Acetaminophen and Alcohol Don't Mix

The American Public Health Association has studied the dangers or mixing over the counter acetaminophen and consumption of alcohol.  Researchers noted that a therapeutic amount of acetaminophen alone, or light to moderate alcohol consumption alone do not pose risk.  However, when taken in combination with one another, results showed a 123% increase in risk of kidney dysfunction.

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

Life In SoCal: Earthquake Preparedness

Most of us in southern California have experienced an earthquake and understand how unsettling it is when the ground below you is unstable.  Being prepared for the "big one" means securing where you live and work (in advance) and following what the kids do in school: practice an earthquake drill.

Safety

The first consideration is the safety of people.  For the drill, remember to get down on your hands and knees, preferable under a desk or piece of furniture, or next to an interior wall with your arms above your head.  If you have to evacuate where you are, have a plan in advance.  Locate emergency food, water and first aid materials.  Know how to turn off utilities if they are dangerous.  Have an outdoor meeting place for your family.  If you are usually in different places, designate a place to eventually meet.

Important Information

For your continuing safety, make not of important information: emergency phone numbers, names and addresses, information regarding utilities, medical history and current medications, vehicle information, and banking information.  What to keep in a fire-proof safe:  birth certificates, ownership certificates, insurance policies, wills, and a household inventory with photographs.  Think about how secure you will feel when you have done these things and are prepared.

Source:  Centers for Disease Control and Prevention


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

Do You Have Sleep Apnea?

Sleep apnea is a disorder which affects 18 million Americans.  It results in loud snoring and excessive daytime sleepiness and fatigue.

Types of Sleep Apnea

• obstructive--the most common--occurs when soft tissue in the back of the throat collapses and obstructs the airway, causing breathing to stop
• central--when the brain doesn't signal the muscles to breathe
• mixed--a combination of the two

How Does Sleep Apnea Affect Rest?

During normal sleep, muscles that stiffen the airway behind the tongue and soft palate relax.  With a normal size airway, there is no problem.  However, if the airway is small (anatomically or because of excess weight), it can close.  Breathing continues against the closed airway and becomes increasingly strong (in response to diminished oxygen levels and increased carbon dioxide levels) until the greater effort causes awakening, which activates the muscles to reopen the airway.  The arousals are brief (and mostly unnoticed) but if they occur frequently enough during the night, sleep becomes fragmented and non-restorative, and daytime sleepiness and fatigue results.

With a proper diagnosis of sleep apnea, some dentists make appliances for patients to wear that are designed to keep the airway open.  Prevention.com has a listing of research studies regarding the health effects of untreated sleep apnea.

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 Implants Are Not An Option: Partials or Dentures

Replace Missing Teeth

Prior to the availability of dental implants, prosthodontists routinely treated patients with missing teeth (some or all) with removable partials or dentures.  In addition, not all patients are candidates for implants, due to financial, anatomical or medical considerations.

Prosthodontists are specialists in the replacement of missing teeth.  What sets them apart from general dentists is their extensive training in the diagnosis, design and fabrication of these prostheses.  When a patient is missing some teeth, or has some teeth that need to be removed, but doesn't want to lose them all, a removable partial denture can be a predictable functional and esthetic solution.  We have many patients who have had removable partials that last for ten or more years.  This success depends on the proper planning and treatment techniques that are part of the specialty of prosthodontics.


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

Be Ready When The Earth Shakes #3

Earthquakes make things move, shake and  fall:

• check windows
• anchor bookcases, cabinet doors, refrigerators, water heaters (it's the law), furniture
• heaters and stoves
• other large appliances
• have flexible connections for gas appliances
• air conditioners
• use plastic containers instead of glass
• secure overhead lights and fans
• anchor wall items above beds
• keep hanging objects away from windows
• place heavy objects on lower shelves
• properly store toxic materials or cleaners

Source:  Centers for Disease Control and Prevention

Read Be Ready When The Earth Shakes #1 and Be Ready When The Earth Shakes #2

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

Be Ready When The Earth Shakes #2

Put together a survival kit for earthquake preparedness:

• tools:  ax, shovel, broom, screwdriver, pliers, hammer, adjustable wrench, rope, plastic sheeting and tape
• safety and comfort:  shoes, gloves, candles and waterproof matches, change of clothes, knife, garden hose, tent, blankets and sleeping bags, portable radio and flashlight with extra batteries, fire extinguisher, pet food and water, toilet tissue, cash
• for the car:  blankets, bottled water, change of clothes, coins, fire extinguisher, first aid kit, emergency signal device, flashlight and batteries, nonperishable food, gloves, map and compass, rope, paper and pencils, current medications, battery operated radio, mirror, toilet tissue, tools, jumper cables, duct tape, extra eyeglasses or contact lens solution
• for the workplace:  same as above

Source: Centers for Disease Control and Prevention

Read Be Ready When The Earth Shakes #3

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

Be Ready When The Earth Shakes #1

Here's what's recommended for your earthquake preparedness first aid kit:

• hydrogen peroxide
• antibiotic ointment
• alcohol wipes
• over the counter pain medications
• current prescriptions
• anti-diarrhea medicine
• eye drops
• bandages
• elastic bandages
• gauze
• Q-tips
• adhesive tape
• scissors and tweezers
• thermometer
• bar soap
• sunscreen
• paper cups
• pocket knife
• plastic bags
• safety pins
• needle and thread
• instant cold packs
• sanitary napkins
• tongue blades

Source:  Centers for Disease Control and Prevention

Read Be Ready When The Earth Shakes #2

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 Loss Ramifications

Rise in Periodontal Disease

Today there are 25 million people in this country who have no teeth, and that number will increase to 38 million in  2020. As age increases, so does the prevalence of edentulism (no teeth):  22% at age 45, 36% at age 55, 42% at age 65, and 56% at age 75.  In addition, another 80 million people are missing at least one or some of their teeth.  The greatest risk factors are untreated periodontal disease, asthma, diabetes, dementia, cancer and heart disease.  An individual with heart disease is 4 times more likely to be edentulous than with no heart disease.  Dr. Tupac, a Board Certified Prosthodontist, has solutions for missing teeth.  Dental implants are disease resistant, preserve bone and conserve remaining teeth.  Find more at www.drtupac.com

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

All-on-4 Considerations

Dental Implant

If you are missing all of your teeth in your upper or lower jaw, the All-on-4 technique has been reported in this blog as an extremely successful method for placing dental implants and restoring them with a fixed bridge.  This technique allows the placement of four implants in the upper jaw in such a way as to avoid the maxillary sinus and not require bone grafting, and four in the lower jaw and avoid the mandibular nerve.  The posterior implants on both sides are tilted in such a way that there is excellent bone anchorage and load distribution and allows the final prosthesis to hold as many as 12 teeth with only short cantilevers.

Multiple studies in the literature, substantiate Dr. Tupac's All-on-4 experience with a cumulative implant survival rate of 92.2% to 100%.  Presurgical diagnosis includes a cone-beam computed tomographic scan to assess the bone volume and density.  It also allows development of a surgical guide to allow for optimal implant position.

Who is a candidate for Dental Implant treatment?

Besides not having any teeth in your upper or lower jaw, what makes you a candidate?  You must be generally healthy and have acceptable oral hygiene.  You must have a jawbone that is greater than 5mm  in width and greater than 10mm in vertical height.  The implants, when placed, must have sufficient stability for immediate function, as determined by the torque measures during placement.

From a facial standpoint, an evaluation of your smile line determines the visibility of the transition from the bridge to your tissues, which must be not visible.  Your lip contour reveals the possible need for a flange for support.  The height of the lower third of your face must allow for the dimensions of the prosthesis.  Inside your mouth, the character of the gum tissues is evaluated.  The height of your bite and jaw relationships need to have room for teeth and esthetic tooth display.

If you want to be examined for this successful procedure that allows you to walk in with a denture and walk out with an implant supported bridge in the same day, give us a call.

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 Eat With Dentures?

Since gums were never intended to withstand the same chewing forces that natural teeth can, it may be necessary for people who wear dentures to modify food choices and preparation techniques in order to maintain a healthy diet.

Studies have shown that tooth loss can be associated with a poor-quality diet, and changes in chewing ability can alter nutritional intake.

Here are some strategies for maintaining nutritional intake with dentures: 

• choose diets that are adequate in vitamins,  minerals and fiber from fresh (cut) fruits and cooked (softer) vegetables

• decrease consumption of foods rich with simple sugars

• eating moist foods or sipping liquids to facilitate chewing is helpful

• balancing your bite by eating smaller amounts on both sides of the mouth at the same time makes things more manageable

By identifying foods that you may be avoiding, you may find new ways to modify how to eat things to include other foods to ensure a healthy diet.

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

Do Patients with Prosthetic Joints Need Antibiotic Premedication?

According to the Science and Technology Updates of the American Dental Association,  the ADA and the American Academy of Orthopedic Surgeons (AAOS) found that there is insufficient evidence to recommend the routine use of antibiotics for patients with orthopedic implants to prevent infections prior to having dental procedures because there is no direct evidence that routine dental procedures cause prosthetic joint infections.

The ADA's Web page about Antibiotic Prophylaxis has information regarding the new clinical practice guidelines.

As always, if you are a patient with an artificial joint, insist your dentist contact your physician to determine the necessity of antibiotic premedication before dental procedures.

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

Board Certified Prosthodontists Treat Oral Fungal Infections Common for During Cancer Treatment

Cancer treatment, involving radiation therapy or chemotherapy, results in a high incidence of oral and gastrointestinal side effects.  Prosthodontists see patients with oral candidiasis on a regular basis.  An extensive study of several large clinical trials was undertaken to look at the effectiveness of different modes of therapy in the treatment of the condition.

The importance of this treatment is that non-treatment is associated with oral and systemic infections, dysphagia, pain, longer hospitalization, greater cost, and affect on the quality of life.  While there is insufficient evidence that any of the antifungal drugs may cure fungal infections in the mouth, prosthodontists have effective measures for reducing the severity of the symptoms.

Source:  wiley.com&citation Id=1579029


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

Use Mouthwash In Moderation

Mouthwash Linked to Oral Cancer

Some of the mouthwashes available on the market today advertise as being as a substitute to and just as effective as tooth brushing.  These products tout their easy availability and the benefit of keeping your breath fresh all day long.  However, it turns out, according to a newly published study from the University of Glasgow, in the journal Oral Oncology, that overuse of mouthwash is linked to oral cancer.

Overuse of Mouthwash 

A study of 1,962 oral cancer sufferers and 1,993 healthy people in thirteen centers in nine countries found that rinsing with such products more than three times per day was associated with an increased risk of the development of mouth and throat cancer.  This is due to cancer causing chemicals in the mouthwashes being absorbed by the mucosal lining of the mouth and throat tissues.  The evidence suggests that overuse of mouthwashes to mask denture odors, periodontal disease, bad breath, smoking, or alcohol intake increases the risk of 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

Prosthodontists Know Dental Implants Are Restoratively Driven

Dental Implants

Board Certified Prosthodontists know that dental implant placement  is decided by the tooth or teeth the implants(s) are going to support.  Historically, when these implants were first developed, most surgeons used the available bone to guide where dental implants were to be located.  Nowadays, the statement "the implants were put where the bone was" is inadequate.  Technological and surgical advances in bone and soft tissue grafting procedures have assured that implant supported teeth can be made to closely resemble the natural teeth they replace.

If a single tooth is missing, or a segment of teeth are to be replaced, then the teeth are planned first and the surgical procedures are planned to realize the eventual prosthetic result.  If an entire arch of teeth are missing, the prosthetic treatment plan is developed first, with the positions of the teeth and dimensions of the prosthetic materials predetermined, and then the surgical considerations planned accordingly.

If you need a dental implant, then your individual needs can bet be explained to you by a board certified prosthodontist.


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

Maintaining Cognitive Function As You Age

Dementia Treatment

As the science of medicine extensively researches and improves the treatment of dementia, Parkinson's disease and Alzheimer's Disease, it is also becoming more aware of the factors over a lifetime that can prevent development of these conditions.

As the average lifespan increases for both males and females, the incidence of these age-related conditions rises.  Worldwide 24 million people are already affected by the cognitive impairment of dementia.  In more developed countries, 70% of these patients are 75 years or older.  Now there is growing evidence that the exposure over a lifetime to certain risk factors is evident.  Even with genetic susceptibility, actions can be taken to prevent the onset or the severity:

• active involvement in physical, mental and social activities has been previously described in this blog as being important; these activities provide brain stimulation and exercise
• blood pressure control
• treatment of diabetes

As time goes on, even more evidence-based research will pinpoint ways all people can minimize their risk of being affected.

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 Demographics and Risk Factors

Smoking Increase Risk 37-Fold 

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.

Source: AAOMS Surgical Update, Vol 24, 1

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

Time for a New Front Tooth?

Replacing an Old Crown Can Enhance Your Mood

Replacing that old crown on your front tooth with today's more advanced dental laboratory technology can make all the difference in the world in how you look, smile, and feel about yourself.  With our in-house laboratory, we can create whichever restorative solution is best for your dental needs. As a Board Certified Prosthodontist, Dr. Tupac welcomes the opportunity to help you! 

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

Men Can Have Lupus

Even though 90% of cases of lupus are diagnosed in women of child bearing age, the other 10% of cases are in men, with much the same symptoms and treatment.  The Lupus Foundation of America has a Patient Education Series, with information on understanding the disease, living with the disease, coping with the disease, how it affects the body and managing lupus in relation to family life and the workplace.  It also has information on the emotional impact of chronic disease.

Source: www.lupus.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

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 Screening

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

Failure of Small Diameter (Mini) Implants

Small diameter implants were first developed by NobelBiocare as smooth surfaced implants for use as temporary implants that could be implemented as part of a treatment plan as intermediate support for a temporary prosthesis while the permanent implants achieved osseointegration.  While conventional diameter (3mm or more) implants were cleared for use by the FDA in 1976, more recently, small diameter (1.8 to 2.9mm) implants have been developed with the same surface characteristics as conventional diameter implants, and were cleared for use by the FDA in 1997.  The reasons for use of SDIs are inadequate bone quantity without grafting and a minimally invasive placement procedure.  Because grafting is not an alternative often chosen by patients, mini implants offer a successful alternative.  They can be highly successful if used to support a lower overdenture.

Prevent Implants Failure

Mini implants are subject to failure, however.  Therefore, there are some requirements to prevent failure: enough bone (4mm in width and 13mm in length), 30Ncm of resistance during placement to indicate sufficient bone quality, the largest SDI possible in available bone--preferably  not 1.8mm diameter and length at least 13mm, parallel placement (divergence less than 15 degrees), implants spread out to allow for size of attachment apparatus, no excess tissue thickness at the crest of the bone, and not used in patients who clench or grind.  These clinical requirements have been developed by Dr. Gordon Christensen.


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 Do You Know You're Having A Heart Attack?

How heart attacks develop

Heart attacks are a leading killer of men and women in the United States. They occur when the flow of oxygen-rich blood to a section of heart muscle suddenly becomes blocked. Typically,  coronary artery disease involves a buildup of plaque inside the arteries over time, and when an area of plaque breaks open, a blood clot forms that can block blood flow in the artery. If the blockage isn't treated quickly, the portion of heart muscle fed by the artery begins to die. Treatment works best at the earliest sign of symptoms to limit damage to the heart.

Symptoms include:

• Chest pain or discomfort in the center or left side of the chest that often lasts for more than a few minutes or goes away and comes back. It can feel like pressure, squeezing, or fullness and can be mild or severe. It can feel like nausea or heartburn.
• Upper body discomfort in one or both arms, the back, neck, jaw or upper part of the stomach.
• Shortness of breath, with o before chest discomfort.
• Nausea, vomiting, light-headedness or sudden dizziness, or breaking out in a cold sweat.
• Sleep problems, fatigue, or lack of energy.

Signs and symptoms can develop suddenly or sometimes slowly (over hours, days or weeks) and quick treatment is the key to the best recovery.


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 Care For Dentures

Careful daily removal of the bacterial and fungal biofilm present in the mouth and on complete dentures is important to minimize denture inflammation (stomatitis) and to help contribute to good oral and general health.  The latest evidence in the literature recommends that patients who wear dentures should do the following:

1. daily cleansing by soaking is superior to denture creams and pastes and less abrasive
2. denture cleansers should only be used outside the mouth
3. dentures should be thoroughly rinsed after cleaning before reinsertion into the mouth
4. dentures should never be placed in boiling water, because they will warp
5. dentures can be soaked in diluted bleach solutions but only for 10 minutes or less

Your local Board Certified Prosthodontist (denture specialist) can help you with your dentures.

Source:  evidence-based guidelines from the AmericanCollege of Prosthodontists as commissioned by the American Dental Association

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

Our Commitment to "Recare" (Recall)

As a Board Certified Prosthodontist, Dr. Tupac most often treats a patient's complete mouth, addressing all a patient's dental problems as part of the treatment plan.  Our commitment to dental care does not end there!  Most patients get to the point of needing complete care by having not had treatment for a period of time.  We don't want that to happen again.  Therefore, our recommendation is that, all patients need to be seen for regular examination and maintenance.  This includes periodic hygiene visits and X-ray examination to make sure any problems that might develop over time can be addressed as early as possible.  The human mouth is constantly changing and  out office is dedicated to keeping yours 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

Analysis of 800 All-on-4 Implants

Full Arch Implants

Dr. Tupac has successfully used the All-on-4 technique to provide full arch prostheses for patients without any teeth in either the upper or lower jaw.  A recent study again substantiates the success of the technique.  An analysis of 800 implants placed following the All-on-4 protocol, from May 2005 until December 2011, at the PI Dental Center, was done.  The results of 152 patients showed the CSR (cumulative survival rate) of the implants was 97.3%, 96% in the upper jaw and 97.8% in the lower jaw, 98.1% in males and 96.9% in females and identical success rates (97.3%) for tilted and axial implants.  Prosthesis survival was 99%, whether opposing a complete denture or an arch of natural teeth.  These are the same success rates of Dr. Tupac's patients.

The advantage of the All-on-4 technique is that tilted implants are used to take advantage of the bone in front of the maxillary sinus and in front of the mandibular foramen, negating the necessity for complicated and expensive bone grafting procedures.

Source:  jopr


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 Implants for a Patient with Eating Disorders

Dental Implants

Eating disorders such as anorexia or bulimia affect up to 24 million people in the United States.  These conditions most often cause sensitivity and erosion of the natural teeth, loss of enamel and occlusal (bite) instability.  Treatment often requires full coverage restorations (crowns) to replace the lost tooth structure. However, these teeth are still subject to a very high rate of recurrent decay, leading to their eventually being non-restorable.

Dental implants are made of titanium and are impervious to the bacteria that cause decay.  If teeth in patients with these disorders need to be removed, they can be predictably replaced with dental implants.
An article in the Journal of Prosthodontics describes the removal of upper front teeth in a patient with immediate placement of dental implants and new temporary crowns, using the NobelGuide protocol.
Dental implant placement maintains the jawbone.  The implants are the closest thing to natural teeth available in dentistry today.


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 Long-Term Success

A 29 year study of patients treated with dental implants and full arch prostheses at the Mayo Clinic has been published.  The statistics point to the overwhelming fact that dental implants can be a successful long term treatment solution for tooth loss.  The overall survival rates at 20 years were 92% for the implants and 86% for the prostheses.  Over half of the patients (58%) needed some type of prosthetic retreatment or maintenance, with the most common prosthetic retreatment required being replacement of broken screws.  9% of patients experienced implant failure, necessitating change of the prosthesis.

For the full article, see: jopr.12084


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 Symptoms and Appearance

Oral Cancer has Many 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.

Various 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

Custom Mouthguards Are Best

Mouthguards Prevent Injuries

Over-the-counter boil-and-bite mouthguards are fitted and formed by heat, finger, tongue and biting pressure.  They have been shown to have limited protective capacity, because of poor fit, poor durability, and interference with speech and breathing.  Custom-made mouthguards, on the other hand, made on dental models of a person's teeth, are accurately adapted to the teeth, retentive, do not deform, and can be fabricated at the proper thickness to absorb and spread impact energy.

To find out more, go to:  www.dentalaegis.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

Warning Signs of Oral Cancer

As part of our celebration of Oral Cancer Awareness Month, these are the warning signs of oral cancer:

• red or white patches in or behind the mouth
• mouth sores or ulcers that bleed easily and do not heal
• unexplained lump in the neck, throat or floor of the mouth
• difficulty or discomfort swallowing
• pain and tenderness in segments of teeth or gums
• change in the fit of dentures or partial dentures
• visible change in mouth tissue
• unpleasant sensations (pain, discomfort, numbness)
• diminished ability to perform normal functions such as opening jaw, chewing or swallowing
• unexplained swelling or fullness in neck 

Your Board Certified Prosthodontist is trained in oral cancer screening procedures.





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

Young Adults Hold the Key to Future Cholesterol Levels

There is an interesting article available that postulates that lifestyle changes between childhood and adulthood appear associated with whether an individual will maintain, improve or develop high-risk cholesterol levels.  It states that young adults making lifestyle changes improve cholesterol levels in adulthood. Read more go to:  www.a-health-blog.com (3/29/14)


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

Lose Weight to Lessen Sleep Apnea

The current issue of The Journal of the American Dental Association contains a study from Finland that was published in Sleep Medicine.  A five year observational study with a one year randomized controlled trial of adult participants who were moderately obese and had mild obstructive sleep apnea.  The investigators reported a significant change in the apnea-hyhpopnea index in the participant group that had lost weight.  Those who lost at least 5% of their weight had an 80% reduction in the incidence of OSA progression compared to those who had lost less than 5%.

Source: JADA, (4/1/14) 145, 329-330


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 Do Powered Toothbrushes Have Timers?

Have you noticed that one of the marketing advantages of powered toothbrushes is that they have built-in timers?  They do because TIME SPENT and ATTENTION TO TECHNIQUE  are more important than how hard you brush.

Brushing Routine

Most of the timers are two minutes in length, which is the universally recommended amount of time to spend on the task.  The best ones are divided into four 30 second intervals, so that you spend equal amounts of time on each quarter of your mouth.  That's because human beings tend to spend more time at the beginning and less time at the end of their normal brushing routine.  Of course, you can do it with a manual brush also, watching the clock at the same time.

Here's a challenge:  time yourself when you brush next time, and see how long it takes you to do it.  The best bet is that it will be less than two minutes.  The time after that, set a timer and spend an entire two minutes brushing all over, and you will realize how much more thorough you have been.  Remember that the brush does the work and toothpaste only provides some detergent action and tastes good.  Once you have the right amount of time down, then we'll discuss specific technique.  Suffice it to say, in two minutes you could actually brush one tooth at a time and get it all done!

Flossing

One more thing: if you  are using a toothpaste that contains fluoride, FLOSS FIRST, so the fluoride in the paste has a better chance of reaching in between your 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

April Is Oral Cancer Awareness Month

As a Board Certified Prosthodontist, Dr. Tupac treats many patients who have had oral cancer.  Special techniques and prosthetic devices are often necessary and training in this area is confined to an area called maxillofacial prosthetics, and Dr. Tupac has had forty years of experience in the treatment of head and neck cancer.

That's why all new patients, all recall patients and all patients who return to the office after not having been seen for a year get a full examination of their oral soft and hard tissues.  This oral cancer screening is performed just as a matter of course, because  early detection is always associated more successful treatment.  If you have any questions about any areas of your mouth, be sure to ask when you see us!


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