What Is Peri-implantitis?

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

Risk factors include:

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

Diagnosis of peri-implantitis:

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

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

Blood Type Matters for Brain Health

Blood type may affect brain function as we age, according to a new large, long-term study. People with the rare AB blood type, present in less than 10 percent of the population, have a higher than usual risk of cognitive problems as they age.

University of Vermont hematologist Mary Cushman and her colleagues used data from a national study called REGARDS, which has been following 30,239 African-American and Caucasian individuals older than 45 since 2007. The aim of the study is to understand the heavy stroke toll seen in the southeastern U.S., particularly among African-Americans. Cushman's team focused on information collected twice yearly via phone surveys that evaluate cognitive skills such as learning, short-term memory and executive function. The researchers zeroed in on 495 individuals who showed significant declines on at least two of the three phone survey tests.

When they compared that cognitively declining group with 587 participants whose mental muster remained robust, researchers found that impairment in thinking was roughly 82 percent more likely in individuals with AB blood type than in those with A, B or O blood types, even after taking their race, sex and geography into account. The finding was published online last September in Neurology.

The seemingly surprising result has some precedent: past studies suggest non-O blood types are linked to elevated incidence of heart disease, stroke and blood clots—vascular conditions that could affect brain function. Yet these cardiovascular consequences are believed to be linked to the way non-O blood types coagulate, which did not seem to contribute to the cognitive effects described in the new study. The researchers speculate that other blood-group differences, such as how likely cells are to stick to one another or to blood vessel walls, might affect brain function.

Cushman emphasizes the need for follow-up studies not only to verify the blood type/brain function association but also to untangle mechanisms for it. In the meantime, those with AB blood need not panic about their future cognitive wherewithal, she says, noting that all our brains are apt to benefit from a healthy diet, awareness of our risk factors for heart disease and stroke, and regular exercise for the body and brain.
—Andrea Anderson

From Blood to Brain
Blood type has been linked with a variety of mental disorders, but the associations are weak—many other factors are more important in determining who ends up with an illness. Still, the fact that a connection may exist intrigues some scientists, who hope one day to uncover the biological processes that link blood molecules to mental health, possibly improving our understanding and treatment of these illnesses.

• People with O blood type may be more likely to have depression and intense anxiety; children may be at a greater risk of attention-deficit disorder.
• People with A blood type may be more prone to obsessive-compulsive disorder; children may be at a greater risk of attention-deficit disorder.
• Children with B blood type may have a lower risk of attention-deficit disorder.

—Victoria Stern

Source: http://www.scientificamerican.com/article/blood-type-matters-for-brain-health/?WT.mc_id=SA_Twitter

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

Dentures: Where Your Natural Teeth Used To Be

Well-fitting Dentures

When teeth are removed, our jawbone begins a continuous, lifelong process of resorption, or shrinkage.  The pressure from dentures on gum tissues contribute to the shrinkage, since gum tissues were never intended to withstand chewing forces.  High quality, well-fitting dentures restore your youthful appearance, allow you to eat most of the foods that you love, helps you feel better about yourself, eliminates embarrassment, enables you to speak more clearly and even helps with digestion.

Loose Dentures

If you've worn the same set of dentures for a long time, your ridges have shrunk.  As a result, your bite has become closed down, and your lips and cheeks have less support from the teeth than they once did.  Since a set of dentures is made to fit the shape of your oral anatomy at the time they are made, often you don't notice the gradual shrinkage as gums and bone recede.  Your dentures become looser and more unstable, affecting speaking and chewing.  The collapsed "denture look" develops, when before nobody knew you were wearing dentures.

If this is you, it's time to get your smile back with a new set of dentures.  The new set will make you look better and feel younger, speak more clearly and enhance your chewing ability.

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 Diet to Fight Type 2 Diabetes

Mediterranean Diet

Researchers studied more than 22,000 participants over an eleven year time period.  They then took those who had developed type 2 diabetes and monitored their dietary habits.  The researchers constructed a 10-point "Mediterranean Diet Score" (MDS) and a similar scale to measure the available carbohydrate (or glycemic load (GL)) of the diet.

A Mediterranean diet features the use of extra virgin olive oil, which leads to a high ratio of monounsaturated fats to saturated fatty acids.  The diet recommends fish and lean meats, whole grains, legumes, fruits and vegetables, and nuts.

MDS Score vs. GL Score

People with an MDS score of over 6 were 12% less likely to develop diabetes than those with a score of 3 or below.  Those with the highest available carbohydtrate in their diet were 21% more likely to develop diabetes than those with the lowest.  Those people with both high MDS and low GL had a 20% less chance of developing type 2 diabetes.  In addition, they found that it was the dietary characteristics, according to these two measures, rather than gross weight (or overweight) that was significant.

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 Do With A Cold Sore

Cold sores usually clear up without treatment.  In the meantime, the following may provide relief:

• topical ointments:  lidocaine, or benzocaine (Zilactin over the counter) can help ease discomfort
• benzocaine should not be used in children younger than 2 years without a doctor's approval
• adults should use the recommended dose only

Oral antiviral medications

•  may shorten the duration of the sores and decrease pain if started early
•  include: acyclovir (Zovirax), Famcyclovir (Famvir), and Valacyclovir (Valtrex)
•  may also be prescribed to prevent recurrence for those who experience them frequently, experience   related illness during an outbreak or have indentifable triggers, such as intense sunlight
•  over the counter pain relievers may help
•  ice or warm compresses to the blisters may ease pain

Most important: let it heal without squeezing, pinching or picking at any blister.

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

Dentures Care

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 be used only 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 American College 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

Prediabetes and the Risk of Diabetes

Prediabetes

The Centers for Disease Control estimates that 1/3 of adults in the United States has prediabetes: 79 million Americans, half of all Americans aged 65 years or older, and that 15% to 30% of people with prediabetes will develop type 2 diabetes within 5 years.

If these risk factors apply to you, seek medical attention:

• age 45 or older
• overweight
• family history of diabetes--parent or sibling
• background--African-American; Hispanic/Latino, American-Indian, Asian-American or Pacific Islander
• history of diabetes during pregnancy (gestational diabetes) or giving birth to a baby weighing 9 pounds or more
• physical activity less than three times per week

Early diagnosis and treatment and lifestyle changes can prevent serious medical consequences.

Source:  www.cdc.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

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

How much do you know about the harmful effects of smoking?

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

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

From a Memorial: What Cancer Cannot Do

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

Cancer is so limited.....

It cannot cripple love.

It cannot shatter hope.

It cannot corrode faith.

It cannot eat away peace.

It cannot destroy confidence.

It cannot kill friendship.

It cannot shut out memories.

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

What Is Denture Stomatitis?

Denture stomatitis is a common disorder affecting denture wearers.  It is characterized as inflammation and redness of the tissues covered by the denture.  It is often asymptomatic; only a minority of sufferers experience pain, itching or burning.  It is primarily identified during a dental examination as the presence of inflammation and swelling under the denture.  It is associated with poor denture fit, increased age of the patient, increased age of the denture, continuous wearing of the denture and poor denture hygiene.  

Bacteria and fungi (primarily Candida Albicans) are likely included.  Patients can see it themselves when their tissues are fiery red under the denture and the redness follows the outline of their denture.  Not removing dentures at night while sleeping allows a biofilm of bacteria to colonize on the inside denture surface without being properly removed.  Treatment of the acute phase requires antifungal medications.  Rapid recurrence of the condition will occur unless the denture is properly disinfected and thereafter a daily denture hygiene regimen of removing the dentures and soaking them in a commercial disinfectant solution or diluted sodium hypochlorite.  Routine follow-up visits to assess that the denture maintains proper fit and function is important in reducing the risk for developing stomatitis.

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

HPV and Oral Cancer

HPV can infect oral tissues.  A subgroup of oral cancer clearly is associated with HPV.  Oral HPV is transmitted sexually but also can be transmitted from mouth to mouth and vertically from an infected mother during delivery.  A detailed description of the mechanism by which an HPV lesion develops into oral cancer, with pictures, is found in JADA August 2011, 142(8), pp905, at www.jada.ada.org

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

Lupus Treatment Oral and Dental Complications

Oral complications that face lupus patients can come about as a side effect of medical treatment.

Certain forms of organ involvement carry dental warnings: with kidney involvement, certain antibiotics (tetracycline) or analgesics (aspirin, NSAIDS) adversely affect kidney function. Antibiotics need to be given prior to treatment for those with Liebman-Sacks Endocarditis (a form of heart involvement) or mitral valve prolapse. Nitrous Oxide (laughing gas) is contraindicated for those with lung problems. Caution should be taken with patients with abnormal bleeding. Those with Sjogren's Syndrome usually have severe dry mouth that may result in massive decay, dental infections, yeast infections and gum disease.

Medications: Anti-convulsants can cause gum atrophy and bleeding. Anti-malarials (plaquenil) can cause intraoral rashes. Immunosuppressive agents (methotrexate) suppress the immune system and may result in bacterial or fungal infections. NSAIDS (advil, motrin, feldene, daypro) can cause oral ulcers. Steroids--prednisone and other corticosteroids increase the likelihood of bacterial and oral fungal infections. Any medications which cause dry mouth put the patient at risk for tooth decay and gum disease. Lupus patients require frequent dental checkups and periodontal maintenance to optimize their oral health.

Source:  Lupus Guide to Dental Care, Heather Galusha-Phillips

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

Molar Implants at the Time of Extraction

A report in the current issue of the Journal of Implant and Advanced Clinical Dentistry of a total of 95 patients (42 female, 53 male) age 19-75 (mean 50.5) with 97 screw type implants immediately placed in molar sites at the time of extraction shows 100% success at three years.  The key to the technique is careful extraction techniques to preserve bone and adequate implant stability upon placement due to obtaining maximum bone to implant contact.  The presence of infection in the extracted teeth was not a contraindication.  On average, the implants were restored with abutments and crowns 12-16 weeks after placement. 

 Source: JIACD, sept/oct2011,vol3,#6,pp37-44  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 (map)

Osteoporosis Medications and Your Dental Health

As we grow older, our bones begin to lose their density and strength, especially after the age of 50. Many factors affect bone density, including diet, physical activity, family history, hormones, lifestyle and certain conditions and medications.

Osteoporosis--porous bone--is a disease that weakens bones, especially hip, spine and wrist, and makes them more likely to break. It affects about 10 million Americans, 8 million of whom are women. The disease affects more women than cancer, heart disease and stroke combined. An additional 34 million Americans have osteopenia, or low bone density, and are at risk for developing osteoporosis.

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

In rare cases, a condition known as osteonecrosis of the jaw (ONJ) has been reported in patients taking these medications. This rare but serious condition can cause severe damage to the jawbone. 94% of those diagnosed with ONJ are patients with cancer who are receiving or have received repeated high doses of medication through an intravenous infusion.

The benefits of these medications greatly outweigh the very low risk of developing ONJ. You should not stop taking these medications without consulting your health care provider. There is no known prevention for ONJ. However, regular dental visits and excellent oral hygiene practices may be the best way to reduce your risk.

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

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

Mandibular Fixed Implant Supported bridge

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

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

Your Smile Is Our Specialty

Your Exceptional Crown

If you've never had a crown or have forgotten the process, you may have some questions.  Will the procedure hurt or damage my tooth?  How long will it take? What will it look like? What can I eat? How long will it last? Is this crown good for me? These are good questions that deserve answers.

Your crown is a prosthesis that is made explicitly for you.  Your tooth is unique like a fingerprint. Someone else's cannot fit your tooth. It had to be individually made for you alone. While it's remarkable that science and engineering has made it possible to make millions of exactly the same thing (pencils), it's a miracle that prosthodontists make millions of teeth that are all different, each individualized for each individual patient's tooth.

An exceptional crown, like the patient's two front teeth (pictured above), can perform all the duties of a tooth and cannot be differentiated from the natural teeth in your mouth.  It must attach seamlessly to your remaining tooth and root, not allowing bacteria or plaque the opportunity to cause more decay or increase the risk of inflammation leading to gum disease. It has to remain attached to your tooth and cannot break, and it has to look like and chew like your tooth.

Skillful management of your gum tissues and precise grinding of your tooth is required. Too much and the tissues are at risk; too little and the crown will be weak. Dental technology has advanced clinical procedures to a high level of quality and achievement. Impression materials capture precise details. Jaw movements are recorded. Materials make crowns more beautiful and stronger than before.

As a Board Certified Prosthodontist, with our advanced techniques and in office laboratory technology, we will provide  the exceptional crown you deserve

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

Lupus Disease and the Oral Cavity

Lupus is a chronic inflammatory disease that can affect various parts of the body, especially the skin, joints, blood and kidneys. Approximately 95% of lupus patients suffer from some form of oral involvement. The oral complications are either directly related to the disease or come about as a side effect of medical treatment. 

Lupus patients may suffer from the following mouth symptoms:

• dry mouth
• cracked lips 
• bleeding gums
• sorejaws
• gingivitis (gum disease) 
• cracked or swollen tongue 
• lesions (ulcers) on any soft tissue surface including the cheeks, lichen planus and yeast infections. 

Denture wearers are more susceptible to soft tissue irritation and sore spots. Lupus patients should make sure their dentist has experience and knowledge of lupus and autoimmune diseases and takes a full medical history and updates the list of your medications regularly. 

Source: Lupus Guide to DentalCare by Heather Galusha-Phillips

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