Medicine Safety in Summer

Packing your medications in a bag and tossing the bag into the trunk of your car could cause your medications to lose their potency and effectiveness.  According to drug information sheets that are included with your prescriptions, most drug manufacturers recommend storing medications at between 68 and 77 degrees Fahrenheit.  If your medicine does get exposed to extreme temperatures, you may not be able to tell.  If the appearance changes, then the quality has changed also.  This advice for traveling safely with medications is from MedlinePlus, a service of the U.S. National Library of Medicine:

• Keep a list of your medications, with contact information for your doctor and pharmacist
• Always have enough for an extra few days
• Keep some with you, so you know the temperature will be correct
• In different time zones, take medications at the same time you would at home
• Keep medicines away from hot places

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 Sore Palate Under Your Denture

Denture stomatitis is a common and longstanding problem for removable denture wearers.  It is found to a greater or lesser extent in about 45% of the denture wearing population, according to studies.  It is an inflammation of the palatal tissue, that can be localized to slight area, involve the entire area of tissue covered by the denture, or be severe enough to create a bubbly, shiny surface.

While many things may contribute to the condition:  poor oral hygiene, wearing the denture at night, trauma, smoking, systemic conditions, allergic reactions to denture materials, and bacterial and fungal infections, the general consensus is that a denture that shows a lack of adaptation (that has poor retention or poor stability) is a cause always present.  As always, since the bone and soft tissues under dentures are shrinking over time, it is important to keep your dentures relined to fit as well as possible to keep your mouth healthy.

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

Resources To Help Quit Smoking

For those people who want to quit smoking, the Tobacco Control Research Branch of the National Cancer Institute, which is part of the National Institutes of Health, has established a website called Smokefree.gov.

Publications available are:

• "Clearing the Air: Quit Smoking Today" for those interested in quitting
• "Clear Horizons" for those over the age of 50
• "Forever Free" for those who have recently quit
• "Guia para Dejar de Fumar" for those who speak Spanish
• "Pathways to Freedom: Winning the Fight Against Tobacco" for those who are African American

The NCI's Smoking Quitline is 1-877-44U-QUIT (1-877-448-7848).

The state has a toll-free hotline: 1-800-QUIT-NOW (1-800-784-8669)

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

Learning To Live With A Chronic Condition

The Kubler-Ross model, commonly referred to as the "five stages of grief", is a hypothesis introduced by Elisabeth Kubler-Ross, that says that when a person is faced with the reality of an awful fate, he or she will experience a series of emotional stages of grief.  It was introduced in her 1969 book On Death and Dying. 
Kubler-Ross originally applied these stages to people suffering from terminal illness, but later expanded it to apply to any form of catastrophic personal loss, including the onset of a disease or chronic illness.  Thus, it is applicable to conditions such as multiple sclerosis, lupus, and fibromyalgia, and many others.

• Denial: "I feel fine.  This isn't happening."  Denial is a defense mechanism--to dispute the diagnosis, to try to maintain your lifestyle, to pretend the condition will not affect you.
• Anger: "Why me?  This isn't fair."  You can be angry at your doctor, yourself, your body or your surroundings.
• Bargaining: "I'll do anything for... What if I become a better person?"  This is an attempt to cure yourself, or negotiate away the situation for more freedom from the condition and avoiding treatment by doing good things.
• Depression: "I'm sad, so why bother with anything?  I don't care anymore."  When the illness or condition is a certainty, you may withdraw or lose interest in outside activities.
• Acceptance: "I will move forward."  The goal is to come to terms with the reality of the condition and learn to live with it.

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

Don't Shy Away From Bleeding Gums

There are many causes of bleeding gums:

• Gingivitis: an often painless inflammation of the gums that is entirely reversible with meticulous oral hygiene--brushing and flossing.  Left untreated, however, it can lead to periodontitis, which is considerably more serious.
• Smoking: inhaling smoke directs toxins to the tissues and causes reduced oxygeneration of the blood supply of the tissues, making them more fragile.
• Hormones: hormonal changes during menstruation and pregnancy increase chances of bleeding gums.
• Medications: bleeding gums are a side effect of over 400 medications.
• Diet: carbohydrates from starchy and sugary foods create debris that sticks to the teeth and gums and can cause inflammation if not removed.
• Poor Oral Hygiene: eating food creates the formation of bacterial plaque on teeth and gums that needs to be removed daily to prevent the acids in the plaque from harming teeth and gums.

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

Dental Implant Placement for Patients Taking Anticoagulants

If you are taking anticoagulants, and want or need a dental implant, is it possible?

Physicians usually prefer that their patients who are on anticoagulant therapy (eg.: Warfarin) not interrupt that therapy, since the dose has been carefully calibrated to the individual patient's condition.  For patients taking Warfarin, the risk of thromboembolism is reduced.  A report in the Journal of Oral Implantology suggests that a less invasive, "flapless" procedure is indicated in these cases, because it reduces the amount of bleeding during and after surgery.

We have been using the Nobel Guide procedures for many dental implant placements for several years.  It is a method in which, using a 3-D scan of the patient's mouth, the surgery is performed "virtually" on a computer first, and a rigid guide is fabricated to fit in the patient's mouth and be used at surgery.  With the guide fixed in place, the implants are placed through the guide without having to reflect the tissues.
As always, we discuss the patient's planned surgery and get approval from the patient's cardiologist prior to the procedure.

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

Risk Factors and Screening for Melanoma

Men and women of all ages and races can develop melanoma, the most serious form of skin cancer. UV radiation is thought to be the biggest risk factor for most melanomas. The main source of UV light is the sun, although tanning lamps also emit high levels of UV light. Aside from UV radiation, there are several other factors that increase the chances that a person will develop melanoma. It is important to be aware of these risk factors, as melanoma is most treatable when detected in its early stages.

Risk factors for melanoma include:

Ultraviolet (UV) radiation Exposure to UV radiation from the sun and from tanning beds increases the risk of melanoma.

Sunburns Blistering caused by overexposure to the sun, especially at a young age, can double a person's chances of developing melanoma. Always apply sunscreen generously and use caution in the sun.

Fair skin and freckles Melanoma occurs more frequently in people with fair skin. Freckles also mark a mild increase in risk.

Light hair and eye color The risk of melanoma is higher for people with blue eyes and those who have blond or red hair.

A large number of ordinary moles People who have more than 50 moles are at an increased risk of developing melanoma.

Abnormal moles Moles that are larger than normal, have several shades of pigment, or have fuzzy or indistinct edges are more likely to become cancerous than ordinary moles.

Family history Melanoma can sometimes run in families; having two or more close family members who have melanoma is a strong risk factor.

Non-melanoma skin cancer People who have other kinds of skin cancer are at a higher risk for developing melanoma.

Examining Your Skin

Get a professional skin examination from a dermatologist once a year, and learn how to perform a monthly skin self-examination. Skin self-exams do not require any special medical equipment. All you need are your eyes, a mirror, and the knowledge of what to look for. Here are some tips for performing a skin self-examination:

• Perform skin self-examinations in a well-lit room in front of a full-length mirror. Use a handheld mirror for hard-to-see places. The best time to do a skin self-exam is after a shower or bath.
  
• Learn the pattern of your moles, freckles, or other birthmarks so that you will notice any changes.
  
• Look for new growths, spots, bumps, or sores that do not heal normally.
  
• Don't forget hard-to-see areas of your body such as your head, the underside of your arms, the backs of your legs, and between your toes.
  
  
  

The “ABCDEs” of Moles

If you have any moles that fit the following criteria, ask your doctor to check them out.
Asymmetrical: Is the mole oddly shaped?
Border: Does the mole have irregular or vaguely defined borders?
Color: Does the mole have uneven coloring or multiple colors?
Diameter: Is the mole larger than a pencil eraser or is it growing in size?

Evolution: Has the mole grown or changed in any way?

Source: This article originally appeared on Oncology Nurse Advisor.


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

Staying Safe in the Sun

The sun is an important part of our lives. Sunny days have a positive impact on our mood, increase our level of physical activity, make many social events and gatherings possible, and even benefit our health by providing our bodies with essential vitamin D. Unfortunately, sun exposure also presents risk factors that can lead to skin or eye damage, and even skin cancer. Skin cancer is the most common of all cancer types. Most skin cancers are caused by too much exposure to the sun's ultraviolet (UV) rays. Prevention and early detection are the best ways to keep your skin healthy. It's important to learn what you can do to protect yourself and how to spot any possible signs of skin cancer.

Here are some easy ways to protect your skin from sun damage:

Wear sunscreen with a SPF 15 or higher. If you have fair skin or light hair, you are more susceptible to the sun's rays and should use a sunscreen with a higher SPF.

Choose sunscreen labeled “broad spectrum” meaning that it protects against two types of harmful rays: UVA and UVB.

Use waterproof sunscreen to make sure it stays on longer, even if you perspire or get wet.

Reapply sunscreen often – usually every two hours, but sooner if you've been swimming or are perspiring heavily.

Cover your whole body. Remember those areas that can be easy to forget, such as your ears, eyelids, lips, nose, hands, feet, and the top of your head.

Seek shade or avoid the sun during the peak hours of 10am – 4pm. The sun is strongest during those hours, even on cloudy days.

Wear a hat with a wide brim to help shade your eyes, ears and head.

Wear wrap-around sunglasses that provide 100% UV protection to safeguard your eyes.

Wear lightweight, loose-fitting clothing that protects a larger area of your skin such as long-sleeve shirts or long pants. Tightly woven fabrics in dark or bright colors are best.

Examining Your Skin

Get a professional skin examination from a dermatologist once a year, and learn how to perform a monthly self-examination. Skin self-exams do not require any special medical equipment. All you need are your eyes, a mirror, and the knowledge of what to look for. Here are some tips:

• Perform skin self-examinations in a well-lit room in front of a full-length mirror. Use a handheld mirror for hard-to-see places.
• Learn the pattern of your moles, freckles or other birthmarks so that you will notice any changes.
• Look for new growths, spots, bumps or sores that do not heal normally.
• Don't forget hard-to-see areas of your body such as your head, the underside of your arms, the backs of your legs, and between your toes.
• Know the “ABCDs” of moles. If you have any moles that fit the following criteria, ask your doctor to check them out.

Asymmetrical: Is the mole oddly shaped?
Border: Does the mole have irregular or vaguely defined borders?
Color: Does the mole have uneven coloring or multiple colors?

Diameter: Is the mole larger than a pencil eraser or is it growing in size?

Source: This article originally appeared on Oncology Nurse Advisor.


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: Causes and Prevention

Melanoma is one of the fastest growing cancers worldwide, especially in young women under 30. However, most melanoma is curable in its early stages, with an over 90% survival rate. The sun's rays that nourish and energize the human body are unfortunately also a main cause of melanoma. It is important to learn what you can do to protect yourself and decrease your risk of melanoma.

Causes Of Melanoma

Ultraviolet rays Most skin cancers are caused by too much exposure to the sun's ultraviolet (UV) rays. The two types of UV rays that cause melanoma are UV-A and UV-B rays. UV-A rays are fairly constant throughout the year, and contribute to aging and wrinkling of the skin. UV-B rays, stronger than UV-A rays, are more intense in the summer months and are the most common cause of sunburn. The longer you are out in the sun, the more UV radiation you receive. A blistering sunburn at an early age can double a person's chance of developing melanoma later in life.

Tanning Beds The popularity of tanning beds has greatly increased in recent years. Tanning beds emit UV rays to speed up the skin tanning process, which has made them especially popular with young people. However, exposure to tanning beds before age 30 increases a person's risk of developing melanoma by 75%. Younger people who regularly use tanning beds are eight times more likely to develop melanoma than people who have never used them. Even occasional use of tanning beds by people under 30 triples the chances of developing melanoma.

Here are some easy ways to help protect your skin from UV rays and reduce your risk of melanoma:

Wear sunscreen with an SPF of 30 or higher. If you have fair skin or light hair, you are more susceptible to the sun's rays and should use a sunscreen with a higher SPF.

Use waterproof sunscreen to make sure it stays on longer, even if you perspire or get wet.

Reapply sunscreen often, usually every two hours, but sooner if you've been swimming or are perspiring heavily.

Cover your whole body. Remember those areas that can be easy to forget, such as your ears, eyelids, lips, nose, hands, feet, and the top of your head.

Choose sunscreen labeled “broad spectrum,” meaning that it protects against both types of harmful rays: UV-A and UV-B.

Avoid tanning salons, as exposure to ultraviolet radiation increases your risk of melanoma.

Wear wrap-around sunglasses that provide 100% UV protection to safeguard your eyes.

Seek shade or avoid the sun during the peak hours of 10 a.m. to 4 p.m. The sun is strongest during those hours, even on cloudy days.

Use extra caution near water, snow and sand, as they reflect the damaging rays of the sun, which can increase your chance of sunburn.

Wear a hat with a wide brim to help shade your eyes, ears and head.


Wear lightweight, loose-fitting clothing that protects a larger area of your skin, such as long-sleeve shirts or long pants. Tightly woven fabrics in dark or bright colors are best.

Source: This article originally appeared on Oncology Nurse Advisor.


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 Other Than Needing Your Teeth Cleaned

Inflamed gums and tooth decay also produce odor.  Foods that contain oils, like onions and garlic, can cause bad breath.  After these foods are digested and the pungent oils are absorbed into the bloodstream, they're carried to the lungs and are given off while breathing until the foods are eliminated from the body.  Dry mouth, decreased salivary production, occurs during sleep and causes morning breath.  Mouth breathing does the same thing.   

Some medications can cause diminished salivary flow.  Nasal discharge in the back of the throat, from sinus or respiratory infection, is another source of bad breath.  Certain illnesses, some cancers and metabolic disorders can produce chemicals that cause distinctive breath odors.  If you have concerns, see your prosthodontist for an examination and consultation.

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

Anyone Can Save A Life!!

Not trained in CPR

Cardiopulmonary resuscitation (CPR) is a lifesaving technique.  The American Heart Association recommends that all CPR begin with chest compressions.  The difference between doing something and nothing could be someone's life! 

Hands-only CPR is the initial recommendation--100 chest compressions per minute.  If you are untrained, and determine the person is unresponsive, put the person on his or her back, kneel on the side at neck and shoulder level, and put the heel of one hand over the center of the chest, between the nipples.  With your other hand on top of the first, and your elbows straight and your shoulders directly above your hands, use your upper body weight to push straight down to compress the chest at least 2 inches, at a rate of 100 compressions a minute.  Continue this until there are signs of movement or emergency medical personnel arrive.  

Trained in CPR

If you are trained in CPR, after the initial 30 chest compressions, you can open the person's airway using the head-tilt, chin-lift maneuver.  If rescue breathing is indicated, two rescue breaths to thirty chest compressions is considered one cycle.  For children ages 1-8, the cycles are the same, using only one hand and breathing more gently.  Most cardiac arrests in babies occur from lack of oxygen.  If you know the baby is choking, clear the airway first.  The cycle is still the same, but chest compressions are carried out with two fingers at the center of the chest.  In general, if you are alone, always perform CPR for at least 2 minutes before calling for help.  When it comes to CPR, quick and simple action can save a life! 

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

I Frequently Have A Patient With Shingles

What is shingles?

Shingles is a viral infection that causes a painful rash, most often appearing as a single strip of blisters that wraps around one side of the torso.  It is caused by the varicella-zoster virus--the same virus that causes chickenpox.  After you've had chickenpox, the virus lies inactive in nerve tissue near your spinal cord and brain and years later can be reactivated.  It is not life-threatening, but can be very painful.  

Symptoms for shingles

Symptoms include pain, burning, numbness or tingling, with a red rash that begins a few days after the pain. Fluid-filled blisters break open and crust over and they can itch.  Sometimes these symptoms are accompanied by fever and chills, general achiness, headache and fatigue.  

Treatment for shingles

The condition is most common in people older than 50--some experts estimate that half the people who live to the age of 85 will experience shingles.  A weakened immune system increases the risk, and cancer treatments (radiation and chemotherapy) may trigger the condition.  

There's no cure for shingles, but prompt treatment with prescription antiviral drugs can speed healing and reduce the risk of complications.  If pain is severe, different medications may also be prescribed.  The chickenpox vaccine is recommended for adults who have not had chickenpox.  There is an approved vaccine for adults over the age of 50, the shingles vaccine, used as a preventive strategy, that has the potential to reduce the course and severity of the disease.  

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

These Drinks Dissolve Teeth

When our youngest daughter was in middle school, her science experiment involved putting extracted teeth in different liquids of varying acidity levels (think: water v. coca-cola) and measuring their weight before and after.  Of course, after being in coca-cola, the teeth weighed less, because the acid dissolved the tooth enamel.  So now a study, published in the May/June issue of General Dentistry Journal, examined the acidity levels in 13 popular sports drinks and nine popular energy drinks.  Researchers determined acidity levels can vary between brands, as well as certain flavors of the same brand.  To determine what the acid levels did to teeth, researchers immersed human tooth samples into each beverage for 15 minutes, followed by immersing the samples in artificial saliva for two hours, four times per day over a five day period.  As few as five days after exposure to both types of drinks, teeth showed damaged enamel.

Energy drinks caused twice as much damage as sports drinks.  This damage to tooth enamel is irreversible.  Over time, this can cause tooth sensitivity and a greater likelihood of cavities.  The concern is that the assumption these drinks are "better" than soda is not the case.  This is especially true for teens,  30-50% of whom consume energy drinks and 62% of whom drink at least one sports drink a day.  If you drink these types of drinks, the recommendation is to chew sugar-free gum or rinse your mouth afterward to increase salivary flow to neutralize acidity levels in your mouth.  

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

Apple or Pear Shape ?--Metabolic Syndrome

Are you an apple or a pear?  Metabolic syndrome is a cluster of conditions--increased blood pressure, high blood sugar level, excess body fat around the waist ("apple shape") or abnormal cholesterol levels-- that occur together.  When these conditions occur in combination, your risk for serious disease is greater.  The symptoms are:  obesity--having a waist circumference of 40 inches or more for men and 35 or more for women; increased blood pressure--numbers higher than 130/85 on both scales; high blood sugar level--fasting blood glucose 100mg/dL or more; and high cholesterol--triglycerides of 150 mg/dL or more and HDL of less than 40 (men) or 50 (women).

The syndrome is linked to the body's metabolism, to a condition called insulin resistance.  Insulin is a hormone produced by the pancreas that helps control the amount of sugar in the bloodstream.  Normally, the digestive system breaks down foods into sugar (glucose).  Blood carries glucose to the tissues, where cells use it as fuel.  Glucose enters the cells with the help of insulin.  In people with insulin resistance, cells don't respond normally and glucose doesn't enter as readily.  As a result, glucose levels in the blood rise despite the body's attempt to control the glucose by producing more insulin.  The higher levels of insulin in the blood can lead to diabetes.  Even if levels aren't high enough to be considered diabetes, the elevated glucose level can still be harmful and is referred to as "prediabetes."  

The risk of metabolic syndrome increases with age, with 40% of people in their 60s being affected.  What to do?  All of the components of metabolic syndrome can be improved by lifestyle changes:  getting more physical activity (30 minutes per day), losing weight (as little as 5 to 10% of body weight), eating a diet that limits fats and emphasizes fruits, vegetables, fish and whole grains, and stopping smoking.  Regular checkups with your physician to monitor your progress are good too. 

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

Getting Enough Sleep

Insomnia is a disorder that can make it hard to fall asleep or stay asleep, or both.  It's common with insomnia to take 30 minutes or more to fall asleep and get six or fewer hours of sleep for three or more nights a week.  There are different ways it may affect a person besides difficulty falling asleep or awakening during the night:  awakening too early, not feeling well rested, daytime fatigue or sleepiness, depression or anxiety, poor focus, increased errors or accidents, tension headaches or digestive symptoms.

Stress can keep your mind active at night.  Anxiety can be disruptive.  Medications may contain stimulants.  Caffeine and nicotine are stimulants.  Alcohol prevents deeper stages of sleep.  Pain, breathing difficulties, frequent urination and other medical conditions promote insomnia.  Hormonal shifts make women more likely than men to suffer from insomnia.  It also increases with age.  Changing sleep habits and addressing any underlying causes of insomnia can restore restful sleep for many people.  Good sleep hygiene--simple steps such as keeping the same bedtime and arising time--promotes sound sleep and daytime alertness.  If these measures don't work, your doctor may recommend medications on a short time basis.  

For more information, go to MayoClinic.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

Prosthodontists Plan the Teeth Before the Implants

Wouldn't it be horrible if you had dental implants successfully placed and then couldn't have teeth on top of them?  You think it couldn't happen, but we've often seen unusable, misplaced implants.  That's why a prosthodontist should be the one to plan your implant therapy, because the final teeth have to be designed first and then the implants placed to facilitate the prosthesis.  Even in the case of a single tooth implant, the restorative requirements come first:  how much vertical space is there for the abutment and the tooth, what are the bite requirements, what does the tissue look like so the implant crown can emerge from the gums like a natural tooth?  These factors dictate where and how the implant must be placed, and also often which implant is most appropriate.  As more teeth become involved, the planning becomes more three dimensional.  What are the forces that will be applied to the new teeth?  How many implants are necessary for replacement of the multiple missing teeth?  How can you be sure implants don't end up between tooth positions?  Implants supporting a full arch fixed bridge, or a denture with a bar or attachments, are the most complicated.  What is the height of your bite?  Where do your teeth come together?  Where do the teeth need to be?  When the tooth position is determined, then how much volume or dimension of the prosthesis is necessary to have a restoration that is durable and long lasting?  How are the implants to be spread out, in what positions, at which angles?  Planning for teeth on implants needs to be made from the "top down", so when you know where the teeth are going to go, the implant foundation can be appropriately established.  Your Board Certified Prosthodontist is best suited to plan your implant treatment. 

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 Treat Oral Cancer Patients

Maxillofacial prosthetics

As Bakersfield's only full time Board Certified Prosthodontist, I have the privilege of working with the area's finest head and neck tumor surgeons.  Many times I have found myself in the operating room with these expert physicians fashioning intraoral appliances for patients undergoing tumor surgery.  This area of treatment is called Maxillofacial Prosthetics.

Oral cancer

Although the prognosis for long term survival is improving for many types of cancers, depression and death by suicide among patients with cancer is a concern.  In a study of 32,487 patients, Yu, etal., reported in the Archives of Otolarygology and Head and Neck Surgery, compared changes in cause of death in four time periods from 1980 to 2007.  They used standard mortality ratios to compare deaths from suicide, cardiovascular disease and pneumonia among patients with oral cancer and oral pharyngeal cancer.  Over the 27 year period, cardiovascular disease related deaths decreased by 45.9% and pneumonia related deaths decreased by 42.9%.  However, suicide deaths increased by 406.2%.  The significant increase in suicide rates are tied to risk factors such as age 55 to 64 years, certain marital status (divorced, separated or never married), advanced tumor stage, treatment with radiotherapy alone and pharyngeal tumor location.  Depression is a treatable condition and suicide is often preventable.  Because of long-standing professional relationships with their patients and the ability for oral cancer screening at dental visits, dentists may be in a position to provide appropriate support and referral for early intervention for patients with oral cancer. 

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

Porcelain Veneers Can Give You A Dramatic Change

For the patient who has bleached their teeth without desired results. For the patient with crooked teeth, spaces (diastemas), rotated teeth, or old unsightly fillings, porcelain veneers can provide dramatic cosmetic and esthetic changes in just two appointments. When orthodontics is not an option, correction of a smile can be a permanent benefit.

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

FDA Warning: Spinbrush

The U.S. Food and Drug Administration has issued a warning about reports of serious injuries and serious hazards associated with the use of all models of the Spinbrush: specifically the Arm & Hammer or Crest Spinbrush.  While turned on, the brush head has either "popped off" or broken off in the user's mouth or near the face, causing cuts to the mouth and gums, chipped or broken teeth, swallowing and choking on the broken pieces, and injuries to the face and eyes, according to the FDA's warning.  The agency provided the following advice:  Before using, inspect for damage and loose bristles and if found, do not use.  Test brush outside of mouth and if the connection is loose, do not use.  Do not bite the brush when using.  To prevent injuries, supervise children and adults who may need assistance.

For more information :  fda.gov/downloads/ForConsumers/ConsumerUpdates/UCM291863.pdf  

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

Xylitol Reduces Adult Tooth Decay

A report published in the Journal of Dental Research, by Ritter, et al., compared the effectiveness of xylitol vs placebo lozenges in the prevention of dental decay in "active-decay" adults.  620 patients were followed for three years.  Participants using the xylitol lozenges had 40% fewer decay lesions on  root surfaces than those using the placebo.

J Dent Res, 2013 (Epub)

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 Fluoride Works To Prevent Tooth Decay

A  report in the journal Langumir, of the American Chemical Society, gives evidence of how fluoride in drinking water, toothpastes, mouthrinses, and other oral care products prevents tooth decay.  Fluoride penetrates a thin layer to harden the enamel on the tooth surface.  In addition, it also works by impacting the adhesion force of bacteria that stick to the teeth and produce the acid that causes cavities.  By reducing the ability of decay-causing bacteria to stick on teeth, it is easier to wash away the bacteria by saliva, brushing and other activities.


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

Take Control of Lupus with Exercise

Exercise can help lupus patients

Lupus, a connective tissue disorder, is a chronic illness.  It is something that you can't control, is extremely frustrating.  It can make you feel like your life is over.  Exercise can give lupus patients the chance to work out some of those frustrations, and give you the feeling that you have some control over your body instead of it controlling you.
  

The benefit of exercise

Exercise doesn't just improve your overall fitness, it can also help relieve many of the symptoms of lupus, by fighting fatigue, relieving stiff and painful joints and releasing chemicals that improve your mood.  Consult with your physician regarding an exercise program that can be integrated into your daily life.  It will usually involve aerobic conditioning at a moderate intensity and will be balanced with appropriate rest.  Because getting moving replenishes your energy supplies, it directly combats fatigue.  Even a daily short period of time can make you feel better.  Moving your joints facilitates their natural lubrication.  Exercise also strengthens the muscles around joints to take pressure off joints.  Flexible, strong muscles help protect joints.  

Exercise is good for your heart

Since exercise is good for your heart and fights obesity, it lowers the levels of inflammatory proteins.  Since lupus is an inflammatory disease, exercise eases inflammation.  When you're in pain all the time, you feel miserable.  Tied into the fatigue are stress, anxiety, depression and poor sleep.  Exercise lifts your mood by triggering the release of endorphins, the feel-good chemicals of the brain, that stimulate feelings of greater comfort, pleasure and confidence.  If you have lupus, just think about what better muscle tone, more joint stability, increased mobility and less fatigue could mean in your life.  

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

Teeth Cleanings Protect from Heart Disease

A study presented at the American Heart Association's Scientific Sessions showed professional tooth scaling was associated with fewer strokes and heart attacks.  100,000 participants were followed for an average of 7 years.  They were roughly equally divided into two groups of similar gender and health condition.  Of those who had dental cleanings by a dentist or dental hygienist, there was a 24% lower risk of heart attack and 13% lower risk of stroke compared to those who had no cleanings.  Protection from heart disease and stroke was more pronounced in participants who got cleanings at least once a year.  Professional tooth cleaning appeared to reduce inflammation-causing bacterial growth that could lead to heart disease or stroke.  

Reported in Science Daily

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 Physiology of Exercise

Dr. Robert Robergs, professor of exercise physiology explains: every time you work out, exercise sets in motion a cascade of events in your body that collaborate to help you lose weight and get healthier.  When you exercise--whether it's walking, biking or lifting weights--your muscles contract.  To contract, muscles need oxygen.  "The benefit of exercise is it stimulates the body to deliver more oxygen to the muscles that are contracting."  The need for oxygen makes you breathe faster.  Every time you inhale, a rush of oxygen-rich air flows into your lungs, making its way to red blood cells.  From there, hemoglobin transports it to muscles and everywhere else in the body it needs to go.  Your heart pumps harder to send the blood out and the more it works, the more efficient it gets.  "Over several weeks, the heart becomes a better pump."  Meanwhile, new blood vessels are produced and the net effect is to reduce your blood pressure.  That's not all exercise does for you.  "Because exercise burns calories, it can help reduce body fat.  It can raise good cholesterol--the HDL cholesterol." HDL (high density lipoprotein) is the "healthy" form that helps sweep the low-density (bad) cholesterol to the liver for removal, before it can build up in the arteries and lead to coronary artery disease. 

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

Cancer Treatment and Recovery Tips

WebMD has a great article on maintaining physical and mental health when dealing with cancer treatment, recovery and retreatment:

1. Make day-to-day health a priority, including taking regularly scheduled medications and some form of daily exercise approved by your physician. 

2. Consult with a dietician because the foods you eat are as important as medication for fuel for body functions. 

3. Attend all follow-up appointments with physicians and take necessary tests. 

4. Listen to your body and report symptoms, including both short and long term side effects of your disease and treatment, to your physician. 

5. Join a support group for an opportunity to meet other survivors with similar life experiences.  

6. Speak with a social worker, or a religious mentor if more support is needed beyond what friends and family provide.  

7. Schedule activities that you enjoy including hobbies, work, and spending time with loved ones.  Living in fear of disease progression will not stop its growth--the energy is more useful if spent living life today as fully as possible. 

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

Prosthetic Treatment for Oral Cancer Patients

Tumors affecting the upper jawbone or overlying tissue often require removal of half of the palate.  Such a surgery creates an opening into the sinus cavity above the jawbone and next to the nose.  In this instance, the entire soft palate was also removed.  The function of a post-surgical prosthesis is to replace the function of what was removed:  to replace the volume of the upper jawbone and teeth, to create a seal between the mouth and sinus, to create surfaces against which the sides and back of the throat can press against to form speech sounds, and to create a seal between mouth and nose so swallowing directs  liquids and solids downward into the throat instead of leaking through the nose.  We work with Head and Neck surgeons in the operating room to  fabricate a prosthesis at the time of surgery to form a foundation against which the tissues can heal and look normal from the outside of the face.  After healing, we create a final prosthesis to restore function.  We are the only office locally to treat these patients.  This patient told me this week that at her work she had been restored to her original position, which involved talking on the phone all day.  She wears her partial without complaint; in fact, she has been an eager participant in regaining normalcy. She has taken her life back, in the face of unimaginable trauma, and her attitude and energy is an inspiration to me, and reminds me of why I do this.  

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

Preschoolers Need Tooth Brushing

The number of preschoolers requiring extensive dental work suggests that many parents are not enforcing daily teeth brushing.  The Centers for Disease Control and Prevention noted an increase, the first in 40 years, in the number of preschoolers with cavities.  Dentists nationwide are seeing, at all income levels, sometimes six to ten cavities or more.  The level of decay, they added, is so severe that they recommended using general anesthesia because young children are unlikely to sit through such extensive procedures while they are awake.  The growing problem is due to a combination of reasons:  endless snacking, juice or sweet drinks before bedtime, leaving a bottle of milk in the crib, parents who choose bottled water instead of fluoridated tap water, and lack of awareness that infants should, according to pediatric experts, visit a dentist by age 1 to be assessed for future cavity risk, even though they may have only a few teeth.  Lax parenting when it comes to brushing or pacifying kids by giving them a sippy cup all day are important causes.

Reported in the New York 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

Smoking and Oral Health

National Center for Health Statistics: Data Brief No. 85: Current smokers (16%) were twice as likely as former smokers (8%) and four times as likely as never smokers (4%) to have poor oral health status.  Current smokers (35%) were almost 1 1/2 times as likely as former smokers (24%) and more than two times as likely as never smokers (16%) to have had three or more oral health problems.  "The evidence for an association between tobacco use and oral diseases has been clearly shown in every Surgeon General's report on tobacco since 1964.  Tobacco use is a risk factor for oral cancers, periodontal diseases and dental caries, among other diseases.  Oral health problems may be early warning signs of other medical problems such as diabetes, HIV, heart disease or stroke."  According to the report summary, "Good oral health is integral to good general health."  Ask your prosthodontist for smoking cessation advice.  
Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Baby Boomers and Hepatitis C

More Americans now die as a result of hepatitis C infection than from HIV related causes.  An estimated 3.2 million Americans are infected with hepatitis C, which can lead to liver cancer.  About two-thirds of those are baby boomers, born between 1945 and 1964.  While 1 in 33 Americans born during that period are infected, at least half don't know because screening is rare.  The disease is commonly spread through contact with contaminated blood, but is usually diagnosed decades later, when routine blood tests uncover liver damage caused by the virus over time.  Conventional treatment include pegylated interferon and ribavirin.  Two new protease inhibitors have been shown to be highly effective in eliminating the virus in people with less-advanced liver disease.  As with any treatment, early diagnosis means greater treatment success. 

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

Heart Disease and Women--Symptoms, Risks

Heart disease affect more women than men

Heart disease kills more women every year than any other health condition.  The Journal of the American Medical Association reports that younger women (under age 55) without chest pain during a heart attack are more likely to die than men, because the diagnosis of heart attack is often delayed.  

Men reported chest pain more often than women

In a study of data on more than 1 million people, nearly 70% of men reported chest pain, compared to 58% of women.  When chest pain occurs, it feels like a ton of weight on the center or left side of the chest that usually last for more than a few minutes or goes away and comes back.  It can be a squeezing, fullness, pain, or heartburn or indigestion.  There may be sharp pain in one or both arms, the back, shoulders, neck, jaw or upper (above belly button) part of the stomach.  There may be sudden and severe shortness of breath at rest or with minimal physical activity.  There may be unexplained or excessive sweating that you know is not menopause.  The most common symptom is sudden or unusual tiredness or lack of energy that may last for days, including muscle weakness or tiredness that is not related to exercise.  This symptom is the easiest to ignore.  There may be sudden dizziness or light-headedness. There may be nausea, vomiting or indigestion, especially in combination with other symptoms. 

Risk factors for heart disease

Risk factors for women include high cholesterol levels, high blood pressure, smoking, diabetes and a family history of heart disease.  Since crushing chest pain doesn't always occur, awareness of these other symptoms leads to earlier treatment. If any of the severe symptoms occur and lasts for more than five minutes, emergency medical care is recommended. 

The earliest treatment may be the key to survival!  

The existence of periodontal (gum) disease has been correlated with a higher incidence of heart disease. 

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

Science Repairs Teeth

Studies reported by the National Academy of Sciences indicate that a peptide, called melanocyte-stimulating hormone (MSH) encourages the regeneration of bones.  The ACS Nano journal reported that a group of French researchers have applied this science to teeth, which have a similar chemical structure to bones.  They found that the peptide, in gel form, when placed next to incipient cavities in the teeth of mice, caused the cells that made up those teeth to regenerate in less than 30 days, and the cavities to disappear.  Popular media sources trumpet this research as the future demise of the dreaded dental drill!

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 Treatment Resources

The Obesity Action Coalition and the American College of Physicians have a new free resource.  Information from the Center for Nutrition and Weight Management at the Geisinger Obesity Institute and the Washington Center for Weight Management and Research is also available.

Visit: www.obesityaction.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

Adopting a Healthy Lifestyle

Research and statistics

The American Journal of Epidemiology published a Johns Hopkins multiyear study of more than 6,000 people that established the protective association of lifestyle factors and early signs of vascular disease, coronary heart disease and death.  You can reduce your chances of death from all causes by 80% over eight years by:

• Not smoking
• Exercising regularly
• Keeping a normal weight
• Eating a Mediterranean diet

Mediterranean diet 

The principal aspects of a Mediterranean diet include proportionally high consumption of olive oil, legumes, unrefined cereals, fruits, and vegetables, moderate to high consumption of fish, moderate consumption of dairy products (mostly as cheese and yogurt), moderate wine consumption, and low consumption of meat and meat products.

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 much do you know about the harmful effects of smoking?

Check out the far-reaching harmful effects of smoking! http://bit.ly/13yKgUo

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

My Broken Crown--How Long Did It Last?

I have a broken crown in my mouth.  One of the dentists in town did it, but it failed after just a few months.  For as much as it cost, I wanted it to last forever. It makes me appreciate the times patients ask: "How long will this last?"  Each meal, let's estimate I chew a bite of food 10 times.  With 20 bites per meal and three meals a day, that's 600 times a day that crown is used, not counting snacks, popcorn, ice, lifesavers, nuts, nibbling on bones, etc.  This is the environment of my mouth: temperature range from 150 ° F (hot coffee) to 30 ° F (ice cream), acid attacks (diet drinks are really bad), bacterial biofilm, clenching or grinding at night and holding a pencil.  So, I suppose my mouth is a tough place for a crown to survive.  Did I mention that many years ago, that tooth broke in the first place and that's why it needed a crown?  Did I mention that the first crown broke after many years and that's why I needed a second one.  What's a realistic estimate for a crown or filling to hold up?  The unsatisfying answer: it depends.  In a person who avoids sweets and sodas, regularly brushes and flosses, doesn't take any medication that causes dry mouth, doesn't grind at night and sees a dentist regularly in an effort to catch problems while they're small, that crown can last up to 15 years.  That's without gum disease or new decay. But regular wear and tear, even in "low risk" patients, will eventually do in any dental work because a prosthesis is never as good as nature. 

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