Dry Mouth

Dry mouth (xerostomia) can be caused by prescription or over-the-counter medications.  More than 500 medications contribute to oral dryness:  antihistamines (for allergy or asthma), antihypertensives (for blood pressure), decongestants, pain medications, diuretics and antidepressants.

In its most severe form, dry mouth can lead to tooth decay, mouth sores and oral infections.  Half of all Americans take at least one prescription medication daily and more than 90% of adults over the age of 65 do the same.  Therefore, older adults are a significantly higher risk.

Each day, a healthy adult normally produces one and a half liters of saliva, making it easier to talk, swallow, taste, digest food, and perform other functions that often go unnoticed.

Treatment options are available at our office.  Call for a consultation.

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

Age-Related Tooth Root Decay

A study comparing the prevalence of decay on tooth root surfaces in two groups--middle-aged adults (aged 45-64 years) and older adults (65 years and older)--shows differences between the two groups.  Middle-aged adults seemed to be prone to this type of decay if they were male, self-reported dry mouth, had exposed roots and increased frequency of eating or drinking between meals.  Older adults did not share the same associations.

Source: JADA, vol. 144, no. 5, 507-516

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 Disease At A Young Age

Medical Conditions Can Ravage Teeth

Sometimes, medical conditions ravage teeth--as in this patient who is not yet 30 years old.  While continued retreatment of the dental decay seems to always result in failure, dental implants are not susceptible to the bacteria that cause decay.  An overall treatment plan is necessary to assess what the health of this patient's mouth will be in the future, with the goal of preserving her jawbone and creating a disease-free environment with 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

Medications and Dry Mouth

Dry mouth (xerostomia) is a condition of reduced or no saliva in your mouth.  Because saliva enhances your ability to taste, aids in digestion and makes it easier to swallow, it affects your enjoyment of food.  In addition, saliva washes away food particles from tooth surfaces and limits the bacterial growth that can cause decay.  Hundreds of medications, including some over the counter drugs, produce dry mouth as a side effect.  They include those used to treat depression, anxiety, and antihistamines.

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

Pedodontists Keep Kids Smiling

Pedodontists (children's dentists) take care of your child's smile.  As soon as your baby's teeth break through the gums, or no later that your child's first birthday, it is time to see the dentist.  Toothbrushing begins with the appearance of the first tooth.  With a child-sized toothbrish, with only a rice-sized amount of fluoride toothpaste, gently clean the baby teeth from top to gumline.  After the age of three, the amount of tooth paste can increase to the size of a pea.  Brushing morning an night, spitting out the foamy paste afterwards, will strengthen the developing enamel and prevent future decay.

Source:  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

Xylitol Reduces Adult Tooth Decay

A report published in the Journal of Dental Research, by Ritter, et al., compared the effectiveness of xylitol vs placebo lozenges in the prevention of dental decay in "active-decay" adults.  620 patients were followed for three years.  Participants using the xylitol lozenges had 40% fewer decay lesions on  root surfaces than those using the placebo.

J Dent Res, 2013 (Epub)


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

Good Mouth Care for Seniors a Must

A new study, in the European Geriatric Medicine journal, found that many older adults don't or can't properly clean their teeth and gums and rely on caregivers for help.  Dutch researchers found that caregivers often overlook mouth care, because they are unaware of its importance and the consequences of ignoring it.  It is important because healthy gums and teeth keep people looking good, and enjoying eating tasty and nutritious food.  Your mouth plays a key role in your overall wellbeing, because the oral bacteria that cause tooth decay and gum disease also are linked to serious medical conditions, such as type 2 diabetes, stroke, and heart and lung disease.

If you are a caregiver, have parents who are seniors, or have relatives in long-tern care facilities, please be sure that your loved ones are receiving proper oral care.


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

Sealants Prevent Decay At All Ages

Causes of Tooth Decay 

In the United States, approximately 41% of children have decay in their baby teeth, and 42% ages 6-19 have decay in permanent teeth.  Decay on the chewing surfaces of molars (primary and permanent) represent the vast majority of cavities and chewing surfaces of teeth are the place where pit and fissure sealants are the easiest to apply and the most effective.

Sealants Reduce Tooth Decay

Decay reductions of up to 90% have been reported with the use of pit and fissure sealants when recall appointments and maintenance were included.  Sealants are more effective than just the application of topical fluoride.  They can halt the progression of incipient decay lesions. Pit and fissure sealants can be placed on permanent teeth of patients at-risk for decay, independent of the age of the patient.

Source: Dr. Fiona Collins, www.dentallearning.net

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

How Fluoride Works To Prevent Tooth Decay

A  report in the journal Langumir, of the American Chemical Society, gives evidence of how fluoride in drinking water, toothpastes, mouthrinses, and other oral care products prevents tooth decay.  Fluoride penetrates a thin layer to harden the enamel on the tooth surface.  In addition, it also works by impacting the adhesion force of bacteria that stick to the teeth and produce the acid that causes cavities.  By reducing the ability of decay-causing bacteria to stick on teeth, it is easier to wash away the bacteria by saliva, brushing and other activities.

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

Sealants Prevent Decay At All Ages

Causes of Tooth Decay 

In the United States, approximately 41% of children have decay in their baby teeth, and 42% ages 6-19 have decay in permanent teeth.  Decay on the chewing surfaces of molars (primary and permanent) represent the vast majority of cavities and chewing surfaces of teeth are the place where pit and fissure sealants are the easiest to apply and the most effective.

Sealants Reduce Tooth Decay

Decay reductions of up to 90% have been reported with the use of pit and fissure sealants when recall appointments and maintenance were included.  Sealants are more effective than just the application of topical fluoride.  They can halt the progression of incipient decay lesions. Pit and fissure sealants can be placed on permanent teeth of patients at-risk for decay, independent of the age of the patient.

Source: Dr. Fiona Collins, www.dentallearning.net

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 Link Between Asthma and Tooth Decay

To test the relationship between asthma and tooth decay, data from Medline, government reports and conference proceedings were searched, allowing only for objective criteria.  In all, 11 studies on the primary dentition were included, and 15 on permanent dentition.  The studies were then analyzed.  Evidence from this analysis suggests that  asthma doubles the risk of decay in both the primary and permanent teeth.  If you or your child have asthma, taking preventive measures (home care, routine dental examinations, etc.) are important!  

Source:  Evidence-Based Dentistry 13, 41 (2012)

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

Common Dental Problems In Seniors

In fact, root caries (decay) is the most common decay experienced by seniors.  A study was done comparing different techniques of treating exposed root surfaces after brushing with a fluoride toothpaste--applying water, a chlorhexidine varnish, a sodium fluoride varnish, or a SDF solution directly to the tooth roots.  The varnishes were applied every three months and the SDF solution every 12 months.  When the Root Caries Index was calculated, all three groups had significantly lower risk for developing new root caries, compared to the (control) water only.  This simple emphasis on improvement in oral hygiene and application of the solution has great promise in the prevention of root caries in seniors.  

Source:  Evid Based Dent, 2011;12(3):70-71

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

Staying Healthy

Healthypeople.gov is your source for information regarding the importance of oral health as an essential part of staying healthy.  Good oral health allows a person to speak, smile, smell, taste, touch, chew, swallow, and make facial expressions to show feelings and emotions.  A healthy, attractive looking smile can increase your confidence and self esteem at any age.  Poor oral health affects Americans at all life stages, from infancy through older adulthood.  Oral diseases ranging from dental decay to oral cancers cause pain and disability for millions of Americans.  Children and adolescents:  tooth decay affects more than 1 in 4 U.S. children age 2 to 5, and 1 in 2 adolescents age 12 to 15.  Adults:  1 in 7 adults age 35 to 44 has gum disease; after age 65, the rate increases to 1 in 4.  Older adults:  1 in 4 age 65 or older have lost all of their teeth.  More than 7,800 people die from oral and pharyngeal (mouth and throat) cancers each year.  A growing body of evidence has linked oral health, particularly periodontal (gum) disease, to several chronic diseases, including diabetes, heart disease, and stroke.  In pregnant women, poor oral health has also been associated with premature births and low birth weight.  These conditions may be prevented in part with regular visits to the dentist.    

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

Sjogren's Syndrome

Sjogren's Syndrome is a chronic autoimmune disorder in which the glands that produce tears and saliva do not function correctly.  As a result, poor salivary production causes dry mouth and lack of tears causes dry eyes.  When the symptoms become more severe, mouth dryness (xerostomia) may feel like a burning or cracking tongue, may result in an increased rate of dental decay, and difficulty swallowing.  It becomes necessary to sip fluids often both with and between meals.  The parotid glands (major salivary glands behind the jaw) may become swollen and painful.  Eye involvement is the other major manifestation.  The decreased tearing causes redness, itching, photosensitivity and a sandy or gritty feeling in the eyes.  There can also be a decrease in mucous gland secretion of the respiratory and gastrointestinal tracts.  One-third of patients can have symptoms outside the glands, effecting joints, muscles, lungs and kidneys.  Treatment attempts to relieve the effects of chronic dryness of the mouth and eyes by increasing the lubrication and moisturization of the affected tissues.  Artificial tears and saliva substitutes have been used.  Medications are prescribed for extraglandular symptoms.  The overall disease course of Sjogren's syndrome requires regular monitoring by a prosthodontist in conjunction with a physician. 

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 Health Affects Overall Health--the Details

Did you know that your oral health can offer clues to your overall health?  Or that problems in your mouth can affect the rest of your body?  What's the connection?  Your mouth is teeming with bacteria, viruses, fungi--most of them harmless.  Remember, the digestive process starts in your mouth.  Normally good oral health care keeps them under control.  However, if out of control, they can cause infections, tooth decay and gum disease.  If the normal balance of these "bugs" is disrupted or your mouth's protective barriers are breached (cuts in soft tissue, holes in teeth, etc.), bacteria may enter your bloodstream.  

Oral health may affect:
Your heart:  if you have a weak immune system or a damaged heart valve, bacteria in your bloodstream may cause an infection of the inner lining of the heart (endocarditis).  

Cardiovascular disease:  some research suggests heart disease, clogged arteries and stroke may be linked to the oral bacteria from chronic gum disease.  

Pregnancy and birth:  gum disease has been linked to premature birth and low birth weight.  

Diabetes:  this disease reduces the body's resistance to infection --putting the gums at risk.  Inadequate blood sugar control leads to gum infections and bone loss around teeth.  Uncontrolled diabetics have greater tooth loss than people who have good sugar control.  

HIV/AIDS:  painful soft tissue lesions are common.  

Osteoporosis:  which causes bones to become weak and brittle, may be associated with periodontal bone loss and tooth loss.  

Alzheimer's disease:  tooth loss before age 35 may be a risk factor.  Protect your oral health by practicing good oral hygiene every day, brushing twice, flossing, replacing your toothbrush every three to four months, eating a healthy diet and limit between-meal snacks.

Regular dental checkups and awareness of signs or symptoms of oral disease is an investment in your overall health.  

Source:  Mayo Clinic  

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

"Good Running Condition"

This is what an appreciative patient wrote in a letter to me:
When I was an automotive technician, I used to preach to my customers about how important preventative maintenance is in keeping their vehicle in top running condition, which in turn would extend the useful life of their vehicle.  Regular maintenance, or "attention to" most everything in our lives leads to a healthier lifestyle and increased fulfillment.  As we age we are faced with new challenges in keeping ourselves healthy and in "good running condition".  Maintenance is even more crucial as we advance through this life.  Starting today I have a new preventative regimen to follow to help protect my roots from decay.  I will add my new tools to my ever growing collection and will use them dutifully to ensure that "long of tooth" will not get the best of me!

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

TBI: Tooth Brush Instructions

Toothbrushing is such an ingrained habit, few people think twice about it.  But, as with any habit, you can get sloppy, and that can lead to tooth decay and gum disease.  There is enough written in the dental literature to point out common toothbrushing mistakes and how to correct them:  

• Not using the right brush:  Richard Price, DMD, consumer adviser for the American Dental Association, says consider the size of your mouth--the brush shouldn't be too big to fit in all areas of your mouth without strain, and should have a comfortable handle.  Many brushes have padded handles that facilitate brushing at the right angle.  While electrical or manual is an individual preference, the "brusher" and technique is better than the brush.  
• Not picking the right bristle:  angled or straight bristles are just as good, but bristles that are too stiff can aggravate gums and have greater potential for creating tooth abrasion.  Soft-bristled brushes are effective in removing plaque.  "Natural" bristles (made from animal hair or boar bristle) are not recommended.  
• Not brushing often enough or long enough:  at lease twice a day is recommended, for at least two minutes.  The evidence in the literature shows tooth protection is greatly increased when that becomes three times a day, for at least three minutes.  That's why some electric toothbrushes have built in timers.  
• Brushing too often or too hard:  excessive brushing could expose the root of the tooth or the gum tissues to irritation.  Brushing vigorously can also erode tooth enamel.  

It's amazing that just a few minutes per day, well spent, can keep your mouth healthy and, in turn, treat your whole body right. 


Source:  webmd.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