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

Periodontal Therapy Can Improve Arterial Structure

As reported by the journal Hypertension, a team of researchers from the University of Sydney, and other Australian and U.S. institutions, enrolled 273 aboriginal Australians who had periodontitis (advanced gum disease) in a parallel-group, randomized clinical trial.  The difference between the two groups was that one received full-mouth periodontal scaling in one visit and the other group received none.  They compared the groups with regard to carotid artery thickness and function.

After 12 months, those in the group treated for periodontitis experienced a significant decrease in intima-media thickness--and indicator of arterial structure--and those in the untreated group did not.

There were no differences between the groups in pulse wave velocity, an indicator of arterial function.
They concluded that the non-surgical periodontal therapy (scaling) significantly reduced the progression  of thickening of the carotid artery.


Source:  JADA, 8/1/2014. vol. 145, no. 8, 802

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

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

Do Implants Work If You Lost Your Teeth To Gum Disease?

Gum Disease

Periodontal disease is the greatest cause of tooth loss in adults. It is caused by specific bacteria that migrate below the gumline, and cause inflammation, bone loss, and tooth loosening. A common question is, if I lost my teeth to gum disease, wouldn't I lose dental implants the same way? The simple answer is: No!

The literature is full of studies of patients who have lost their teeth due to a history of chronic periodontitis. Natural teeth are anchored in bone, but are connected to the boney socket by a ligament called the periodontal ligament. This soft tissue connection is what is damaged by periodontitis and starts the progression of bone loss and loose teeth. Dental implants are anchored directly to the bone, without any soft tissue interface between bone and implant to break down.

Candidates for Dental Implants

In addition, the bacteria that cause periodontitis in the natural dentition are different from the bacteria that can cause inflammation around implants. The literature substantiates that those patients who have lost their teeth to periodontitis are good candidates for dental implants.


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 Gums Look Like This, You Need....

If your gums look like this, you need treatment.  In this situation, the difference between the tissue disease around the six front teeth--porcelain jacket crowns--and the tissue health around the back teeth is very apparent.  This inflammation and bone loss--called periodontitis--requires both tissue therapy and replacement of the existing crowns, so that harmonious crown contours can be constructed, especially below the gumline, that facilitate effective oral hygiene of the tissues after they have been appropriately treated and healed.

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 Disease has Warning Signs

What's the number one bacteria source on your body?

Your mouth is full of bacteria--more than any other part of the body--because the digestive process starts there.  Brushing and flossing lowers the bacterial count, but harmful bacteria can still cause gum inflammation. Gum disease starts with surface inflammation, then spreads deeper, until it can even destroy the bone around your teeth.

What are the signs of gum disease?

• red, swollen or tender gums or other pain in your mouth
• bleeding while brushing, flossing, or eating hard food
• gums that are receding, making the teeth look longer
• loose or separating teeth
• pus around the gumline
• sores in your mouth
• persistent bad breath
• a change in the way your teeth fit together when you bite

Left untreated, gum disease leads to tooth loss.  If you have any of the problems listed above, and they persist, then it's time for a dental checkup!

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

More Than Normal Wear and Tear: Bite Disease

Prosthodontists are interested in your bite, the way your teeth come together and mesh together--and that is known as your "occlusion".  Jose-Luis Ruiz, DDS, FAGD, in Inside Dentistry, noted in an excellent monograph that "occlusal disease" impairs normal function:

• masticatory: chewing difficulty due to muscle pain, tooth pain, missing teeth, and jaw joint problems
• phonetic: tooth fractures, tooth mobility and bone loss lead to missing teeth
• esthetic: disfiguring tooth wear and tooth loss caused by fractured teeth
• periodontal and endodontic problems

Signs and symptoms include pathological wear, tooth sensitivity, tooth mobility, cracked teeth, bite sensitivities, vertical bone loss, pain and tired chewing muscles, and jaw joint pain.  Dr. Ruiz states that Occlusal Disease cannot be cured but can be managed with proper therapy.

For the entire article: www.dentalaegis.com/id/2014/01

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

Implants Treat the Disease of Bone Loss

The bone around tooth roots is a special kind of bone:  alveolar bone.  It receives stimulation from the roots of the teeth it encloses.  Alveolar bone is healthy unless subject to inflammation from periodontal (gum) disease, which cause it to recede, or if the forces of chewing are greater than the capacity of the bone to withstand.  The full-mouth series of radiographs above clearly shows some teeth, and some segments of teeth, to have significantly reduced levels of bone.  The one universal truth about alveolar bone is that it resorbs (shrinks) when teeth are removed, because the bone loses its stimulation.  The best thing about dental implants is that they preserve bone.  Placed as soon as possible after tooth loss, the implants stimulate bone in the same way that natural tooth roots used to.  This means that possible dental implants  should ideally be included in treatment planning before teeth are removed.  A CT Scan can be used with dental imaging software to determine the exact location, size and number of implants.  By preserving bone, dental implants counteract the results of tooth loss and aging, and help control facial changes.  They give you the security of knowing things will stay in place when you eat, talk and smile.  They contribute to your comfort, quality of life, and self esteem.

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 Peri-implantitis?

Risk Factors in Implants Failure

Peri-implantitis is a more serious disease distinguishable from the condition of peri-implant mucositis.  It is characterized by an inflammatory process around an 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 1mm 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 2mm 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 peri-implantitis, 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 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

Successful Long-Term Removable Partial Treatment

A study of clasp-retained removable partial dentures covering a period of 25 years showed a survival rate of about 90% (89.8) after 10 years.  Published in the March/April 2012 issue of the International Journal of Prosthodontics, investigators in the Regensburg, Germany, University Medical Center, explored the survival rate of 174 partials made in the Department of Prosthodontics between 1984 and 2009.  They analyzed the frequency of and time to fracture of clasps, connectors or bases, the occurrence of decay or gum infections, loss of critical teeth and the need for maintenance procedures such as relines or adjustments.  The survival rates for all partials was 96.4% after five years and 89.8% after ten years.  Clasp fractures were the most common problem, occurring in one in five partials in five years and one in four partials in ten years.  New decay rates and periodontal problems were mostly manageable at normal recall visits during the ten year period.  According to these statistics, a removable partial denture can be considered a durable and long lasting prosthesis.

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

Syndrome of Lupus

All Lupus patients suffer from some sort of oral involvement, and these complications often 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.

Oral Health 

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, HeatherGalusha-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

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

US Periodontal Health Assessment Update

The American Academy of Peridontology (AAP) was recently invited to provide testimony to the Centers for Disease Control and Prevention's Division of Oral Health (CDCDOH) as part of the strategic planning process for 2011 through 2014. The goal is to develop a surveillance program to determine the incidence and prevalence of periodontal disease in the US population.  An initial study indicates that the incidence of periodontal disease may be two to three times higher than previous estimates.  This is important because of the growing body of research that links periodontal disease to other disease states, such as cardiovascular disease and diabetes. The testimony recommends promoting public awareness of periodontal disease prevalence in the US and the importance of periodontal health in achieving overall health. 

Source: www.jiacd.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

Reverse Pre-Diabetes

Nearly 25% of Americans are thought to have pre-diabetes--a condition of slightly elevated blood sugar levels that often develops into diabetes within 10 years-- but only 4% are aware of it.  Diabetes can mean a lifetime of drugs and blood sugar monitoring, an increased risk of heart disease, periodontal disease, Alzheimer's disease, and other health threats.  Prevention.com offered the following healthy habits to reverse pre-diabetes:  

• Lose weight:  a  5% weight loss equals a 70% reduction in risk.  

• Walk:  worldwide studies show the increased activity gotten from walking daily helps the body utilize insulin to move blood sugar into cells that provide energy and nutrition whole grain cereals:  

• Indulge coffee:  the Harvard School of Public Health studied 126,210 men and women over 18 years and found four cups or more of coffee with caffeine offered protection.  

• Skip fast food:  University of Minnesota scientists followed 3,000 people, ages 18 to 30, for 15 years, and found those who ate fast food more than twice per week gained 10 more pounds and developed twice the rate of insulin resistance, the two major risk factors for type 2 diabetes.  

• Eat vegetables more often:  by eating vegetables and reducing the amount of red meat and processed meat, risk is significantly lowered, according to a 37,000 women study at Bringham and Women's Hospital.     

• Cinnamon:  German researchers studied adults with type 2 diabetes who then took a capsule containing the equivalent of 1 g. cinnamon powder 3 times a day for 4 months and reduced their blood sugar by 10%.     

• Daily relaxation:  simple relaxation exercises and other stress management techniques reduce blood sugar levels, according to a study conducted at Duke University.  Get 6 to 8 hours of sleep a night: Yale University found less than 6 hours of sleep doubled diabetes risk, and more than 8 hours tripled risk.     

• Be social:  women who live alone are 2.5 times more likely to develop diabetes.     

• Have a blood test:  a simple blood test measures sugar levels.  People with pre-diabetes--slightly elevated sugar levels, between 100 and 125 mg/dl--often develop a full blown case within 10 years. Knowing you are at risk can put you on a course of simple diet and exercise changes.    

Source:  Women's Health Magazine/Prevention.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

Metabolic Syndromeand Toothbrushing

We've talked before about adults being "apple" vs "pear shaped" and the health hazards that come with "pear shaped" being termed "Metabolic Syndrome."  The main hazards are higher rates of diabetes and cardiovascular disease.  Inflammation has been strongly related to metabolic syndrome (MetS).  Periodontal disease is the most common chronic infection in adults.  As reported in the Journal of Dental Research (Epub 2/29/12) a study of 925 people for three years, increased toothbrushing frequency was related to lower hypertriglyceridemia and high-sensitivity C-reactive protein.  The study found that more frequent toothbrushing is related to lower prevalence and incidence of MetS.  The results suggest that more frequent toothbrushing may contribute to the prevention of MetS due to the inflammation/triglyceride pathway.

The syndrome can best be identified by studying blood sugar levels over a three month period.  Ask your doctor for recommendations on how you can stay 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

Successful Long-Term Removable Partial Treatment

A study of clasp-retained removable partial dentures covering a period of 25 years showed a survival rate of about 90% (89.8) after 10 years.  Published in the March/April 2012 issue of the International Journal of Prosthodontics, investigators in the Regensburg, Germany, University Medical Center, explored the survival rate of 174 partials made in the Department of Prosthodontics between 1984 and 2009.  They analyzed the frequency of and time to fracture of clasps, connectors or bases, the occurrence of decay or gum infections, loss of critical teeth and the need for maintenance procedures such as relines or adjustments.  The survival rates for all partials was 96.4% after five years and 89.8% after ten years.  Clasp fractures were the most common problem, occurring in one in five partials in five years and one in four partials in ten years.  New decay rates and periodontal problems were mostly manageable at normal recall visits during the ten year period.  According to these statistics, a removable partial denture can be considered a durable and long lasting prosthesis.

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

Heart Disease and Women--Symptoms, Risks

Heart disease affect more women than men

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

Men reported chest pain more often than women

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

Risk factors for heart disease

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

The earliest treatment may be the key to survival!  

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

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

Update on Periodontal Disease and General Health

The American Academy of Peridontology (AAP) was recently invited to provide testimony to the Centers for Disease Controland Prevention's Division of Oral Health (CDCDOH) as part of the strategic planning process for 2011 through 2014. The goal is to develop a surveillance program to determine the incidence and prevalence of periodontal disease in the US population. An initial study indicates that the incidence of periodontal disease may be two to three times higher than previous estimates.  This is important because of the growing body of research that links periodontal disease to other disease states, such as cardiovascular disease and diabetes. The testimony recommends promoting public awareness of periodontal disease prevalence in the US and the importance of periodontal health in achieving overall health. 

Source: www.jiacd.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