope.

It cannot corrode faith.

It cannot eat away peace.

It cannot destroy confidence.

It cannot kill friendship.

It cannot shut out memories.

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

Periodontal Bone Regeneration and Smoking

A scientific analysis of the review of 10 articles, as reported in the Journal of Periodontology. looked at the clinical and radiographic indicators of bone regeneration for the 12-month period following periodontal therapy. Smokers and non-smokers were compared with regard to the healing of intrabony defects and furcation defects.

The general conclusion was that smoking negatively influenced bone regeneration after treatment of a periodontal defect. Since smoking is recognized as an important risk factor for periodontal disease, and smoking has been previously shown to have a negative influence on soft tissue healing after periodontal therapy, it now has been associated with negative affects on bony healing also.


Source: JADA, 144(5), 531-532


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

Ways to Prevent Osteoporosis

There are ways to forestall the loss of bone mass that accompanies aging.

• Get enough calcium--the National Institutes of Health (NIH) recommends 1,000mg of calcium daily, increasing to 1,200 mg daily for women over 50 and men over 70
• Avoid soda--cola, in any form, has been linked to greater risk of bone thinning, and, in addition, can cause weight gain which has adverse effects on bone health
• No smoking--puts bone health at risk
• Reduce sodium intake--especially with high blood pressure, sodium increases calcium excretion 
• Vitamin D--either by sunshine or with diet or supplements, this vitamin helps calcium absorption

More at: www.toyourhealth.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

Obesity as a Cause of Cancer

According to the Cancer Prevention and Early Detection Facts and Figures 2013, obesity is the second most common risk factor for cancer, after the use of tobacco products.

Body Mass Index (BMI) is used to classify body weight, and these are the latest statistics:

• Between the years of 2009 and 2010, 16.9% of children and adolescents, as well as 35.7% of adults in the United States were classified as obese
• Childhood obesity, between the ages of 6 and 11, has more than doubled, from 7% in 1980 to 18% in 2010
• Adolescent obesity, between the ages of 12 and 19, was 5% in 1980 and 18% in 2010
• Adult obesity, between ages 20 and 74, was 15% in 1980 and 36% in 2010

The link between obesity and cancer is believed to be that fat cells produce cytokines and the immune system response to that creates an inflammatory environment that enhances tumor growth.  The American Cancer Society believes that much of this is preventable, and recommended guidelines for both exercise and diet can be found at www.cancer.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

Meditation and Managing Stress

Meditation is a mental exercise that helps reach a  heightened level of awareness.  It can be beneficial in managing stress, reaching mental tranquility, focusing attention, and maintaining an overall healthier lifestyle.  A study at Massachusetts General Hospital showed that brain gray matter was thicker in those who meditated 40 minutes daily.  It also showed thickening of the cerebral cortex, which is responsible for decision-making, attention and memory.

Beginning a meditation regimen involves setting aside a relaxed time that will be free from distractions and sitting comfortably to that you can close your eyes and focus only on your breathing.  By concentrating on the sensation of your breathing, your ability to concentrate will improve and when finished will be able to return to your normal routine feeling relaxed and refreshed.

For more suggestions on mastering the art of meditation, see www.toyourhealth.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

Air Pollution As A Cause Of Death In Children

According to the 2010 Global Burden of Disease Study, air pollution is currently the worldwide seventh-leading cause of death, and there are projections that it will become the leading cause by 2050.

The UCLA School of Public Health Department of Epidemiology analyzed data on 3,950 children born between 1998 and 2007 who had been diagnosed with cancer at age 5 or younger.  Exposure to traffic-related pollution was calculated for each trimester of the mother's pregnancy and during the first year of the child's life, by estimating gasoline and diesel powered traffic within 1,500 meters of the child's home and analyzing roadway geometry, vehicle emission rates and weather.

Researchers found increased exposure to traffic-related air pollution was associated with increased risk of three rare childhood cancers: acute lymphoblastic leukemia, germ cell tumors and retinoblastoma.

www.newsroom.ucla.edu

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

Tooth Stem Cells Used in Bone Reconstruction

Stem cells from teeth and dental pulp of canines can be grafted and regenerate bone between parents and offspring, according to a report published online in Cell Transplantation.  Researchers in Nagoya, Japan found bone defects filled with graft materials of canine mesenchymal stem cells/PRP, or canine dental pulp stem cells/PRP, or primary tooth stem cells/PRP, all showed good bone formation.  "This study highlights the promise of obtaining stem cells from teeth and their potential benefits in familial treatments for bone reconstruction.  Due to their potential to also become other cell types such as neural cells, it will be interesting to see their future uses," said Julio Voltarelli, MD, PhD, professor of clinical medicine and clinical immunology at the University of Sao Paulo, Brazil. 

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

Medication-Caused Dry Mouth (Xerostomia)

Dry mouth (xerostomia) can be caused by prescription or over-the-counter medications.  More than 500 medications contribute to oral dryness:  antihistamines (for allergy or asthma), antihypertensives (for blood pressure), decongestants, pain medications, diuretics and antidepressants.  In the most severe form, dry mouth can lead to tooth decay, mouth sores and oral infections.  Half of all Americans take at least one prescription medication daily and more than 90% of adults over the age of 65 do the same. Therefore, older adults are at significantly higher risk.  "Each day, a healthy adult normally produces one and a half liters of saliva, making it easier to talk, swallow, taste, digest food, and perform other important functions that often go unnoticed," notes Dr. Fares Elias, past president of the AGD.  

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

Latest Statistics: Prophylactic Antibiotics

The Journal of the American Dental Association is reporting a 10 year study from the Medicare Current Beneficiary Survey.  The authors examined an administrative data set to assess whether dental procedures were associated with prosthetic joint infections (PJIs).  The findings, comparing PJIs after total joint arthroplasty in patients with and without invasive or any other dental procedures, showed NO association with the dental procedures and risk of infection.  It concluded that the clinical importance of prophylactic antibiotics in dentistry for patients who have undergone joint arthroplasty, therefore, may be questioned.

JADA, 12,2011

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

We Perform Oral Cancer Screenings

Oral cancer symptoms

Oral cancer can present with many different symptoms.  Often, a non-healing ulcer (wound), whether or not it is painful, is the first presenting symptom.  A recent study suggests that the onset of orofacial pain that worsens during function may be an important predictor for the transition from oral pre-cancer to cancer.  Screening patients who have new-onset orofacial pain may lead to a diagnosis of early resectable head and neck cancer, and may improve quality of life and survival rates for patients.  

More oral cancer symptoms

Other symptoms that should raise suspicion include: white or red spots, bleeding mouth sores, increased mouth pain, loose teeth, poor fitting dentures, non-healing extraction socket, ear pain, lip or tongue numbness, difficult or painful swallowing, change in speech or a lump in the neck.  It is very important to remember that any white/red lesion or ulcer in the mouth that has not healed within three weeks should be evaluated.  

Oral cancer screening

Dr.Tupac provides oral cancer screening as part of new patient and patient recall examinations.  He also works with Dr. Tung Trang, Chief of Head and Neck Oncology, of Kern Medical Center with the prosthetic treatment of cancer patients both in the operating room and after tumor surgery for patients recovering with surgical defects.  Dr. Tupac had almost 40 years of experience in the prosthetic reconstruction of oral cancer patients to reestablish near normal function as it relates to speaking and eating in addition to maintaining facial appearance.

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

Oral Cancer: Who, When, Where

In the US there are an estimated 36,450 new cases of oral cancer diagnosed each year, 25,420 in men and 11,120 in women.  Nearly 7,880 people die of cancer of the oral cavity and pharynx each year.  The average age for diagnosis is 62 years and 1.02% of people born today will be diagnosed with it during their lifetime.  Approximately 90% of oral cancer is on the surface and called squamous cell carcinoma.  Traditional risk factors are tobacco and alcohol.  When someone smokes and drinks, their risk is increased 37-fold.  Higher risk sites include the tongue and floor of the mouth.  Cancer of gum tissues accounts for about 10% of all oral cancers.  Although the average age for diagnosis is 62 years, a rapidly growing number of younger patients without traditional risk factors are being diagnosed with HPV - related tumors of the tonsils and base of the tongue.

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 Importance of Bone Density

Osteoporosis

As we grow older, our bones begin to lose their density and strength, especially after the age of 50.  Many factors affect bone density, including diet, physical activity, family history, hormones, lifestyle and certain conditions and medications.  Osteoporosis--porous bone--is a disease that weakens bones, especially hip, spine and wrist, and makes them more likely to break.  It affects about 10 million Americans, 8 million of whom are women.  The disease affects more women than cancer, heart disease and stroke combined. 

Osteoporosis affect women than men

An additional 34 million Americans have osteopenia, or low bone density, and are at risk for developing osteoporosis.  Broken bones, as a result of osteoporosis, will affect 50% of women and 25% of men over the age of 50, according to the National Osteoporosis Foundation.  To prevent broken bones, many people with low bone density or osteoporosis take drugs called bisphosphonates (fosomax, boniva, actonel, reclast, etc.).  Studies indicate that, in many people, these medications help reduce the chance of breaking bones by reducing bone loss and increasing bone density.  

Osteonecrosis

In rare cases, a condition known as osteonecrosis of the jaw (ONJ) has been reported in patients taking these medications.  This rare but serious condition can cause severe damage to the jawbone.  94% of those diagnosed with ONJ are patients with cancer who are receiving or have received repeated high doses of medication through an intravenous infusion.  The benefits of these medications greatly outweigh the very low risk of developing ONJ.  You should not stop taking these medications without consulting your health care provider.  There is no known prevention for ONJ.  However, regular dental visits and excellent oral hygiene practices may be the best way to reduce your risk.  

Source: American Dental Association, JADA, vol. 142, #11, 1320, Nov. 1, 2011

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 Infections in the Mouth

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

HPV and Cancer of the Base of the Tongue,Tonsils and Oropharynx

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. 

Details in:  JADA, 2011, 142 (8), pp. 915 with pictures 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

Voluntary Tooth Extraction After 7 Episodes of Bacterial Endocarditis: Mayo Clinic Report

Bacterial endocarditis is associated with high morbidity and mortality rates.  In this report a patient with several episodes voluntarily had full mouth extractions and dentures made, because routine dental procedures had precipitated his infections.  After three years, the patient had no further episodes.  While this treatment is unique, there are certain instances where a patient-centered approach necessitates alternative options.  

JProsthet Dent 2011; 106: 1-5

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

Tooth knocked out? What To Do

What do you do if your tooth gets knocked out? DON'T rinse it with water! Lick it clean and put it back in place and gently bite to hold it in position until it stabilizes. If you need to transport it to the dentist, soak it in milk. Tooth reimplantation does sometimes work, the sooner the better, if you're lucky.

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 Jaw All-on-4

"Everything stays in place. I can smile and laugh again without worrying. It gives me a feeling of security and confidence. It has changed my life!”

We have had great success placing tilted hex top Nobel implants (as in the All-on-4 technique) in severly resorbed maxillas.  The implants are fitted with angled multiunit abutments to hold a fixed hybrid.  Previously unmanageable dentures then derive support and retention by holding to the implants.  Patient satisfaction has been tremendous!

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

Implant Tissue Bar

LH wanted dental implants to help stabilize and retain his upper denture.  He had the required bone of adequate quality and quantity.  After using radiographic markers to determine implant position with a surgical guide, four implants were placed.  After the implants were ready to restore, according to Osstell Resonance Frequency measurements, they were connected with a tissue bar.  Limited occlusal clearance and the labial position of the anterior teeth required attachments be placed on the palatal aspect of the bar.  Because the overdenture is opposed by natural teeth, a cast superstructure strengthens the overdenture and supplies housings for the nylon attachments.  At 5 year recall, bone levels are excellent and the patient reports he is pleased with his ability to eat, the stability of his appearance and the durability of the prosthesis.

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 Unique Crown: Your Smile Is Our Specialty

Is crown good for me?

Single front tooth crowns are difficult--the front tooth on the right of this picture has a porcelain crown.

If you've never had a crown or have forgotten the process, you may have some questions.  

Will the procedure hurt or damage my tooth?  How long will it take? What will it look like?  What can I eat?  How long will it last?  Is this crown good for me?  These are good questions that deserve answers.  

Your tooth is unique

Your crown is a prosthesis that is made only for you.  Your tooth is unique like a fingerprint.  Someone else's crown cannot fit your tooth.  It has to be individually made for you alone.  While it's remarkable that science and engineering has made it possible to make millions of exactly the same thing (pencils), it's a miracle that prosthodontists make millions of teeth that are all different, each individualized for each patient's tooth.  An outstanding crown, like the patient's front tooth, can perform all the duties of a natural tooth and cannot be differentiated from the rest of the teeth in your mouth.  It must attach seamlessly to your remaining tooth and root, not allowing bacteria or plaque the opportunity to cause more decay or increase the risk of inflammation leading to gum disease.  It has to remain attached to your tooth and cannot break, and it has to look like and chew like your tooth.  Skillful management of your gum tissues and precise grinding of your tooth is required.  Too much and the tissues are at risk; too little and the crown will be weak.  Dental technology has advanced clinical procedures to a high level of quality and achievement.  Impression materials capture precise details.  Jaw movements are recorded. Materials make crowns more beautiful and stronger than before.  As a Board Certified Prosthodontist, with our advanced techniques and in office laboratory technology, we will provide the exceptional crown you deserve.

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

No Preparation Veneers

We have been providing no preparation veneers for many years. Called Lumineers, or promoted by Smile Simplicity, for those whom they are appropriate, these veneers fill spaces, correct chipped teeth, change shape and color and can be done without any injections.

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. Census Bureau: Dental Utilization

According to the National Health Interview Survey in 2011:

• 1% of adults had never visited a dental professional
• 8% of adults had lost all of their natural teeth (16% of adults with less than a high school education, 4% of adults with a bachelor's degree or higher)
• Most recent dental visit:  44% within the previous six months, 17% between six and twelve months, 13% between one and two years, 12% between two and five years, and 13% more than five years ago
• 61% of the civilian noninstitutionalized adult population aged 18 and over had excellent or very good health; 11% had been told they have heart disease, 9% had been told they had diabetes, 22% had been told they have some form of arthritis, gout, lupus or fibromyalgia, 19% were current smokers, 34% of adults were overweight and 28% were obese according to body mass index.

Source: cdc.gov

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 8% of the adult population had lost all of their natural teeth5060 California Ave., #170, Bakersfield, CA 93309

Breast Cancer Detection With Cosmetic Breast Implants

Breast implants vs no implants

A report just published in the British Medical Journal, does a systematic review and meta-analysis of twelve observational studies.  The objective was to evaluate whether the stage distribution among women diagnosed as having breast cancer differs between those who have received breast implants for cosmetic purposes and those with no implants and to evaluate whether cosmetic breast augmentation before the detection of breast cancer is a predictor of post-diagnosis survival.

Breast implants have a higher risk for cancer

The systematic review suggests that women with cosmetic breast implants have later stage tumors at diagnosis of breast cancer, and that there is a higher risk of breast cancer specific mortality among women with breast cancer who have implants compared to those without implants.  The finding can be explained by the fact that both silicone and saline implants create a radiopaque shadow on mammograms, which impair visualization of breast tissue.  The study concludes that even though cosmetic breast implants have become increasingly popular in recent decades, there is increased concern that these implants may impair the ability to identify breast cancer at an early stage when survival is generally more favorable.

For the full paper, go to 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

17-year Implant Bridge Success

Today I had the privilege of seeing a 63 year old patient I treated 17 years ago.  She had her teeth removed when she was 20 years old, and for the last 30 years before I treated her had been unable to wear a lower denture.  She was very thin, had digestive problems due to a poor diet and had become a recluse because she was reluctant to leave the house and be out in public with a collapsed face. We placed four lower implants and, according to the original Branemark protocol, fabricated a mandibular fixed implant supported bridge.  Now she dances three nights per week and has a healthy glow about her.  She joked that she has to watch her weight because she can eat anything on the menu.

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

All-on-4 Success in Bakersfield

Parel and Phillips, in the Journal of Prosthetic Dentistry report on a study of implant survival rates for 558 jaws treated with 4 implants per jaw in a patient population between 2008 and 2010.  A total of 2,132 implants were placed, with only 48 failures, giving a 97.8% success rate.  Of the few failures, they were 5 times more likely in the upper jaw and more often associated with male patients, poor bone density, opposing natural teeth and the location of the most posterior implant.  Smoking, bone volume, systemic factors, addictive drug use and pathology, including the existence of periapical infections did not appear to be related to failure in this population.  When patients with greater risk had additional implants placed, there were no failures.  Dr. Tupac, Bakersfield's only full time Board Certified Prosthodontist,  specializes in taking patients from failing teeth to implant supported fixed bridges and has been successfully treating patients in this manner for many years.  All treatment, from diagnosis and treatment planning, to extractions and implant insertion, to fabrication and placement of the fixed bridges is accomplished in his office.

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 Bad Breath

What causes bad breath?

Oral causes are responsible for 76% of oral malodor (bad breath).  The main sources are:

• tongue coating accounts for 43% of it
• gingivitis and periodontitis accounts for 18%

The Journal of Clinical Periodontology  reported on a study from the halitosis clinic at the Catholic University Leuven in Belgium.  A protocol for not eating onions, garlic or spicy food, not drinking coffee or alcohol or smoking cigarettes, and not using chewing gum, mints, drops, scents or mouthrinses before the breath measurements was established.  Medical history, oral hygiene habits, ENT problems and diet were recorded.  A clinical examination was performed, including and organoleptic (smelling of the breath) test and an evaluation of tongue coating visually and by weighing the scrapings from the back of the tongue.

Results for bad breath

The results showed clear correlations between organoleptic scores and tongue coating scores, weight of tongue scrapings, and the objective measure of volatile sulphur compounds by the OralChroma device.  In addition, subjects who smoked, did not floss between their teeth or had a diet of predominantly soft food had more tongue coating and higher oral malodor scores.

J Clin Perio 40:180-185, 2013, as reported in Dentaltown news
    
Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Understanding Macular Degeneration

More than 2 million men and women over age 50 have age-related macular degeneration.  The macula is a tiny area near the center of the light-sensitive retina, and its function is to help produce sharp close up vision.  Progressive damage to the macula  eliminates central vision, even though side vision remains clear.  However, the area of eliminated vision widens over time.

Although some factors are known to be associated with the disease--family history, smoking, sunlight--the cause is unknown.  Presently, there is no cure, and some supplements of high levels of antioxidant vitamins and minerals may slow the progression of advanced disease.

Source: AARP

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

Understanding Glaucoma

Effect of glaucoma

More than 2.5 million people over the age of 40 have glaucoma.  In this disease, there is a progressive reduction of peripheral vision, that eventually begins to effect central vision, and may damage the optic nerve.

Risk for developing glaucoma is increased for those individuals who are over the age of 45, have a family history of the disease, are nearsighted or farsighted, are African American or Hispanic, or have diabetes, migraines or low blood pressure.

Glaucoma treatment 

Left untreated, glaucoma can cause blindness.  Treatment usually consists of eyedrops to lower pressure in the eye itself, and there are also some surgical options.  Research is also investigating whether this is a neurological disorder.

Source: AARP

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 Peri-implantitis?

Risk Factors in Implants Failure

Peri-implantitis is a more serious disease distinguishable from the condition of peri-implant mucositis.  It is characterized by an inflammatory process around an implant, which includes both soft tissue inflammation and progressive loss of supporting bone beyond biological bone remodeling.  It is present when there is bleeding on probing and/or suppuration and detectable bone loss.  Since after all dental implants are placed, the bone undergoes a process of remodeling that results in the loss of an average of 1mm of bone height, the only way to document further bone loss is by comparison to a baseline radiograph obtained at the time of suprastructure placement, or by (if no baseline radiograph is present) using a threshold vertical distance of 2mm from the expected marginal bone level following remodeling post implant placement.  Risk factors include:

• previous periodontal disease--does not affect implant survival rate, but is a more frequent finding in patients with a history of periodontitis
• poor plaque control or difficulty cleaning due to prosthesis design dictated by esthetics, phonetics and function
• residual cement that provides a positive environment for bacterial attachment
• smoking--a 3.6 to 4.6 times greater risk of inflammation
• genetic factors that contribute to patient susceptibility
• diabetes--which affects tissue repair ability and defense against inflammation
• possible bite overload

Diagnosis of Peri-implantitis

The presence of bone loss and probing depth alone is not enough to make the diagnosis.  Only in the presence of bacterial inflammation, is bone loss, seen over time, definitive for peri-implantitis.  Non-surgical therapy has not been shown to be effective in the treatment of peri-implantitis, therefore surgical intervention is necessary, and there are several ways to do it.  An understanding of peri-implant mucositis and peri-implantitis underscores the importance of regular monitoring and professional care for dental implants as well as natural 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

Understanding Cataracts

Over age 40, an estimated 25 million people have cataracts.  Light normally passes through the eye's clear lens to the retina, the light-sensitive area at the back of the eye.  After the age of 40, small clumps of protein can form on the lens and cause it to become cloudy--and the loss of vision cannot be corrected with glasses or contact lenses.  This clouding of the lens is called a cataract.  As there is no way to reverse this cloudiness, the only effective treatment is surgical replacement of the lens with a clear artificial lens.  My patients who have had this quick, painless procedure report that the results are almost immediate and universally beneficial.

Source:  AARP

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 Peri-implant Mucositis?

One of the inflammatory reactions (not infection) around a dental implant is called peri-implant mucositis.  It has been described as a disease in which the presence of inflammation is confined to the soft tissues surrounding a dental implant with no signs of bone loss of supporting bone following initial bone remodeling during healing.  Signs that mucositis is present include bleeding on probing of depths> 4mm and/or suppuration.  The condition is reversible with early intervention and removal of the causative factors.  Usually surgical intervention is not necessary.

It is important for patients who have dental implants to have regular professional care for them as well as their remaining natural teeth.

A full description of the condition and treatment, as well as differential diagnosis regarding other peri-implant inflammatory disease, is found in a monograph from the Task Force on Peri-Implantitis of the American Academy of Periodontology.

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

Implant Maintenance With A Water Flosser

Dental implant (single or multiple) restorations present a hygiene challenge due to their infinite locations and shapes.  No single toothbrush, manual or powered, and no particular type of dental floss has been shown to be superior for cleaning purposes.  Given the substantial investment in dental implant restorations, this is a problem.

Water Pik, Inc. makes an oral irrigation device called a water flosser.  It is an easy to use device with ten pressure settings and five different tips.  It can clean both above and below the gumline, in between teeth, and under and around implants and different prosthetic designs.  It can remove plaque biofilm.  It has been show to be more effective than string floss.  It can be used in conjunction with antibacterial solutions, such as chlorhexidine, and salt water.

For more information, see: www.waterpik.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

Eye Exams: How Often?

Experts recommend these things for keeping your eyes healthy:

• wear sunglasses that protect against UV light
• don't smoke
• maintain a healthy weight
• control diabetes
• keep blood pressure and choloesterol in check
• eat a healthy diet
• exercise

Get your eyes checked:

• ages 40-54:  every 2-4 years
• ages 55-64:  every 1-3 years
• ages 65+: every 1-2 years

Source: AARP

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

Study Links Higher Colon Cancer Risk and Smoking in Women

A study published online in Cancer, Epidemiology, Biomarkers & Prevention, shows female smokers more susceptible than male smokers to colon cancer.  A 30-year study of 602,242 patients by the University of Tromso in Norway compared females and males, smokers and never smokers.  Smoking, as a risk factor alone versus those who had never smoked, raised the risk of colon cancer in women by 20% and in men by 8%.

For more details, see HealthDay News.

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 New Science of 'Breath-omics'

Chemotherapy Advisor  had an interesting article on the emerging field of Breath-omics.  It is described as analysis of exhaled breath into a device (like a breathalyzer for alcohol level testing) by measurement of the chemical waste products that are produced by certain cancers.  Just as saliva testing is being used more and more to diagnosis medical problems, these chemical "breath prints" have the same potential for non-invasive, real-time screening and diagnostic clinical testing for malignant and nonmalignant chronic diseases.  Exhaled breath tests are being studied for lung cancer and other respiratory diseases, and even Alzheimer's and Parkinson's disease.

Source:  www.chemotherapyadivsor.com

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

Sports Dentistry

The Academy for Sports Dentistry will hold its annual meeting on August 1-3, 2013.  The group's mission is to effectively serve the combination of the fields of dentistry and athletics.  The "team dentist" has a variety of roles:

• preparation and readiness of the athlete
• sleep apnea considerations
• evaluation and management of concussions
• recognition and treatment of dental trauma
• restoration of teeth after trauma
• custom mouthguard fabrication
• intraoral suturing 

The group is affiliated with the Special Olympics Special Smiles program and the United States Olympic Committee.

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

Temporary Toothache Relief

If you have a toothache, and need some temporary relief until you can get to your dentist, a new study shows that over the counter benzocaine gels can be effective.  Under double-masked conditions, investigators used a variety of gels for 576 participants who applied the gel to open tooth cavities and surrounding oral tissues.  The results were that 10% benzocaine gel offered relief and that 20% benzocaine gel was even more effective and safe in the temporary relief of acute toothache pain. JADA, vol. 144, no. 5, 517-526








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

Age-Related Tooth Root Decay

 A study comparing the prevalence of decay on tooth root surfaces in two groups--middle-aged adults (aged 45-64 years) and older adults (65 years and older)--shows differences between the two groups.  Middle-aged adults seemed to be prone to this type of decay if they were male, self-reported dry mouth, had exposed roots and increased frequency of eating or drinking between meals.  Older adults did not share the same associations.

Source: JADA, vol. 144, no. 5, 507-516










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

Missing Teeth and Diabetes

A study of 2,508 participants in a diabetes database compared to patients without diabetes shows some remarkable statistics:

• Among adults with natural teeth, those with diabetes have, on average, lost 50% greater numbers of teeth than those without the disease
• Among adults with no teeth (edentulous),  those with diabetes are twice as likely to have no teeth that those without the disease

One in every five cases of edentulism in the United States is linked to diabetes. 

JADA, vol. 144, no. 5, 478-485

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