Relief From Oral Mucositis

What is oral mucositis?

Oral mucositis is an inflammatory condition of the tissues that line the mouth and throat.  It can be exquisitely painful.  It is caused by many medications, medical conditions, and treatment for oral cancer.  Currently, paychotherapy, analgesics, and oral rinses are all part of the armamentarium against oral mucositis.  Some of the formulas include chamomile, antiseptics, immunomodulatory agents, topical anesthetics, and antibacterial agents.  In addition, some compounds include antifungal agents, antiviral agents, mucosal barriers, and coating agents.  Many different approaches are being evaluated because there is still such a large unmet medical need.

A new study has found that doxepin rinse may result in a modest but significant improvement in mouth and throat pain over a four hour period.  It is both an anesthetic and analgesic.

Source: J Clin Oncol. 2014;32(15):1571-1577, from ChemotherapyAdvisor

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

Look Better And Younger With Dentures From Your Board Certified Prosthodontist

When teeth are removed, our jawbone begins a continuous, lifelong process of resorption, or shrinkage.  As a result, there is a collapse of facial support, less height in the lower third of the face and weakening of chewing muscles.  A well made set of dentures from your Board Certified Prosthodontist can recapture much of what is lost cosmetically, but not functionally.  The evidence is that dentures can generate only 15-25 lbs. of chewing force, compared to the 125 lbs. of force that natural teeth can.  That's why fibrous foods like meats, fresh vegetables, lettuce and unpeeled fruit, which take up to 60-70 lbs. of force to chew through, are so difficult to manage.

A set of dentures is not meant to last forever because your denture was made to fit the original shape of your oral anatomy and that shape changes as the gums and bone underneath recede.  Often you don't notice the gradual shrinkage that causes them to loosen and become unstable, affecting you in a number of different ways.

New Set of Dentures

With bone loss, the denture slips and moves.  Lips, cheeks and tongue struggle to compensate and form words.  Shrinkage also affects the alignment and balance of the upper and lower dentures and creates chewing insufficiency.  Denture wearers are more prone to dietary inadequacies as a result.  If you're developing wrinkles and that sunken "denture look" of closing too far, it may be time for a new set of dentures.

With a new set of dentures, you'll look better and younger with the lip and facial support that you need, and have a smile with a more natural appearance.  You'll speak clearly again, chew better, and best of all, will feel better about yourself.
  
Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

AARP Recommended Minute Minders

The current AARP Magazine has these 60-second health boosters:

• Kick off your shoes--at the front door, to keep from tracking allergen-loaded soil and pollen throughout the house
• Give someone a squeeze--a 10-second hug lowers blood pressure by increasing the feel-good hormone oxytocin and lowering the stress-chemical cortisol
• Drink your watermelon--a tall glass of watermelon juice can relieve muscle soreness with its high levels of the amino acid L-citrulline
• Remember your feet--the tops of toes and tips of ears burn easily and need sunscreen
• Savor a slice--a cucumber slice pressed to the roof of the mouth for 90 seconds can help eliminate bad breath by increasing saliva flow
• Stick out your tongue--and scrape it, to reduce bad breath and protect against gum disease, colds and tooth decay.

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

Caring For Aging Parents

As our parents age, we take care of them more and more.  I see this often in my patient population--either the side of the coin in which seniors are brought in for treatment by their grown children, or the other in which adult patients share their experiences as they are more and more responsible for their parents.  We have many in-depth discussions, and my personal experiences of having a father in his late 80's with progressive Alzheimer's disease still living at home with  my mother, or my father-in-law, aged 90, living with us, add to the discussion.

I remember well an L.A. Times article in which the author wrote about his aging and dependent parent--acknowledging that his father had a powerful need to maintain control over his life when the difficulties that came with age made it not possible.  He understood his father still nurtured the deep desire to see and appreciate that his life had meant something, that his legacy was consolidated. This phenomenon will become more frequent as the boomer generation ages.

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 Your Smile Can Do

That smile of yours is a big deal:

• It looks back at you from the mirror and makes you feel good
• It is the first thing others notice
• It makes you more approachable
• It can spark a new romance
• It can open doors in a job interview
• It will make other people smile back

If you want to know ways to improve your smile, 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

June Is National Cancer Survivor Month

I am two weeks from the five year mark after having an invasive squamous cell carcinoma removed from my chest. I am certainly grateful for that fact, and there are some lessons from my experience:

• I watched it develop for too long but ignored it, believing it couldn't happen to me
• I have a lifetime habit of not using enough sunscreen, a fair skinned person searching for that golden tan, when the truth is that I mostly burn and peel.
• I did, however, take note of the statistics, that having had one skin cancer, I am more at risk for a second skin cancer, and, on a regular checkup, I asked that another "growing spot on my thigh" be removed--and it was a squamous cell also.

Even though the Mohs technique was successful for me, and it was accomplished under local anesthesia, I have a clear recollection of the pulling and tugging involved that was necessary to bring the tissue together, resulting in a five inch scar across my chest.  I joke that it ended my modeling career. If there are any questions about something on your skin, see your dermatologist.

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

Look Younger With Dental Implants

When teeth are removed, the jawbone begins a continuous, lifelong process of resorption, or shrinkage.  As a result, there is a collapse of facial support, less height in the lower third of the face, loss of facial and lip muscle tone, and weakening of the chewing muscles.

The main physiological benefit of dental implants is that they preserve bone.  The implants stimulate the jawbone as the tooth roots once did.  By doing so, facial contours are maintained also. With natural lip and cheek support, the implants help maintain your youthful 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

FDA Warning Labels for Tanning Beds

The statistics are alarming:  32% of all 12th grade girls report using tanning beds. Because such exposure poses the highest risk for skin cancers for young persons under the age of 18, the Center for Disease Control and Prevention has issued new guidelines for visible warnings on tanning beds and booths.

The FDA has reclassified the devices from ow-risk to moderate-risk devices and requires warnings that these devices put users at a greater risk of skin 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

Weight-loss Surgery: Get Thinner and Fight Cancer

The journal Obesity Surgery reports that bariatric surgery may do more than lower the risk of heart problems and improve type 2 diabetes in obese patients.

A study of more than 54,000 people looked at cancer rates after surgery and found that before surgery obese individual has double the risk of cancer rates than the normal weight individuals.  After surgery, the rate went back to the same as normal weight individuals.

Source:  Obes Surg, 2014:doi:10,1007

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

Oh, My, BMI!

Body Mass Index, or BMI, is a common way of measuring body fat.  It is determined by dividing an individual's body weight in kg by the square of their height in meters (kg/m2).

• Normal: BMI 18.5-24.9
• Overweight: 25.0-29.9 --13% higher risk of death
• Obesity Class I: 30.0-34.0 -- 44% higher risk of death
• Obesity Class II: 35.0-39.9 -- 88% higher risk of death
• Obesity Class III: 40.0-49.9 -- 250% higher risk of death

31.6% of U.S. adults are at a healthy weight.
68% of U.S. adults are overweight or obese.

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

Periodontal Disease: Here's What You Can Do

Periodontal disease (gum inflammation plus loss of bone around teeth) is a bacterial infection. It affects 47% of the American population over the age of 30. The association of gum disease and systemic disease is becoming more apparent.  However, periodontal health can be established and maintained.
What can you do?

• eliminate or reduce tobacco use
• keep your calcium and vitamin D levels optimum with a healthy diet and supplements
• be aware of medications that cause dry mouth and keep your mouth moist
• be mindful of your insulin and sugar levels to prevent diabetes
• keep your mouth free of tooth decay
• fix any defective fillings or crowns
• keep your teeth brushed and flossed daily and with regular professional cleanings

You can't keep from getting older (and therefore more prone to the disease), or your genetic makeup, but you can make informed decisions about your oral health status and treat accordingly.

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

Fair Skin Needs Protection, Especially for Teens

A study published in Cancer Epidemiology, Biomarkers, and Prevention followed 109,000 Caucasian women and the relationship between their sunburns and melanoma, the deadliest form of cancer.
Those who had five or more blistering sunburns as teenagers had a greater likelihood of developing melanoma, basal cell carcinoma and squamous cell carcinoma.  Adult exposure also increased the risk of skin cancer.

Protection from ultraviolet radiation in the form of sunblock is an important method of protecting children from harm, but staying in the shade is even better.

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

Eat What You Want With Dental Implants

Dentures Vs. Dental Implants

Dentures are not a substitute for natural teeth; they are a substitute for having no teeth at all.

Gums were never intended to withstand chewing forces--people with dentures can generate only 15-25 lbs. of chewing force, compared to the 125 lbs. of chewing force that natural teeth can.  That's why fibrous foods, like meats, fresh vegetables, lettuce and unpeeled fruit, which take up to 60-70 lbs. of force to chew through, are so difficult to manage with dentures.

With dental implants holding your teeth in, you can order from the entire menu!

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

Smile More With Dental Implants

Dental Implants Restore Patient Confidence with a New Smile

The denture patient said:  "It takes so much effort to use my tongue and lips to hold my dentures in place, I avoid smiling."

Full Dentures Move

Since full dentures sit on soft tissues, which are compressible, they move.  Since full dentures are surrounded by things that are always moving--lips, cheeks, tongue, floor of the mouth--they move.
Dental implants hold teeth in place, preventing that movement.  They make you smile more!


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

A, B, C's of Toothbrushes

Given the enormous number of bacteria in your mouth, and the fact that most toothbrushes are kept in the bathroom, cleaning and storing toothbrushes appropriately goes a long way to fostering oral health.

• Let your brush Air dry, in an upright position.  Eliminating moisture between uses means eliminating micro-organisms.
• Do a Bristle check--if they are frayed or bent, or if the brush is three months old, it's time to replace the brush.  Come in to our office, we'll give you a new one.
• Thoroughly Clean the brush after each use, rinsing well, or soaking for a short time in an antibacterial mouth rinse.

Rinsing your mouth with that same antibacterial mouth rinse before flossing and brushing also reduces the number of micro-organisms, and makes your mouth easier to clean.

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

Women With Lupus: Osteoporosis

Osteoporosis affects 44 million Americans.  For those with lupus, some treatments increase the risk of the disease, resulting in weaker bones and a greater chance of fracture.  In fact, women with lupus experience osteoporosis-related fractures almost five times more often than other women.  Therefore, bone health is important.

Bone Loss

How can you keep your bone strong?  Get moving!  Activities, even walking, that strain bone, both stimulate bone growth and reduce bone loss.  In addition, your lupus physician will perform bone density testing, determine nutrient values in your blood, and prescribe medications and supplements to prevent osteoporosis.

Source:  Lupus Foundation of America

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 Benefits of Pre-pregnancy Weight Management

The Journal of the American Medical Association has reported a large study of the relationship between maternal body mass index and the risk of fetal death, stillbirth and infant death.  The systematic review was conducted to eliminate bias in the study.

Thirty eight studies in forty four publications reported 10,147 fetal deaths, 16,274 stillbirths, 4,311 perinatal deaths, 11.294 neonatal deaths, and 4,983 infant deaths.  The risk of death was compared to maternal BMI.
The results were that, as maternal BMI rose from normal (20) to 25 and 30, risk of fetal rose accordingly.
Even a modest increases in maternal BMI were associated with increased risk of fetal death, stillbirth, and neonatal, perinatal and infant death.  Weight management guidelines for women who plan pregnancies should take these findings into consideration to reduce their risk.

Source:  JAMA 2014:311(15):1536-1546

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

Breast Cancer Rates and Obesity

The American Society of Clinical Oncology reported a study of 80,000 women in 70 clinical trials.  The object of the study was to determine the affect of obesity on breast cancer survival.  Researchers differentiated between pre- and post-menopausal women, type of cancer (ER+ or ER-), tumor size, lymph node involvement and treatment regimens to isolate the effects of BMI on mortality.  Previous studies have already linked obesity with a greater risk of developing cancer.  The results showed that death rates were significantly higher for premenopausal obese women with estrogen-receoptor (ER+) breast cancer.

Source:  Chemotherapyadvisor

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

Pregnancy Vitamin D Levels Important for Infant Teeth

The journal Pediatrics reported a study from the University of Manitoba that followed 133 mothers and their 135 infants in the first year of life.  The researchers measured the mothers' serum vitamin D levels during pregnancy and compared them with dental decay rates in their infants.  Of the women, 33 had deficient vitamin D levels.  Their infants had a 22% rate of enamel hypoplasia and a 23% rate of early childhood dental decay.  Mothers of children with early childhood decay had significantly lower prenatal vitamin D concentrations.  The researchers theorized that prenatal vitamin D levels may have an influence on the development of healthy primary teeth in their infants.

Source:  JADA, vol. 145, no. 6, 526

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

Implant Success: What A Patient Can Do

Each patient has a role in the success of their dental implant. What can you do?

• proper nutrition is important because it is necessary for optimal wound healing.  Intake of vitamin A, C, D, and E and minerals (calcium, magnesium and boron) are recommended.
• stress management is important because in the short term it effects wound healing time.  In the long term, stress manifested in clenching or grinding can affect implant survival.
• smokers are at a higher risk of inflammation and bleeding around implants which can lead to bone loss.
• uncontrolled diabetes is associated with a higher risk of implant failure on placement and on greater inflammatory risk over the long term.
• satisfactory hygiene--control of bacterial contamination of tooth/implant surfaces is important. This biofilm combination of microorganisms can be removed on a daily basis through thorough oral hygiene and regular maintenance visits for professional cleaning.

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 Surgery Changes Taste, Smell, Appetite

The journal Obesity Surgery has published a study on the effects of (Roux-en-Y) gastric bypass surgery.  It indicates that patients will likely experience sensory changes in taste, smell or appetite.  The Leicester Royal Infirmary in Leicester, England reported that a group of 103 patients who had surgery between 2000 and 2011 had the following side effects:

• 97% experienced changes in appetite
• 73% had changes in taste
• 43% had changes in smell
• 73% had aversion to specific foods

Those with food aversions (most often to meat products) had significantly greater weight loss and loss in body mass index.

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

June Is National Smile Month

If your teeth bother you, we can make you happy when you look in the mirror!

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 Next Denture: Made By Computer

Computer Generated

CAD/CAM (computer-aided design/computer-aided manufacturing) is a technology that is being applied to many prosthetic dentistry techniques.  In the past couple of years, more methods of computer-generated dentures have emerged.

Leading the way are groups from Loma Linda University Dental School and Louisiana State University School of Dentistry and Ohio State University College of Dentistry.  The methods involve fewer appointments to make impressions and jaw relations so that a virtual denture may be designed and then fabricated by a milling center.  We use our NobelBiocare Procera Laser Scanner to design and fabricate implant abutments, tissue bars and fixed-detachable hybrid frameworks.

Learn more by visiting our office.

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

Missing Teeth and Diabetes

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

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

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

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

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

Should All Wisdom Teeth Be Removed?

Third Molars Present

When trained in dental school, the idea that all wisdom teeth (third molars) needed to be prophylactically removed was just accepted.  But, of course, millions of patients live their entire lives with their third molars present, even though orthodontists seem to want them out of the way, and having your wisdom teeth removed seems like it is a high school rite of passage.

Now that dentistry is relying on evidence-based (relying on facts, statistics) decisions in diagnosis and treatment, there are studies regarding whether to remove wisdom teeth.  A current article in the Journal of the American Dental Association (JADA) offers a guide to systematically classify the presence of symptoms or disease attributable to the third molar and can be used as an indicator for extraction.

The guide cautions, however, that an asymptomatic third molar does not mean the absence of disease.  It recommends active surveillance, a prescribed program of followup, and reassessment at regular intervals rather than waiting for the onset of symptoms.

Source:  JADA, vol. 145, no. 6, 570-573

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

Vitamins/Minerals Vital for Women's Health

A healthy woman needs essential vitamins and minerals throughout life.  For that reason, she ought to consider supplementation with the following:

• calcium--for bones and teeth, muscle and nerve function, and hormonal secretion. 1,000 mg to age 50, 1,200 mg after that age
• iron--for protein hemoglobin, which carries oxygen in the blood and to muscles. 18 mg to age 50, 8 mg after that age
• zinc--for white blood count and the immune system, hormone regulation and calcium absorption. 8 mg for all ages
• magnesium--for energy metabolism, proteins, bone health and muscle and nerve function. 310 mg to age 30, 320 mg thereafter
• iodine--for nutrient metabolism, detoxification, nail, hair, skin and tooth condition, mental development.  150 mcg for life (220 mcg if pregnant)
• selenium--cleanses many metabolic systems and processes. 55 ug for life (60 ug if pregnant)

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

Ways to Prevent Osteoporosis

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

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

More at: www.toyourhealth.com

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