Relieving Teething Pain Depends Upon Age: FDA Warning

The FDA has reissued a warning about the use of benzocaine gels or liquids to relieve teething pain for children under the age of 2.  Parents should not use over the counter medications containing benzocaine for children under 2 because they are at particular risk for the rare but serious disease of methemoglobinemia, a disorder in which the amount of oxygen carried through the blood stream is greatly reduced.  The most severe cases can result in death.  Adults with heart disease or breathing problems and smokers are also at greater risk for the disease.  Symptoms of the disorder are sometimes difficult to recognize, and include pale skin, lips and nail beds, shortness of breath and fatigue.  For treating teething pain, the FDA recommends using teething rings chilled in the refrigerator, or gently massaging the child's gums with your finger.



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 "Lupus Fog?"

As many as half of all people with lupus describe feelings of confusion, fatigue, memory loss, and difficulty expressing their thoughts.  This collection of symptoms is termed cognitive dysfunction, although many people call it "lupus fog."  It is associated with problems with memory, concentration, speech and logical reasoning.  Currently, it is not understood whether these problems are medication related or a reaction to a chronic illness.

Research is being done to determine the causes of cognitive impairment with lupus.  Staying physically fit and keeping a healthy diet are critically important to good cognitive health.  This means avoidance of nicotine, excessive caffeine, and alcohol, and, equally importantly, it means regular exercise.  Improved organization can also help overcome the difficulties and frustrations associated with worsening memory and concentration.  In addition, separate from lupus fog, people with lupus may be twice as likely to experience migraine-like lupus headaches.  This problem is usually treated by a neurologist, because different types of headaches respond to different types of 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

Why Gum Health Can Worsen With Age

Gum Health

New Research from Queen Mary, University of London, in collaboration with research groups in the United States, may elucidate the reasons behind deteriorating gums as we age.  According to the study, published in Nature Immunology, the worsening of gum health, common with aging, is associated with a drop in the level of a chemical called Del-1.  In the study's abstract, authors wrote that aging is "linked to greater susceptibility to chronic inflammatory diseases, several of which, including periodontitis, involve neutrophil-mediated tissue injury."  The authors report finding "aging associated periodontitis was accompanied by a lower expression of Del-1, an endogenous inhibitor of neutrophil adhesion dependent on the integrin LFA-1."  

Prevent Gum Disease

According to a news release from the university, authors believe understanding more about Del-1 and its effects on the body's immune system could help in the treatment or prevention of serious gum disease.  The study compared gum disease in young and old mice and found that an increase in gum disease in the older animals was accompanied by a drop in the level of Del-1, a protein known to restrain the immune system by stopping white blood cells from sticking to and attacking mouth tissue.  Mice that had no Del-1 developed severe gum disease and elevated bone loss and researchers found unusually high levels of white blood cells in the gum tissue.  When they treated the gums of the mice with Del-1, the number of white blood cells dropped and gum disease and bone loss were reduced.

Source:  nature.com/ni/journal/v13/n5/full/ni2260.html

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 To Remove Tooth Stains from Coffee and Cigarette Smoke

A recent study published in the Journal of the American Dental Association evaluated the stain removal ability of toothbleaching and simulated toothbrushing after coffee and cigarette smoke staining.  In addition, researchers determined the enamel susceptibility to restaining.  They measured tooth color with a colorimeter, before and after immersing half of the samples in coffee and exposing the other half in a smoking machine.  Then they remeasured color after toothbleaching and toothbrushing.  They found specimens stained with coffee and smoke showed a significant removal of stain after bleaching.  However, only the smoke stained specimens responded to toothbrushing.  The authors concluded that 6% hydrogen peroxide at-home bleaching removed both coffee and smoke staining.  However, restaining potential was greater for tooth surfaces stained with coffee than for those stained with cigarette smoke, regardless of the removal method used.  Finally, the authors wrote, continued frequent consumption of coffee can increase the staining susceptibility of enamel.  

Source: JADA, 143:5, May 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

Recommended: MouthHealthy.org

The American Dental Association's website for the public, MouthHealthy.org, is now live.  It provides timely and credible oral health information on prevention, care and treatment people are looking for with in-depth content, new video and a highly engaging presentation for visitors.  It has:  Oral health information by life stages from pregnancy through seniors, A-Z topics with videos, ADA Seal of Acceptance products and tips and activities to make oral health care fun for kids.

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

Why Denture Wearers Want Implants

Reasons denture wearers want implants:  

• They miss eating their favorite foods.  
• They want to order from the entire menu.  
• They are tired of worrying whether their teeth will pop out.  
• They are sick and tired of adhesives.  
• They want to appear younger and have better facial structure.  
• They want more functional teeth.  
• They want the self-confidence from knowing their teeth are secure.  
• They want to preserve their jawbone from further shrinkage. 

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 Fluoride for Children

Rubbing toothpaste on your teeth can provide four times better fluoride protection, according to a recent study.  Researchers tested various brushing techniques and brushing either two or three times a day with high-fluoride vs standard toothpaste.

The results revealed that those who used a high-fluoride toothpaste three times a day had four times better protection than those who used standard toothpaste twice a day.

Researchers also found that massaging toothpaste onto teeth with a finger to be at least as effective as a third brushing in increasing the amount of fluoride in the 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

Bone Density Testing and Osteoporosis

A bone density test measures your bone strength and if you are at risk for osteoporosis.  The test is painless and is like an x-ray scan of your body and takes about 15 minutes.  If you are a woman age 65 or older, schedule a bone density test.  If you are a woman age 50-64, ask your doctor if you need one.  If you are a man over 65, discuss it with your doctor.  If you are at risk for osteoporosis, you may be tested every two years.  

Osteoporosis has no signs

Osteoporosis is a bone disease that has no signs or symptoms.  It weakens bone and makes them more likely to break, especially bones in the hip, spine and wrist.  It is most common in older women.  One in two women and one in four men over age 50 will break a bone in their lifetime because of osteoporosis.  How to protect your bone health:  Get enough calcium and vitamin D!  The calcium shopping list includes low fat or fat free milk, cheese and yogurt, almonds, broccoli and greens, orange juice with added calcium and calcium supplements.  Get enough vitamin D--from salmon or tuna, fat free or low fat milk with vitamin D, some cereals and juices and yogurt with added vitamin D, and vitamin D supplements.  Stay active!  Physical activity slows bone loss.  Moderate aerobic activity and strengthening exercises can make a big difference.  Discuss any medication or supplements with your doctor.  

Source:  National Health Information Center 

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 Charge of Your Health Care

The more you play an active role in your health care, the better quality of care you will receive.  Most people depend upon different doctors, nurses, pharmacists and insurance programs for their health care.  It's a team effort, and you (the patient) are the most important member of the team.  To take charge of your health care, follow these steps:  

1.  Keep track of important health information, kept together in one place, available for all medical appointments.  It includes: name, birth date, blood type, emergency names and phone numbers, list of medical providers, dates and results of checkups and screening tests, list of shots received, health conditions and allergies, and current medications.  

2.  Know your family health history.  

3.  Keep regular checkups.  Adults typically need a checkup every one to five years.  Remember, early detection of problems means easier treatment.  

4.  Make the most of your doctor visits:  write down a list of questions ahead of time, and you may want to bring a family member or friend with you to take notes.  Be sure to talk about any changes since your last visit.  

Source:  healthfinder.gov  

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

Regular Tooth Scaling = Less Heart Disease

Recent study results showed an association between regular tooth scaling and a decreased risk of future cardiovascular events.  Using a nationwide, population-based study and a prospective cohort design, participants aged at least 50 years were selected from the Taiwan National Health Insurance Research Database.  Authors of the study, published in the American Journal of Medicine, used 10,887 subjects who had received full-mouth or localized tooth scaling and compared them to 10,989 subjects who had not received any tooth scaling.

Tooth Scaling and Heart Disease  

After following the subjects for an average period of seven years, the group that had undergone tooth scaling had a lower incidence of acute myocardial infarction, stroke, and total cardiovascular events.  "Furthermore, when compared with the nonexposed group, increasing frequency of tooth scaling correlated with a higher risk reduction of acute myocardial infarction, stroke, and total cardiovascular events," the authors wrote. 

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

Childhood Tooth Care Has Lifetime Benefits

How you take care of your child's teeth now will determine what kind of smile they have when they are an adult.  Infants at birth already have 20 teeth under their gums.  The average age for teeth to start coming in is 6 months and by the age of 3 most children have all of their baby teeth.  Babies can get cavities.  The American Dental Association recommends you start cleaning a baby's gums when they are a few days old.

Cleaning Baby Teeth

Damp gauze or a soft wash cloth gently rubbed on the gums starts the process.  When teeth appear, use a child's toothbrush and water.  At the age of two, a pea sized amount of tooth paste can be used, twice a day, spitting out the paste afterward.  By the age of 6 or 7, children can usually take over the task on their own.  The ADA recommends the first dental visit around the first birthday, to get used to going to the dentist.  The dentist will inspect the mouth, check for cavities and clean the teeth.  Recommendations, such as not leaving a bottle in bed with a child, to prevent baby bottle tooth decay, may be given.

Starting Young

Baby teeth are important because they hold spaces for the permanent teeth.  If they are lost early, a spacer may be placed to hold open the spot so the permanent tooth comes in straight.  As soon as molars come in, fluoride treatments may be used and sealants may be placed to prevent cavities from developing.  Diet recommendations such as avoiding sugary drinks and sticky foods, and not eating after brushing at night help keep teeth healthy. Developing healthy dental habits in kids can benefit them for a lifetime! 

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

Healthy Implants, Healthy Smiles

This healthy young (40 years old) man, with a difficult dental history, finally found himself in the position to fix his mouth.  The one thing he knew for sure--he didn't want to have a denture.  His upper remaining teeth were failing, and the upper back teeth had been gone for such a long time that the bone had shrunk also. The idea of sinus lifts and bone grafts, a more serious surgical procedure, did not appeal to him.  Fortunately, the bone in the front of his upper jaw, examined by means of a CT Scan,  was more than ample for us to place six dental implants.  

Position of Implants

The positions of the implants, their distribution, and the "tilted" angulation of the most posterior implants, allow fabrication of a computer-designed, milled titanium framework to support a full complement of upper teeth and be screw retained.  The end result will be a permanent upperfixed bridge.  We have had great success for many years treating both upper and lower jaws with the All-on-4 technique.  More information is available on our website, with patient reports on their experiences. 

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 Lupus Implications of Staph Infections

Chronic exposure to even small amounts of staph bacteria could be a risk factor for the chronic inflammatory disease lupus, Mayo Clinic research shows.  Staph, short for Staphyloccus aureus, is a germ commonly found on the skin or in the nose, sometimes causing infections.  In the Mayo study, mice were exposed to low doses of a protein found in staph and developed a lupus-like disease, with kidney disease and autoantibodies like those found in the blood of lupus patients.  The findings are published online this month in the Journal of Immunology.

Research on Lupus  

The next step is to study lupus patients to see if the staph protein in question plays a similar role in humans. "We think this protein could be an important clue to what may cause or exacerbate lupus in certain genetically predisposed patients," Dr. Vaidehi Chowdhary, co-author, says.  "Our hope is to confirm these findings in lupus patients and hopefully prevent flares."  In the mice studied, a staph protein activated white blood cells, leading to an inflammatory illness mirroring lupus.

Research on people has shown that carrying staph bacteria is linked to autoimmune diseases such as psoriasis, Kawasaki disease and granulomatosis with polyangilitis.  Since the cause of lupus is still unknown, the discovery of the staph protein's role is exciting, Dr. Chowdhary says.

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 Keep Baby Boomers Smiling!

A healthy, attractive looking smile increases your confidence and self esteem.  It speaks all languages.  It is contagious. 

Baby boomers keep smiling due to techniques practiced by prosthodontists--specially trained in beautiful smiles through the restoration and replacement of lost teeth.  Teeth become brittle and easier to break with age.  They have thinner enamel, a darker appearance and get worn down.  Bone loss and gum disease increases, roots become exposed by recession, and shifting of teeth can cause bite problems and jaw joint pain.

Prosthodontist Technology  

Your prosthodontist has the technology and knows how to turn back the clock and create and place natural looking teeth that are comfortable and function properly.  Crowns and bridges, veneers, dentures and dental implants are a prosthodontist's special focus.  Your prosthodontist is equipped to give you a thorough review of your dental condition and explain your options for restoring your smile.

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

Live Well By Keeping Dentures Secure

Millions of people visit their dentist each year complaining of dentures "moving around."  They become loose over time because the jawbone supporting them becomes smaller and the denture has less to hold on to.  For many, relining them or making a new set makes them fit snugly again.  Unfortunately though, for some patients, relining or a new set doesn't help.  So what are the options for these patients?  What can be done to keep their dentures in place all day, without the use of messy adhesives?

Dental Implants Changed the World of Dentistry  

The introduction of dental implants has changed the world of dentistry and improved the lives of thousands of patients, including denture wearers.  Implants have been around for over 50 years and the technology has improved to a success rate of 95%.  They can be used in many different ways to aid in the form, function and aesthetics of a patient's smile. The implant is placed in the jaw to simulate the natural root of a tooth.  Once the implant is placed, a restoration is connected on top of it, depending on the need of the patient.  
In the case of denture wearers, implants provide much more stability.  They improve the ability to eat and speak.  Sore spots are reduced.  Most of all, they prevent further bone loss, maintaining facial structure over the years.  Normally, two implants are placed for a lower denture and four implants for an upper denture.  As seen in Living Well Magazine.     

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

Rheumatoid Arthritis and Heart Attack Risk

According to research, the risk of having a heart attack is 60% higher just a year after a patient has been diagnosed with rheumatoid arthritis.  Swedish researchers followed 7,469 patients diagnosed with rheumatoid arthritis between 1995 and 2006, together with 37,024 matched controls without rheumatoid arthritis to determine the risk of ischemic heart disease, with particular reference to myocardial infarction (heart attack).  Average age at diagnosis was just  under 57 years  and  71%  of the patients were women.  The median time from appearance of symptoms to diagnosis was  6.2 months.  RF (rheumatoid factor) positive and RF negative patients were statistically the same.  The risk of an acute heart attack rose by 60% one to four years after diagnosis and remained at that level in years 5 to 12.  According to lead author Marie Holmquist, the findings emphasize the importance of monitoring a patient's heart status from the moment they are diagnosed with rheumatoid arthritis.  

Source:  www.ahealthblog.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

GERD Dissolves Teeth

Acid regurgitation resulting from gastroesophageal reflux disease (GERD) causes tooth structure to dissolve.  GERD is a common condition affecting 10 to 20% of the population in Western countries.  A study by Pace showed a 24% prevalence of dental erosion as a manifestation of the disease. It is usually measured in areas of the teeth that do not contact, so the acid is the the known cause.  Now a study also measures the amount of tooth loss. In this new report (ADA Journal, March 2012), authors show that both front teeth and back teeth are affected and the amount of tooth wear is twice as high on surfaces where teeth touch when combined with acid reflux.  Normal tooth wear, with the addition of acid, can be rapid and devastating to your teeth.  If you have excessive or rapid loss of tooth structure, see your prosthodontist for advice and ask your physician about diagnosis and treatment of acid reflux.  

Source: JADA  

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

Maintain Healthy Bones Throughout Life

Osteoporosis

Bones provide structure for your body, protect organs, anchor muscles and store calcium. Protecting bone health is easier than you think.  Bone is continually remodelling itself, but after the age of 30 you lose slightly more than you gain.  

The higher your peak bone mass, the less likely you are to develop osteoporosis as you age.  Some factors that affect bone health--getting older, being a woman, your race, frame size and family history--you can't change.

Prevent Bone Loss

But, there are many things you can do to prevent or slow bone loss:  Include plenty of calcium in your diet. The Institute of Medicine recommends 1,000 milligrams (mg) of calcium per day for women up to age 50 and men up to age 70.  Women over 50 and men over 70 require 1,200 mg per day. Dietary sources of calcium are dairy products, almonds, broccoli, kale, canned salmon with bones, sardines and soy products (tofu).  Vitamin D: up to age 70, at least 600 international units (IUs) daily.  Over the age of 70, 800 IUs are recommended.  Besides sunlight, sources are oily fish (tuna and sardines), egg yolks, fortified milk, and vitamin D supplements.  People who are physically inactive have a higher risk of osteoporosis, so include physical activity in your daily routine.  Weight-bearing exercises such as walking, jogging or climbing stairs for 30 minutes a day help slow bone loss.  Avoid tobacco use and more than two alcoholic drinks per day.  Anorexia and bulimia are risks for bone loss.  Stomach surgery (gastrectomy), weight-loss surgery and some conditions (Crohn's disease, celiac disease and Cushing's disease) can affect your body's ability to absorb calcium.  

For women, bone density drops dramatically due to reduced estrogen after menopause.  Your physician may recommend hormone replacement therapy, keeping in mind that there are risks associated with it.  There are medications, such as bisphosphonates (Fosomax, Boniva) designed to maintain bone mass, that your physician may recommend.  

Source:  Mayo Clinic.com  

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

What To Tell Your Dentist If You're Pregnant or Think You Are

Expectant mothers with severe gum disease have a seven times greater risk of delivering PTLBWB babies. This is true for women under the age of 17 and over the age of 34.  Currently, 12% of US pregnancies are complicated by preterm birth, meaning less than 37 weeks' gestation.  Low birth weight is categorized by less than 5 lbs. and 8 oz. and small gestational age refers to a baby in less than the 10% percentile.  In addition, other complications such as miscarriage and preclampsia may be related to periodontal disease.  While there are significant risks to the mother, preterm low birth weight babies risk neurodevelopmental problems, respiratory and behavioral problems, learning disabilities, and cardiovascular and metabolic problems.  All studies suggest periodontal treatment is safe for expectant mothers.  

Source:  Compendium 

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

If Your Face Droops, Seek Immediate Attention

Bell's Palsy (also known as facial palsy) is a condition that causes sudden weakness in the facial muscles of half of the face, making your smile one sided and the eye on the same side hard to close.  It can occur at any age and is thought to be the result of inflammation of the nerve that controls the muscles on one side of the face.  It may be a reaction that occurs after a viral infection.  For most people it is temporary--symptoms usually start to improve within a few weeks, with complete recovery in about six months.  The mild weakness to total paralysis can come on suddenly.  The facial droop may be accompanied by pain around the jaw, increased sensitivity to sound on that side, decrease in ability to taste and headache.  Immediate medical help is mandatory.  Since the palsy is linked to viral infections, antiviral drugs are often prescribed.  In addition, corticosteroids, started as soon as possible, are powerful anti-inflammatory agents and can reduce the swelling of the facial nerve.  Home treatment involves over the counter pain relievers, applying moist heat and keeping the open eye properly lubricated.

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

Replacing Missing Teeth Critical for Daily Function

The muscles of the head and neck work together to determine how we eat, breathe, speak and how we look.  Chewing muscles are supported by the jaws and teeth, and are responsible for the stability of the head and neck.  For this reason, the replacement of missing teeth is important in maintaining our social and biological capability in many different areas:

• lower jaw position, in relation to the skull--allows neck muscles to hold the head in its proper posture--a loss of teeth can cause the head to drop, eyes to be downcast and breathing space of the throat to be decreased
• the height of the lower third of the face--upper and lower tooth contact maintains the length of chewing muscles, keeps the lips and cheeks supported, and contributes to facial attractiveness
• speaking--both the space in the mouth and the airflow through the mouth determined by the shape of the palate, tongue and position of the teeth creates proper speech sounds
• eating--mastication of the right kinds of foods to have a balanced and nutritious diet

Tooth replacement enhances quality of 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

Your Mouth And Teeth Age Too

Paul had a 3-tooth fixed bridge for 15 years until one of the anchor teeth (that had a root canal and gum surgery) failed in 1978.  So, it grew to a 4-tooth bridge that lasted until 1986, when the next anchor tooth failed.  Two dental implants were placed in 1988, which held a new fixed bridge, until a third implant was placed in 1990.  This 4 tooth fixed bridge supported by three implants exists to this day.  Paul's experience illustrates that, even when everything that could be done had been done, his mouth kept changing.  Your Board Certified Prosthodontist has the specialized training and experience to help you with your dental needs.

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

When To Premedicate With Antibiotics?

Antibiotic prophylaxis is the administration of antibiotics to patients without evidence of infection to prevent bacterial colonization and reduce subsequent postoperative or post-treatment complications.  In the treatment of certain medically at-risk patients, those with impaired defenses, (chemotherapy, organ transplant or tissue graft recipient, insulin-dependent diabetes, alcoholics) antibiotic therapy is established.  Prevention of infective endocarditis by prophylactic antibiotics is indicated for patients with specific medical conditions (prosthetic cardiac/heart valve, history of previous infection, cardiac transplants, some congenital heart diseases and other special circumstances).  All patients during the first two years following orthopedic joint replacements should receive antibiotics to counteract the potential risk of total joint infection.  Detailed guidelines for these recommendations are available.  

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 Infections and Antibiotic Myths #5-8

According to the American  Association of Endodontists:  

Myth #5:  Multiple antibiotics are superior to a single one:  Combined antibiotic therapy usually results in a greater selective pressure on the microbial population to develop drug resistance.  The primary clinical indication for combined therapy is a severe infection in which the offending organism is unknown and major consequences may ensue if antibiotic therapy is not instituted immediately before culture and sensitivity tests are available.  

Myth #6:  Bactericidal agents are always superior to bacteriostatic agents:  Bacteriocidal agents are required for patients with impaired defenses.  However, bacteriostatic agents are usually satisfactory when one's defenses against infections are unimpaired.  

Myth #7:  Antibiotic dosages, dosing intervals and duration of therapy are established for most infections:  Amount and timing of antibiotics are often unknown for most specific infections, due to the number of variables present.  Therefore, the current recommendation is to employ antibiotics on an intensive basis with vigorous dosage for as short a period of time as the clinical situation permits.  The goal is to achieve drug levels in the infected tissue.  Upon initiation of therapy, a loading dose is recommended.  

Myth #8:  Bacterial infections require a "complete course" of antibiotic therapy:  There is no such thing as a complete course since the only guide for determining the effectiveness of the therapy is the clinical improvement of the patient.  When there is sufficient evidence that the patient's defenses have regained control of the infection and that it is resolving or resolved, antibiotics should be terminated.  

See Myths #1-4

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 Infections and Antibiotic Myths #1-4

According to the American Associationof Endodontists:  

Myth #1:  Antibiotics cure patients:  Antibiotics function to assist the re-establishment of the proper balance between a person's immune and inflammatory defenses and the invasive agent.  Antibiotics do not cure patients; patients cure themselves.  

Myth #2:  Antibiotics are substitutes for surgical intervention:  The cause of the infection must be removed (with or without antibiotic therapy) when the cause is identifiable.  Whenever antibiotic therapy is used the risk of bacterial selection for antibiotic resistance is present.  

Myth #3:  The most important decision is which antibiotic to use:  Since up to 60% of human infections resolve by host defenses alone following removal of the cause of the infection without antibiotic intervention, the most important initial decision is not which antibiotic to prescribe but whether to use one at all.  

Myth #4:  Antibiotics increase one's defense to infection:  The greatest harm to one's defenses are those that penetrate cells and the least harm is observed with bacteriocidal, non-penetrating agents such as penicillin and cephalosporin.  

See Myths #5-8

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

Prescription Drug Abuse Statistics

Prescription Drugs 

We are witnessing a national epidemic of prescription drug abuse!  A culture of solving problems with a pill has developed over the last two decades.  Watch TV, listen to the radio, read magazines, or browse the internet and you cannot avoid advertisements for improving your mood, building your muscles, losing weight, sleeping more soundly or conquering any ailment you may have.

Prescription Drugs Are Addictive

The problem is that many of these drugs are extremely addictive and continuous use can produce neurological changes as well as physiological dependence.  Here are some alarming statistics:

• the three most abused drug classes are narcotic painkillers (opioids), central nervous system depressants and stimulants
• between 1991 and 2010 prescription stimulants increased from 5 million to 45 million
• 6600 people per day started non-medical use of prescription drugs in 2010
• from 2004 to 2008, the CDC reported emergency room visits for non-medical use of prescription drugs increased 111%, from 144,644 to 305, 900
• the largest age group overdosing on prescription drugs is 35 to 44
• the Center for Health Statistics reports these groups had the highest percentage of overdoses: non-hispanic whites 13.5%, native Americans 11.7% and non-hispanic blacks 10.9%
• 40 people a day die from non-prescription overdoses
• enough prescription painkillers were prescribed in 2010 to medicate every American adult around the clock for a month

Source: Health Blog

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 Panic Attacks

In the United States, 2.4 million people (1.7% of the adult population between the ages of 18 and 54) have panic disorder.  Women are twice as likely as men to have it, and symptoms usually begin in early adulthood.
The attacks are generally brief (10 minutes or less) and involve sudden feelings of terror that strike without warning.  There can be the following symptoms:

• "racing" heart
• feeling faint, weak or dizzy
• tingling or numbness in the hands and fingers
• sense of terror, impending doom or death
• sweating, chills
• chest pains, imitating having a heart attack
• difficulty breathing
• feeling a loss of control

The disorder is manageable.  Psychotherapy and medication have been used.

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 Vaccinations

Because HPV infections are very common and often asymptomatic, because there is a direct relationship between HPV infection and increased prevalence of cervical, anogenital and oropharyngeal cancers, because diseases often develop many years after infection, and because there is an available vaccine, the FDA recommends vaccination of boys and girls at the age of 11 or 12 years.

The vaccines currently available prevent infection from the HPV strains that cause most of the cervical, vaginal and vulvar cancers in women.  Vaccinating boys curtails HPV transmission.  Both males and females may develop cancers of the oropharynx and tonsils.  The FDA recommends that the vaccines be given up to the age of 26.

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 Health Threat of Temperature Swings

Summer Temperature May Be A Health Threat

A 20 year study shows extreme summer temperature swings, which are becoming more common, may be a health threat to people age 65 or older.  Published in Proceedings of the National Academy of Sciences, the study compared more than 20 years of Medicare records with summer temperature changes over the same time period for 135 US cities.  Taken into account were other environmental variables, also, such as air pollution, the number of parks and trees in an urban area, income, education and race.

The results were that changes in a city's average summertime temperature range of as little as 1 degree Celsius, or 1.8 degrees Fahrenheit, were linked to higher death rates for seniors with heart and lung disease and diabetes.  For each 1 degree Celsius change, death risk rose 4.0% for those with diabetes, 3.8% for those who'd had a previous heart attack, 3.7% for those with chronic lung disease and 2.8% for those with heart failure.  In the US population, this could be responsible for as many as 14,000 deaths in heart attack survivors each year, for example.  

Stress 

The problem seems to be that temperature swings stress the body, and many elders cannot adjust.  Therefore, friends, relatives and neighbors should try to keep a closer eye on people with chronic health problems, watching for changes in their daily vital signs or complaints.  This is important whether the temperature goes up or down. 

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