Dr. Tarpley is contracted as a participating provider with United Concordia.

Dr. Pham is contracted with United Concordia, Delta USA and Delta Premier, and Anthem Blue Cross Blue Shield.

Most insurance PPO policies will allow you to see a provider of your choice. We will file with your insurance company and accept assignment of benefits after your first visit with us. The difference between seeing a participating provider versus a non participating provider is sometimes a higher out of pocket expense. Please check with your provider to see if this is the case with your plan. You will be responsible for whatever your insurance company does not cover.

We will file the sedation with your insurance provider, however, most times it is not a covered service.

At your initial appointment, the Dr. will review your health history and determine your pre op dosage. You will take an evening dosage and another dose one hour prior to your appointment. Once you arrive at our office the Dr. will give you enough medication to make you comfortable. Many of our patients are very pleased with the results!

Bleeding gums mean that there is some gum disease present. The initial phase of irritation called gingivitis is caused by the presence of plague. Plague is a sticky substance which builds up on the teeth and is made up primarily of germs. Gingivitis is a mild form of periodontitis or gum disease. It develops as toxins from the germs in plague irritate the gums, making them red, tender and likely to bleed easily. Gingivitis can usually be eliminated by daily brushing, cleaning between the teeth and regular dental cleanings and checkups.

Gingivitis may lead to a more serious form of gum disease called periodontitis. This occurs when the toxins in plague and tarter lead to destruction of the tissues that support the teeth. Left untreated periodontitis can lead to tooth loss.

For more information, go to www.collagenex.com and select "For Patients and Consumers".

Most bad breath is caused by the organisms that live in the mouth. These organisms eat the food that we eat and release sulphur compounds, which smell and taste bad.

Thorough brushing and flossing is necessary every day to remove the culprits that cause odor. In addition, the tongue also needs to be cleaned. The tongue is covered with long filaments (like a shag rug) that easily collect and harbor bacteria. Special tools called tongue scrapers can be purchased in a drug store and used to cleanse the surface of the tongue. You can also keep your tongue clean by brushing it gently with a soft toothbrush or scraping the back part periodically with a bent spoon.

If cleaning is not enough, mouthwashes like Listerine and Peridex (only available by prescription) have proven to be helpful in killing germs in the mouth. There are also mouthwashes like ProxiPure, Oxyfresh and ClôSYSII (which contain the germicide chlorine dioxide) which are thought to be helpful. At this point in time, these are only available through dentists.

Gingivitis and periodontal disease can cause bad breath as well. Both of these need to be treated by a dental professional. Also, broken down and decayed teeth can smell bad and can trap food which can spoil and contribute to foul breath.

Certain foods, like garlic and onion, can affect your breath immediately after you eat them. The chemicals in these foods are released into the lungs and can taint the breath for hours afterwards. Alcohol can be detected in the breath due to the same mechanism; absorption from the stomach into the bloodstream and released from there into the lungs. Eating will halt the body's need to break down stored foods.

"Morning breath" is caused by the overgrowth of bacteria which occurs when saliva flow slows. Brushing and flossing immediately or even after eating will help eliminate this type of bad breath.

IF NOT DENTAL, BAD BREATH MAY BE CAUSED BY MEDICAL REASONS. Most bad breath problems are caused, however, by something happening in the mouth. See your dentist first and if she says the problem is not associated with the mouth, she will direct you to an appropriate physician for investigation of medical causes.

Dental Implant System

Do you find yourself covering your mouth when you smile because of embarrassing missing teeth? Dental Implants are a permanent solution to missing teeth, and offer an alternative to traditional dentures. Implants will allow you to enjoy your favorite foods and have the confidence you desire to enjoy an active professional and social life.

Years of research have demonstrated that dental implants are an effective and predictable choice of treatment for tooth loss.

The dental implants are small titanium fixtures which are surgically placed in the upper or lower jawbone. They replace the root of your missing tooth and provide an anchor for your dental prosthesis (single crowns, bridges, and partial or full dentures). A natural appearance is achieved, and normal chewing and speech are maintained.

Implants can replace a single missing tooth, without involving healthy adjacent teeth.

Implants provide extra support for your existing partial or full denture alleviating uncomfortable movement.

In many cases, implants may be placed to support a fixed bridge eliminating the need for a removable partial or full denture. Also, implants minimize gum irritation and pain often associated with removable partials or conventional full dentures.

What to Expect as an Implant Patient. Your dentist will perform a complete examination involving x-rays to determine if you are a suitable candidate for dental implants.

Each patient's needs are handled individually. A gentle surgical procedure is performed to place the dental implant. After the gums have healed and the implant has integrated with the bone, your dentist will attach the crown or bridgework to the top of your new implant. The entire procedure is relatively painless.

For complete details about Dental Implants visit 3i Implant Innovations, Inc. web site by clicking here. Be sure to bookmark our web site before you leave, or use the back button to return to this page.

"3i" is a trademark of Implant Innovations, Inc.
© 1996, Implant Innovations, Inc.
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Palm Beach Gardens, FL 33410, 800-443-8166

Research has recently suggested that there may be a connection between gum disease and other health problems. For instance, several studies indicate associations between gum disease and the development of cardiovascular problems. There is evidence that bacteria in the mouth, which are associated with gum disease, may be connected to heart disease, artery blockages and stroke.

Bacterial pneumonia has also been linked with the same bacteria that cause gum disease. Pregnant women who have gum disease have been found to have an increased risk of pre-term delivery, which can increase the risk of having a low-birth-weight baby. Studies show that many times people with diabetes have periodontal disease as well. In these studies it has shown that the periodontal disease can make it harder to control blood sugar. Because of this, if the periodontal disease is treated in diabetes, the ability to control blood sugar may be improved.

Periodontal Disease, or gum disease, is an infection in the gums. In the early stages, gums may become red or even swollen and bleeding may occur. Over time, the gums may separate from teeth causing pockets, which collect bacteria. Bacteria and their toxins are what cause the inflammation of the gums. If left untreated, the teeth may become loose and may eventually fall out or need to be removed.

Almost all periodontal disease can be prevented by good daily oral hygiene and consistent professional care. Daily brushing and flossing can help in preventing your gums from becoming irritated by toxic agents that are produced by plaque bacteria. Over time, plaque can harden, turning into calculus. Calculus has a rough surface, which makes it easier for plaque to continue to build up. The rough surface makes it harder to keep your teeth clean. Good oral hygiene and consistent professional care work hand in hand toward obtaining a healthier mouth and a healthier body.

DALLAS, April 20 – Taking a precautionary antibiotic before a trip to the dentist isn’t necessary for most people, and in fact, might create more harm than good, according to updated recommendations from the American Heart Association.

The guidelines, published in Circulation: Journal of the American Heart Association, are based on a growing body of scientific evidence weighing the effectiveness of antibiotics against possible risks.  The updated recommendations say that only people who are at the greatest risk of bad outcomes from infective endocarditis (IE) – an infection of the heart's inner lining or the heart valves – should receive short-term preventive antibiotics before common, routine dental procedures.  This includes people with artificial heart valves, a history of previous endocarditis, certain serious congenital heart conditions, and heart transplants patients who develop a problem with a heart valve.

For decades, doctors have given short-term antibiotics prior to a dental procedure to many patients with the belief the drugs would prevent IE.  As a result, patients with any kind of heart abnormality from mild, symptomless forms of mitral valve prolapse (MVP) to serious congenital birth defects have been instructed to take an antibiotic prior to dental work, even teeth cleaning.

However, the drugs carry risks, including fatal allergic reactions and possibly making the bacteria that cause IE to become resistant to antibiotics.  Although allergic reactions are minimal, new evidence shows the risks outweigh the benefits for most patients receiving these antibiotics.

“We’ve concluded that if giving prophylactic antibiotics prior to a dental procedure works at all – and there’s no evidence that it does work – we should reserve that preventive treatment only for those people who would have the worst outcomes if they get IE.  That’s a profound change from previous recommendations,” said Walter R. Wilson, M.D., a professor of medicine at the Mayo Clinic in Rochester, Minn., and chair of the writing group.

The new recommendations apply to such common dental procedures as teeth cleaning and extractions.  They are based on a comprehensive review of published studies that suggests IE is more likely to occur from bacteria that enter the bloodstream as a result of everyday activities than from a dental procedure. 

The statement cites a 1999 study estimating that tooth brushing twice a day for a year carried a 154,000 times greater risk of exposure to blood-borne bacteria than a single tooth extraction, the dental procedure reported to be the most likely to cause a bacterial infection.  The writing group found no compelling evidence that antibiotic prophylaxis prior to a dental procedure prevents IE in individuals who are at risk of developing this infection.

“In fact, maintaining good oral health and hygiene appears to be more protective than prophylactic antibiotics,” Wilson said.  “This changes the whole philosophy of how we have constructed these recommendations for the last 50 years.  Rather than based on the risk of getting IE, they’re based on the risk of which patients would have the worst outcome from the infection.”

Wilson said it’s difficult to estimate the number of people affected by the new guidelines.  Measurements of the prevalence of mitral valve prolapse range from less than 2 percent to almost 20 percent of the population. 

According to American College of Cardiology/American Heart Association guidelines for the management of patients with valvular heart disease, when using current echocardiographic criteria for diagnosing MVP, the prevalence is 1 percent to 2.5 percent of the population.  Even this estimate means millions of people have been taking antibiotics prior to dental procedures.

Patients at the greatest danger of bad outcomes from IE and for whom preventive antibiotics prior to a dental procedure are worth the risks include those with:

• artificial heart valves
• a history of having had IE
• certain specific, serious congenital (present from birth) heart conditions, including

         –unrepaired or incompletely repaired cyanotic congenital heart disease, including those with palliative shunts and conduits

         –a completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first six months after the procedure

        –any repaired congenital heart defect with residual defect at the site or adjacent to the site of a prosthetic patch or a prosthetic device

        –a cardiac transplant which develops a problem in a heart valve.

“Except for the conditions listed above, antibiotic prophylaxis is no longer recommended for any other form of congenital heart disease,” the statement said.

“These new recommendations are a major change that has evolved over nearly 50 years,” said Michael Gewitz, M.D., chair of the AHA Rheumatic Fever, Endocarditis and Kawasaki Disease Committee, a co-author of the guidelines and professor of pediatrics at New York Medical College and Physician-in-Chief for Maria Fareri Children’s Hospital at Westchester Medical Center in Valhalla, N.Y.  “Over this time, patients with common heart conditions were told they needed to take antibiotics prior to a dental procedure.  Now, they’ll be told they no longer need them.  This will likely cause anxiety and concern in patients and health care providers.” 

Gewitz says this is especially true for the millions of people, young and old, affected with congenital heart diseases.  “There is likely to be some confusion until dentists and primary care doctors, and even specialists, all hear about these changes and get used to them,” he said.  “Since patients with congenital heart disease can have complicated circumstances, even after surgical or other treatment, families and primary care doctors should check with their cardiologist if there is any question at all as to which category best fits the individual patient.”

He added that patients and their families should ask careful questions of their providers anytime antibiotics are suggested before a medical or dental procedure.  They should also be aware that overuse of antibiotics many times can lead to a worse outcome than if they were not used at all.

Wilson acknowledged that patients and health care professionals may take awhile to get used to the new guidelines.  Many dentists and physicians are used to prescribing the drugs to any patient with any possibility of a heart abnormality, no matter how slight.  Likewise, many patients are used to taking the antibiotics, which provide a sense of security, he said.

The guidelines say patients who have taken prophylactic antibiotics routinely in the past but no longer need them include people with:

• mitral valve prolapse
• rheumatic heart disease
• bicuspid valve disease
• calcified aortic stenosis
• congenital heart conditions such as ventricular septal defect, atrial septal defect and hypertrophic cardiomyopathy.

“These patients still have a lifelong risk of IE,” Wilson said.  “We’re just saying that the risk is much greater from a random blood-borne bacterial infection resulting from everyday activities than from a dental or medical procedure.”

The guidelines also do not recommend any prophylactic antibiotics to prevent IE for common gastrointestinal procedures or procedures on the urinary tract.  This holds true even for patients with the highest risk of bad outcomes from IE, Wilson said the revised guidelines were prompted in part by the growing body of scientific research that raised questions about the usefulness of widespread prophylactic antibiotic use.  The new recommendations are also more in line with international practice.

“Over the years, a number of publications have called into question the rationale and efficacy of prophylaxis,” he said.  “We did a very thorough search of the literature and assembled the world’s experts on endocarditis and we based our conclusions on evidence-based medicine.”

The Council on Scientific Affairs of the American Dental Association has approved these guidelines as they relate to dentistry.  In addition, the guidelines have been endorsed by the Infectious Diseases Society of America and by the Pediatric Infectious Diseases Society.

Co-authors include: Kathryn A. Taubert, Ph.D.; Peter B. Lockhart, D.D.S.; Larry M. Baddour, M.D.; Matthew Levison, M.D.; Ann Bolger, M.D.; Christopher H. Cabell, M.D., M.H.S.; Masato Takahashi, M.D.; Robert S. Baltimore, M.D.; Jane W. Newburger, M.D., M.P.H.; Brian L. Strom, M.D.; Lloyd Y. Tani, M.D.; Michael Gerber, M.D.; Robert O. Bonow, M.D.; Thomas Pallasch, D.D.S., M.S.; Stanford T. Shulman, M.D.; Anne H. Rowley, M.D.; Jane C. Burns, M.D.; Patricia Ferrieri, M.D.; Timothy Gardner, M.D.; David Goff, M.D., Ph.D. and David T. Durack, M.D., Ph.D.
NR07-1144 (Circ/Wilson-IEstmt)

Chronic Dry Mouth: Strategies for wetting your whistle

                As a natural lubricant, saliva aids in swallowing, eating, and talking; and as a natural cleanser, it helps wash away harmful bacteria and other microorganisms that contribute to cavities, gum disease, and oral infection.
                Unfortunately, as the population ages, more and more people have trouble salivating. Surveys indicate that over 40 percent of those older than 65 say their mouth usually feels dry.
                It’s not aging that’s responsible; older people are simply more apt to use certain medications or suffer from conditions that impair the normal function of the salivary glands.  But chronic dry mouth can affect adults at any age.

A drought in your mouth
                Most often, chronic dry mouth is a side effect of drug therapy.  Medications used to treat hypertension, anxiety, depression, or psychosis cause the most difficulty.  Antihistamines, antispasmodics, cancer-chemotherapy drugs, decongestants, and muscle relaxants are sometimes to blame.  In addition, extensive radiation therapy to the face and neck can cause severe dry mouth. 
                Many diseases also hamper saliva flow.  The leading culprit is Sjogren’s syndrome, an often undiagnosed auto-immune disorder.  Other conditions include bacterial and viral infections, poorly controlled diabetes, salivary-gland stones, tumors, Alzheimer’s disease, anxiety, depression, Bell’s palsy, and Parkinson’s disease.

Get your juices flowing
                When mouth dryness is caused by drug therapy, your physician or dentist may be able to recommend an alternative medication that won’t impede saliva flow.  Even when the underlying cause of dry mouth can’t be conquered, the following strategies may help stimulate the saliva glands and boost the flow:

• Eat foods that taste sweet, sour, bitter, or spicy.  (Chronic dryness will make your mouth more easily irritated, so experiment to find the level of seasoning you can tolerate.)
• Suck on sugar-free hard candy, and chew sugar-free gum.  Your best bet: chewing-gum brands that contain xylitol, a sweetening agent that reduces cavity-causing bacteria (available through health food stores and over the Internet); or Trident Advantage with Recaldent, which has a remineralizing agent that adds calcium and phosphate to the teeth.
• Chew fibrous foods, such as carrots and celery, especially between meals. 

If those approaches don’t bring relief, you might benefit from pilocarpine (Salegen), a prescription oral tablet that can increase salivary output for up to two hours per dose.  Not all patients respond equally, however.  Moreover, the drug commonly causes excess sweating.

Moisturize your mouth
        Whether or not you succeed at boosting saliva output, these steps can reduce the discomfort:

• Sip water throughout the day.
• Suck on ice cubes and sugar-free Popsicles.
• Consider using an over-the-counter saliva substitute (Moi-Stir, Mouthkote, Optimoist, Salivart).  The benefit is generally short-term, and many patients find that frequent sips of water work as well or better.
• Use sauces and gravies to make food easier to swallow.
• Avoid irritants, such as tobacco and alcohol—including high-alcohol-content mouthwashes (Listerine, Original Mint Scope) – and products containing cinnamon, peppermint, or wintergreen.
• Breathe through your nose.  (Breathing through your mouth evaporates moisture.)
• Use a room vaporizer to cut down on mouth dryness.

Protect your teeth and mouth
        A lack of moisture in the mouth raises the risk of cavities and gum disease.  Consequently, diligent dental hygiene is especially important.  For added protection, choose toothpaste that contains fluoride, and use a fluoride rinse or brush-on fluoride gel before bedtime.  If the dryness is severe, your dentist may prescribe a high-fluoride toothpaste (PreviDent 5000).
        Dentures make people with dry mouth more susceptible to infection from yeast organisms, which adhere to the plastic.  Overnight soaks in denture cleanser or in one part chlorine bleach (Clorox) to ten parts water should prevent infection.