Total Joint Replacement

In 2012, the American Dental Association and the American Academy of Orthopaedic Surgeons (AAOS) released the first co-developed evidence-based guideline on the Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures. The clinical practice guideline, with three recommendations, is based on a systematic review of the literature. The review found no direct evidence that dental procedures cause orthopaedic implant infections.

The following is a summary of the recommendations of the AAOS-ADA clinical practice guideline, Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures. This summary does not contain rationales that explain how and why these recommendations were developed, nor does it contain the evidence supporting these recommendations. All readers of this summary are strongly urged to consult the full guideline and evidence report for this information. We are confident that those who read the full guideline and evidence report will see that the recommendations were developed using systematic evidence-based processes designed to combat bias, enhance transparency, and promote reproducibility.

This summary of recommendations is not intended to stand alone. Treatment decisions should be made in light of all circumstances presented by the patient. Treatments and procedures applicable to the individual patient rely on mutual communication between patient, physician, dentist and other healthcare practitioners.

The Guideline Recommendations:

  1. The practitioner might consider discontinuing the practice of routinely prescribing prophylactic antibiotics for patients with hip and knee prosthetic joint implants undergoing dental procedures.


Strength of Recommendation: Limited

A Limited recommendation means the quality of the supporting evidence that exists is unconvincing, or that well-conducted studies show little clear advantage to one approach versus another.

Practitioners should be cautious in deciding whether to follow a recommendation classified as Limited, and should exercise judgment and be alert to emerging publications that report evidence. Patient preference should have a substantial influencing role.

  1. We are unable to recommend for or against the use of topical oral antimicrobials in patients with prosthetic joint implants or other orthopaedic implants undergoing dental procedures.


Strength of Recommendation: Inconclusive

An Inconclusive recommendation means that there is a lack of compelling evidence resulting in an unclear balance between benefits and potential harm.

Practitioners should feel little constraint in deciding whether to follow a recommendation labeled as Inconclusive and should exercise judgment and be alert to future publications that clarify existing evidence for determining balance of benefits versus potential harm. Patient preference should have a substantial influencing role.

  1. In the absence of reliable evidence linking poor oral health to prosthetic joint infection, it is the opinion of the work group that patients with prosthetic joint implants or other orthopaedic implants maintain appropriate oral hygiene.


Strength of Recommendation: Consensus

A Consensus recommendation means that expert opinion supports the guideline recommendation even though there is no available empirical evidence that meets the inclusion criteria.

Practitioners should be flexible in deciding whether to follow a recommendation classified as Consensus, although they may set boundaries on alternatives. Patient preference should have a substantial influencing role.

Dental procedures

Prophylaxis is recommended for all dental procedures that involve manipulation of gingival tissue or the periapical region of the teeth, or perforation of the oral mucosa.

Additional considerations about antibiotic prophylaxis

Sometimes patients forget to premedicate prior to their appointments. The recommendation is that the antibiotic be given before the procedure. This is important because it allows the antibiotic to reach adequate blood levels. However, the recommendations to prevent infective endocarditis state:

“If the dosage of antibiotic is inadvertently not administered before the procedure, the dosage may be administered up to two hours after the procedure.”


George A. Malkemus DDS
2 Padre Pkwy #200, Rohnert Park, CA 94928
Phone | (707) 585-8595


Comfortable Dentistry – No Fear!

Dentistry has made great strides in creating a more comfortable atmosphere for patients.  Vast improvements in dental technology have made dental treatment much smoother, more effective and much more comfortable for patients.  In my office, patients have the option to listen to an I-pod  with headphones or use their own cell phone to alleviate dental noise.  Many patients elect to use nitrous oxide for relaxation.  Fearful patients can have Conscious Sedation Dentistry, which safely allows them to sleep during dental treatment.

Dental materials and technology, as well as patient comfort, have advanced rapidly over the last 30 years.  When I began practicing, silver-mercury amalgam fillings were the norm.  Gloves where only used for surgery. Extractions and dentures were the common treatment.  All billing, appointment scheduling, and treatment records were hand written or typed.  Computers were unknown in the dental office.

It doesn’t seem possible, but things have changed so quickly.  Now dental implants have allowed teeth to reappear where they had been missing.  Computerized digital x-rays have revolutionized x-ray taking, improving performance, comfort and safety. Video viewing and digital photos of a patient’s mouth during a dental examination is an amazing advancement in communication and understanding of oral health. Computerized records storage has done away with paper charts and filing. With new bondable white materials, the ability to make beautiful tooth-like restorations is a reality. New high technology electric drills are quiet and more efficient than traditional air driven drills. Dyes can detect decay so it can be completely removed.  Sterilization of dental instruments used for each patient is total; everything is autoclaved or discarded.   Dental lasers allow fine precision surgeries. Isolite allows comfortable suction and opening for dental procedures. Painless, long-appointment dentistry is now possible with Conscious Sedation Dentistry.

Dental Comfort Needs

Many people are relaxed in the dental office and only need dental anesthetic with an injection for treatment.   Many enjoy listening to music with headphones. Many others have a fear of dental treatment, usually from a terrible childhood experience.  Others have had difficultly with dental treatment, due to an extremely small mouth opening, a painful jaw joint from opening, or an awful gag reflex.  For these patients, either Nitrous Oxide [N2O] for mild cases or Conscious Sedation for advanced cases can be effective and comfortable for dental treatment.


Nitrous oxide [N2O], also called “laughing gas,” has been available for many years. N2O is inhaled through a dental mask covering the nose and relaxes the patient. Nitrous oxide makes time go by without the patient being anxious and stressing about when the procedure will over.  Often times, the patient will say, “ Are you already done?”  The level of gas can be adjusted to allow the patient to be in just the right relaxation state. 100% oxygen is breathed at the end of the appointment to clear their head and avoid getting a headache.  The patient is clear headed when they leave, so can drive themselves home.


Conscious Sedation Dentistry


Conscious Sedation, often called Sleep Dentistry, is a procedure where sedative medications are taken orally at home the night before and the morning of the dental appointment.   During treatment in the dental office, additional sedative medications will be given, as needed. The medications make the patient groggy and sleepy, but able to easily respond to touch and voices.  Even though conscious, the patient is totally relaxed in a sleep state and has no memory of the visit. With Conscious Sedation, the medication does not immediately wear off like nitrous oxide, so someone is needed to give the patient a ride to and from the office.  Not all dentists offer N2O or Conscious Sedation, so you need to ask your dentist if either of these options is available to you.

One of the greatest improvements in my practice has been the use of Conscious Sedation Dentistry.  Before I was trained and certified in the use of Conscious Sedation Dentistry, I had many phobic patients who would call only for treatment when they had a terrible toothache.  Treatment usually involved either having an extraction or a root canal.   The patient underwent a fearful visit to relieve the immediate pain without the benefit of advanced planning.  I would explain the importance of regular, early preventive visits, having regular cleanings and less involved filling treatments to catch the decay while it was still small.  But their fear of going to the dentist was so strong, they would wait until they had a roaring tooth ache to return to the office for treatment, usually a number of years later.  Now conscious sedation allows that same patient to have years of dental neglect reversed in one appointment with no discomfort whatsoever during and after treatment, and have little or no memory of the visit.

Last year I saw a fearful woman in her mid-40s who had not seen a dentist in over 25 years.  She had a terrible dental experience in her teenage years, when she was not completely numb and the dentist continued drilling anyway.  She was traumatized.  This is so common, where a painful childhood experience has jaded a person and made them a dental phobic.  Her husband had to bring her to the office and hold her hand during her initial visit.  She had been living with dental pain for years, unable to chew on her right or left side without pain.  Her smile was unpleasant with dark, decay-ridden teeth.  After conscious sedation, she was happily smiling and chewing comfortably.  She is now ecstatic about her dental experience and her new smile.

Imagine not being afraid to go to the dentist.  Imagine being able to accomplish all your dental care in as little as one appointment.  This is what Conscious Sedation Dentistry can do for you.  You will be able to smile with confidence and chew your food without pain.  If you have been putting off years of dental work, Conscious Sedation Dentistry can change your life.

My best tip is to have regular dental checkups. Early detection and treatment can oftentimes prevent the need for extensive procedures later.


George Malkemus has a Family and Cosmetic Dental Practice in Rohnert Park at 2 Padre Parkway, Suite 200. Call 585-8595, or email info@  Visit Dr. Malkemus’ Web site at


2 Padre Pkwy #200, Rohnert Park, CA 94928
Phone | (707) 585-8595

Comfortable Dentistry – No Fear!


I recently viewed Al Gore Global Warming sequel at the Summerfield cinema.  I urge you to go see it and the purchase the accompanying book. They are powerful.  Al Gore is an amazing, uplifting, positive, perseverant human being.  It has been 11 years since “An Inconvenient Truth” and much has changed.  The Globe has become even warmer to near no return, but the world leaders have acknowledged the problem [our own President not included] and agreed in Paris to advance technology to reduce green house gases, particularly with solar energy.  I will write a follow up article soon about the current state of affairs, high-lighting Al Gore’s documentary and book, and the change from 11 years ago.  Following is the article that I wrote in 2006. Enjoy


Go see “An Inconvenient Truth”!  Al Gore’s documentary on global warming is playing at the Rialto, and purchase the accompanying book at North Light Books.  The film depicts the warming of our planet earth in an overwhelmingly visual and clear way.  The need and urgency for a value change in our way of life is shockingly obvious if we wish our quality of life to continue.  We must reduce our energy use from burning fuels, which produce greenhouse gases that are warming our planet.  Of course this is inconvenient, when our life styles have become use to cheap convenient energy from burning oil, gas, coal and wood.  But the change is necessary and soon.


Scientists throughout the world are all in agreement that the planet is heating up at an unprecedented alarming rate.  Of the 21 hottest years in recorded history, 20 of the 21 have occurred within the last 25 years, including the last 12 in a row.  2005 was the hottest year recorded during the entire period.  This alarming increase in world temperature parallels the dramatic increase in CO2 levels in our atmosphere. CO2 is the main greenhouse gas produced by burning fuels.


The glaciers are melting on every continent.  The glaciers from Alaska to the Alps, the Himalayas to the Andes are rapidly receding.  The snows of Kilimanjaro in Africa are disappearing.  Antarctic and Greenland ice shields are much reduced and recently melting faster than any computers had predicted.  The Arctic ice is dramatically thinner, and the North Pole has become open ocean much of the year.  For the first time polar bears have been drowning in significant numbers.  Such deaths have been rare in the past.  But now, these bears find they have to swim much longer distances from floe to floe.  In some places, the edge of the ice is 30 to 40 miles from shore.

If ice continues to melt at the present rate, it will cause worldwide flooding within the next 50 years, including San Francisco Bay and most of Southern Florida.  Increased ocean temperatures cause an increased in the number and intensity of storms, hurricanes in the Atlantic Ocean and typhoons in the Pacific Ocean.  Hurricane Katrina increased in intensity to unprecedented levels while crossing the warm Gulf waters.  In 2004, for the first time ever a hurricane formed in the South Atlantic and hit Brazil.

What Can We Do?

Gore’s positive attitude is empowering, considering the grave problem the film illuminates.  The scientific evidence that Gore portrays is staggering, but he gives us hope by summarizing ways to stop the warming trend with energy conservation and new energy technologies that don’t burn fossil fuels.

Reducing our own individual energy use, lowers our own costs  [a big saving in our pocket book], while reducing global warming.  It is a win-win.  Every little bit of savings adds up to a massive amount when added up nationally and globally.

Save Energy At Home

One of the easiest savings is to replace regular light bulbs in your home and office with compact fluorescent lights.  They last 10 times longer and use 66% less energy.  If every home in the US replaced even one light bulb, it would have the same effect as removing a million cars from our nation’s roads. Lighting accounts for 33% of our nation’s energy use. Keep lights off when not in use. Install motion detectors for security lighting.

Choose energy-efficient appliances, called Energy Star, when making new purchases. Conserve hot water. You can cut energy use by setting your water heater to no higher than 120 degree F.  Take showers rather than baths, and install efficient aerating showerheads. Save energy by running full loads in your dishwasher and washing machine.  Use the cool or warm setting rather than the hot.  When you have time, wash your dishes by hand, and use a clothesline to dry your clothes.  Over the last year, I began to frequently hang dry my clothes, and I am amazed at the reduction in my PG&E bill.  Adequately insulate your house, seal any air gaps, insulate hot water pipes, and replace single pane windows with double pane.

Get Around on Less

Reduce the number of miles you drive by walking, biking, carpooling, or taking mass transit.  I am lucky to live only 3 miles from work, so I ride my bike.  It doesn’t take any longer, I get daily maintenance exercise, I save money on gas and it is fun.  Drive smarter.  Avoid gas-brake-gas brake type driving.  Avoid unnecessary idling and keep your car in good running order.  Make you next vehicle a more energy efficient one.

Consume Less, Conserve More

Energy is consumed and greenhouse gases are produced in the manufacturing and transport of everything you buy.  Buy less. Buy things that last. Buy local products and produce [or grow your own] as much as possible.  The farther a product travels, the more energy used.  Recycle.  Compost.  I produce more than a cubic yard of rich soil every year from composting kitchen scraps and paper.

Support Alternative Energy Sources

Solar, wind, and geothermal are great alternative sources of energy.  We are lucky to have the geysers in Sonoma County.  Solar panels have become efficient and cost effective over a number of years.  They actually give energy back to PG&E.

Support energy efficient green building; Windsor recently began selecting new construction based on green design.  Sonoma County is actually a leader in the energy reduction process.  Our nine largest cities, including Cotati and Rohnert Park have ratified the Kyoto Treaty on their own and are implementing policies to reduce global warming pollution below the levels required by the protocol. The Kyoto Treaty, which reduces Greenhouse gas emissions, has been ratified by 132 developed nations. The U.S. and Australia are the only advanced nations not to sign the Treaty.

We Need To Lead The Way

In the past, The U.S. has led the way when there has been a global concern.  The protective ozone layer was being depleted by chlorofluorocarbon emissions.  CFCs were the major chemical use in refrigeration since the 1930s.  In 1987, with a Republican president, Ronald Reagan, and a Democratic Congress, the U.S. drafted a treaty, secured worldwide agreement and began elimination of the problem chemicals.  To date CFCs level in the atmosphere have stabilized or declined.  The ozone layer is in the healing process.

Our nation and the world need a unified commitment, much like our effort during WWII.   Our nation came together under that world threat; everyone sacrificed for the each other and the greater good.   Global warming is an even greater threat – just not as obvious, yet.

Quoting Gore, “There was a storm in the 1930s of different kind: a horrible, unprecedented gathering storm in continental Europe.  Winston Churchill warned the people of England that this was different from anything that had ever happened before, and told them they needed to prepare for it.  There were many who did not want to believe his warning and he became impatient with their dithering.  And he said this: THE ERA OF PROCRASTINATION OF HALF-MEASURES, OF SOOTHING AND BAFFLING EXPEDIENTS, OF DELAYS, IS COMING TO ITS CLOSE.  IN ITS PLACE WE ARE ENTERING A PERIOD OF CONSEQUENCES. Winston Churchill, 1936”

So let our nation awaken, and begin a commitment to reducing Global Warming!

 Halitosis Reduction

Remember to brush, floss and see your dentist and hygienist regularly.  You will reduce global warming by reducing halitosis.  By eliminating bad breath, you will have more friends as well as improving the environment.

Enjoy Life and Keep Smiling!

George Malkemus has had a Family and Cosmetic Dental Practice in Rohnert Park at 2 Padre Parkway, Suite 200.  #585-8595


2 Padre Pkwy #200, Rohnert Park, CA 94928
Phone | (707) 585-8595


Tobacco Use Causes Mouth Cancer

Mark Twain once said, “Quitting smoking is easy.  I’ve done it a thousand times.” Stopping tobacco use is difficult because all tobacco forms – cigarettes, E-cigarettes, cigars, pipe smoking and smokeless [spit] tobacco – contain nicotine.  And nicotine causes addiction or dependence.  However compared to Mark Twain’s day, there are many modalities to make quitting tobacco use easier.  If your using tobacco, research the many methods available to stop; quitting is the best thing you can do for your health.

Smoking causing lung cancer is widely known.  Less known is cancer of the throat and mouth that are directly caused by tobacco use.  In America, 30,000 people will be diagnosed with oral cancer or pharyngeal cancer this year. This results in 8,000 deaths, roughly breaking down to one death every hour of every day.  What makes this figure so terrifying is that early detection of oral cancer symptoms can result in an 80 to 90 percent recovery rate. Diagnosing symptoms of oral cancer too late is what keeps mortality rates so high.

Over 90 percent of all oral cancers are squamous cell carcinomas, which are directly linked to tobacco use. This cancer can be located on the tongue, cheeks, soft palate, lips, tonsils and throat.   Cancer-causing substances in tobacco mutate the genes, which control cell behavior. These mutated genes grow and spread and multiply at an uncontrolled rate.  Lab studies have now show that electronic cigarette vapor causes DNA damage in cell cultures [ as well as, traditional tobacco] even in nicotine-free vapor.cigarette-150153_960_720

Early Diagnosis

The earlier oral cancer signs are diagnosed the better. In fact, it can mean the difference between life and death. An oral cancer screening should be done at every dental examination and cleaning.  In my practice, I use a dental video camera and a visual examination to check for oral cancer on the roof and floor of the mouth, on the surface, underside and base of the tongue, along the insides of the lips and cheeks and the soft palate and tonsils. The face, jaw and neck are checked as well.

Many sores, such as biting or burning the inside of the mouth or a loose fitting denture or a cold sore, can mimic the appearance of oral cancer, but most will resolve within two weeks.  If any sore, discoloration, irritation or swollen tissue in the mouth does not resolve within two weeks on its own, it should be checked by a dentist and possible have a biopsy taken of the area.

The Development of Mouth Cancer

Mouth cancer develops in stages.  The first sign is leukoplakia, a whitish toughening, precancerous stage where the cells are beginning to change slightly.  Usually the progression to cancer is reversible if the tobacco use is stopped at this stage and the area will change back to health pink tissue.  The next stage will usually become red, raised and slightly raw.  This can advance to a sore, swollen, ulcerated area.  If left untreated, this can become an enlarged grotesque growth, which usually leads to disfigurement from surgery and often death.

The location of the mouth cancers is related to the type of tobacco used and where the tobacco is most concentrated.  Cigarette smokers most often have tissue changes on the tongue, soft palate, and tonsils, as well as the throat and lungs.  Pipe smokes tend to have tissue changes and cancer on the lip where the pipe is held or on the roof of the mouth where the smoke first touches.  Cigars smokers have the greatest amount of lip cancer from the tobacco juices concentrating on the lips where the cigar is held.

When smoking tobacco, the smoke penetrates throughout the mouth, so cancer can be found throughout the mouth. Cancer from chewing tobacco almost always appears in the spot it is place. When I do an exam on a patient who chews tobacco, I usually see tissues changes in the area the tobacco is placed.  Instead of healthy pink, soft tissue, I find a whitish toughened tissue that looks a lot like a callous.  This is a precancerous stage. I always recommend that the patient stop tobacco use and if they are not going to stop than lessen use.  And in the case of chewing tobacco, if they are going to continue, then move it around to different spots in their mouth.pipe-159453_960_720

Who Is At Risk for Mouth Cancer?

With tobacco use, it is a continual long-term effect on the tissues, which causes cancer.  So people who have been smoking for many years are at a greater risk for mouth, throat and lung cancer.   So it is found most often in people over 40 with the risk increasing in the 50’s, 60’s and 70’s.  Smokeless tobacco is the exception with most cases found in people who are in their 20’s and 30’s and some cases even in teenagers. This is due to the cancer-causing juices being concentrated in one location.  28 cancer-causing substances are found in smokeless tobacco!

Heavy alcohol use is linked to oral cancer as well.  In particular, smokers who are also heavy alcohol drinkers increase their oral cancer risk significantly. These two substances act together to become even more deadly and more debilitating.

Mouth Cancer Treatment

If a symptoms, sores, lumps or swelling last beyond the two-week period, usually a biopsy of the area will be taken and analyzed by a laboratory. In the event that a positive diagnosis is received, oral cancer treatment will require the help of several doctors from many fields of medicine. Oral cancer treatment generally involves a surgeon, radiation oncologist (doctor trained to give X-ray treatments), oncologist (cancer doctor trained in chemotherapy), and a rehabilitation and restorative specialist. Squamous cell carcinoma grows aggressively, so often large resections of the tongue, lip and/or jaw are necessary along with strong treatments of radiation and chemotherapy.  Of course, the earlier the cancer is found, the lighter the treatment.  That is why early detection is so critical.

Tobacco use causes mouth cancer.  The best option is to quit.  If unable to quit, as so many millions are, it’s imperative that one visits his/her dental professional twice a year for an oral cancer screening.

Enjoy Life and Keep Smiling!

George Malkemus has a Family and Cosmetic Dental Practice in Rohnert Park at 2 Padre Parkway, Suite 200. Call 585-8595, or email info@  Visit Dr. Malkemus’ Web site at


2 Padre Pkwy #200, Rohnert Park, CA 94928
Phone | (707) 585-8595

Tobacco Use Causes Mouth Cancer

Wimbledon Tennis Finalist Venus Williams Has Sjogren’s Syndrome

On Saturday July 15, 2017,  U.S. tennis star, 37 year-old Venus Williams lost in the finals of the Women’s Wimbledon Tennis Championship to 23-year old Garbine Muguruza of Spain.  Williams was the oldest Wimbledon finalist since 1994 when Martina Navratilova was also a runner-up  at the same age.  In a young women’s sport, Venus is showing amazing ability, talent and energy, especially considering that she has Sjogren’s Syndrome.

Venus’s last Grand Slam final was in 2009, over seven years ago.  Later that year in 2009, Venus Williams, at age 31, pulled out of the U.S. Open after having suffered joint pain, hand swelling, numbness, fatigue, dry eyes and a dry mouth.   She had an overall feeling of being “beat up.”  Venus was finally diagnosed with Sjogren’s syndrome, a little-known autoimmune disorder.

Sjogren’s (pronounced SHOW-grins) is often misunderstood and misdiagnosed.  In 2005, Venus Williams was diagnosed with exercise-induced asthma after having trouble breathing and was given medication that didn’t work.  She had been struggling with unclear symptoms until 2009 when it was determined that she had Sjogren’s.  At that time on Good Morning America, Williams discussed her experience with Sjorgren’s and cited the disease as the reason she pulled out of the U.S. Open. She also said that she was “thankful to finally have a diagnosis”.

What is Sjorgren’s Syndrome?

Sjogren’s Syndrome [SS] is a chronic disorder in which white blood cells target the body’s moisture-producing glands. Its hallmark symptoms are dry eyes and dry mouth, but Sjogren’s patients also often experience extreme fatigue and joint pain and sometimes problems with other organs or the central nervous system. People with Sjogren’s also have a higher risk of developing lymphoma, particularly in the salivary glands. The condition is named after Henry Sjogren, a Swedish ophthalmologist, who first described the primary clinical features of this disorder in 1933.

Two distinct forms of Sjogren’s syndrome have been recognized:

Primary Sjogren’s syndrome – defined as dry eye and dry mouth that occur by themselves and are not associated with another autoimmune disorder. Primary Sjogren’s syndrome occurs in approximately 50% of cases according to the Sjogren’s Foundation of America.

Secondary Sjogren’s syndrome – characterized by dry eye and dry mouth that occurs in the presence of a major underlying autoimmune connective tissue disease such as rheumatoid arthritis, systemic lupus erythematosus, or scleroderma.

It has been estimated that up to 4 million Americans are afflicted with Sjogren’s syndrome.  However, because the disorder is difficult to diagnose, the incidence of the disease may be considerably higher.  Sjogren’s syndrome affects predominately women rather than men by a ratio of 9:1; however, the symptoms in males and females are the same.

The typical patient is a Caucasian female, usually of Northern European ancestry.  Symptoms of the disorder most often begin between the ages of 40-60, predominantly in post menopausal women, but are also seen in young women in their 20s and 30s. The average age of onset is 52 years old. Venus Williams is an example of the range of exceptions.   However, SS is probably under diagnosed particularly in black women, who often are misdiagnosed with lupus. On average it takes a person six to seven years to be diagnosed with SS, as symptoms are often mistaken for depression, menopause, even hypochondria.


There is no known cure for Sjögren’s syndrome, nor is there a treatment to restore secretion of moisture by the glands. For the most part, treatment is designed to help relieve symptoms.  Severity of symptoms varies greatly.  Some patients’ lives have minimal impact from the disease beyond eye and mouth dryness; others develop more serious complications. Others have to learn to cope with chronic pain and fatigue.

Dry eyes

The drying effect on eyes from SS varies and includes:

  • Eye redness, itching, and burning
  • Photosensitivity and glare
  • Blurred vision
  • Conjunctival infection
  • Corneal ulceration
  • Blindness

Dry eyes can usually treated with teardrops when only moisture is needed.  But other treatment options are sometimes necessary to manage dry eye symptoms that worsen, including, methylcellulose inserts, eye ointments, medications, and even surgery.

Dry Mouth

Dryness of the mouth results from an inadequate flow of saliva. Saliva coats and lubricates tissues in the mouth.  Saliva helps cleanse the mouth and begins the digestive process with chewing.   Drying irritates the soft tissues in the mouth, which can make them inflamed and more susceptible to infection.  Severe dry mouth can promote the growth of harmful organisms. Oral candidiasis, a fungal infection, has been reported to occur in up to 80% of SS patients. Without the cleansing and shielding effects of adequate salivary flow, caries [tooth decay] and periodontal [gum] disease become common problems.  Constant dryness and the lack of protection provided by saliva contribute to bad breath.dry_mouth

Often SS patients experience changes and reduction in taste, as well as, burning sensation in the mouth.  Dry mouth can cause difficulties in chewing, swallowing and speaking.  Dry mouth also causes dentures to become less comfortable because there is no thin film of saliva to help them adhere properly to oral tissues.

There are numerous saliva substitutes on the market that can be prescribed, but artificial saliva is not a perfect substitute for natural saliva, which is complex physically and chemically.  Most patients prefer sipping water to using a saliva substitute, since artificial saliva’s benefits are short lived.  Not only is water sipping the most cost-effective means of improving oral moisture in the short-term, it has the added advantage of contributing to improved hydration.  Sipping water continually during the day using a water bottle with a straw-type top is ideal.

Using saliva stimulants, such as, chewing sugar-free gum [Gum sweetened with xylitol has been shown to reduce cavities] and sucking on sugar-free candy can be helpful for increasing saliva flow. Good oral hygiene practices are particular important: brushing, flossing and using a fluoride rinse.

Venus Williams has been able to control her Sjogren’s Syndrome symptoms since she was a diagnosed in 2009.  She has been amazingly able to continue to play tennis at a high level and even improve her game, which is so impressive making the Wimbledon finals.  Venus Williams is a shining example and spokes person for Sjogren’s syndrome.


George Malkemus has a Family and Cosmetic Dental Practice in Rohnert Park at 2 Padre Parkway, Suite 200. Call 585-8595, or email  Visit Dr. Malkemus’ Web site at


2 Padre Pkwy #200, Rohnert Park, CA 94928
Phone | (707) 585-8595

Wimbledon Tennis Finalist Venus Williams Has Sjogren’s Syndrome

4 Risk Factors of Gum Disease to Discuss with Your Dentist

Have you ever had something caught in your teeth for days? It’s likely because it was lodged deep between a tooth and your gums. That gum tissue is what keeps our chompers in place. There are three stages of gum disease and all are treatable.

The mild form of gum disease is Gingivitis. This is where plaque and other byproducts irritate the gums. It makes them swollen, tender, and more likely to bleed. Periodontitis is stage two. The gum tissue starts deteriorating as it detaches from the teeth forming pockets around the roots. This leaves teeth exposed and more susceptible to decay. Finally, Advanced Periodontitis can set in. Tooth pockets get deeper as the severe gum recession leads to bone loss causing loose teeth.

Common Risk Factors of Periodontal DiseaseGum Disease Sigh

  • Genetics – it’s hereditary and some of us are just unlucky! While you may be more susceptible to periodontitis, having a good oral hygiene routine with regular dental visits can help your smile stay healthy. Talk to us about finding the right balance for your needs.
  • Health – underlying medical conditions like diabetes and Crohn’s disease, as well as lowered immunity from illnesses and treatments often affect gum tissue. Medications, hormonal changes and obesity are also culprits and should be discussed.
  • Bad Habits – chewing on ice, not brushing or flossing daily and using tobacco are the most common behavior changes we encourage you to ditch. However, substance abuse and a diet lacking in vitamin C will also impact your smile.
  • Stress – it’s inevitable. But keep an eye on exactly how much it’s weighing you down. High levels or chronic stress can lead to poor hygiene habits. Anxiety can also lower your immune system from effectively fighting off bacteria that causes gingivitis (stage 1).

When to Seek HelpCapture

Common red flags of gum disease include:

  • Bleeding gums
  • Swollen or tender gums
  • Gums look bright red
  • Teeth wiggle

There’s no home remedy to cure gum disease. Only professional treatment can help, so call and schedule an exam today (707) 585-8595


2 Padre Pkwy #200, Rohnert Park, CA 94928

Phone | (707) 585-8595

4 Risk Factors of Gum Disease to Discuss with Your Dentist

Relay For Life: ‘Celebrate. Remember. Fight Back.’

Last Saturday, June 24th at 10am began the 18th annual Rohnert Park-Cotati Relay For Life at Sally Tomatoes event center Sonoma Mountain Village.  Relay For Life is a fundraiser for the American Cancer Society that is so much more.  It is a life-changing event that is about community celebrating the lives of people who have battled cancer and survived, remembering loved ones who have lost the battle, and thanking the care givers who have helped them through this stressful process.

Relay For Life is an awesome event!  An up lifting experience!  I recommend the program to everyone, particularly if you, your loved ones, or close friends have an experience with cancer.  The Rohnert Park-Cotati Relay is usual the 3rd or 4th weekend in June.  You can find other Relay events at different dates and places.  For more information, see

The event is based on teams of people who camp out overnight and take turns walking or running around a path for 24 hours from Saturday morning to Sunday morning.   A representative of each team is on the track at all times because ‘cancer never sleeps’. Relay for life celebrates survivor ‘Birthdays’.  Birthdays begin from the date of original cancer diagnosis.   I am celebrating my 12th birthday by surviving colorectal cancer, discovered on May 15, 2005.

Relay For Life began in May of 1985, when Dr. Gordy Klatt , a colorectal surgeon, took his first step on a 24-hour marathon run [83 miles in total] around a Tacoma, Washington track to show his dedication to finding a cure for cancer and raising $27,000 for the America Cancer Society. Since then, Relay for Life has become a worldwide movement to end cancer.  Each year, more than 3.5 million people in over 4,500+ communities in the U.S. gather to raise much-needed funds and awareness to save lives from cancer.  The event has spread to over 20 other countries and raised over $3 billion dollars.  Our own local Relay has raised over one million dollars since it’s inception in 1989.

The Rohnert Park-Cotati Relay is located in a beautiful, protected setting with both sun and shade trees, a paved perimeter-walking path and event stage.At registration, survivors are given a purple tee shirt; this years theme written on the shirt says: “WE ARE THE COURAGEOUS.  WE ARE THE PASSIONATE. WE ARE THE DETERMINED.  WE ARE HOPE.”

The event begins with inspirational short speeches, followed by vibrant singing of the National Anthem, and then the walk begins with cancer survivors leading the way.  In 2009, I had the honor of being a speaker at the event as a cancer survivor.  This year I was pleased to presented a $500 check from the Rotary Club of Rancho Cotati.  To date, this years Rohnert Park- Cotati Relay has raised over $50,000.  August 30, 2017 is last day of this year’s fund raising, so it is not too late to contribute.

There are many touching stories, poems, and songs throughout The Relay.  Each year at the event, I meet so many wonderful people with their own challenging cancer stories.  Many have positive survivor results, like mine.  But others were not so lucky and their love ones have come to celebrate and remember their lives.

Throughout the event there is great music, food, and activities.  One of the highlights each year is the Luminaria Ceremony.  Luminaria bags are decorated to honor survivors and to remember lost love ones.  Each bag is filled with a canned food item to raise the height of a candle in the bag to be lit and illuminated.  After the event, the canned goods are donated to the NOAH food bank for distribution to Rohnert Park needy families.

Ever year I make a bag in honor of my cousin Steve Malkemus.  Steve and I were the same age and grew up together.  He was diagnosed with colon cancer at age 47 and died at 51.  Steve was a wonderful man and I still miss him. At dark, the luminaria are lit.  Thousands of luminaria encompassed the entire perimeter of the park.  It is a beautiful, inspirational sight, walking the path and seeing all the names and color designs on the luminaria.  A few years ago, a full moon was rising over the eastern mountains as the luminaria glowed.  A peacefully lit sign with the word HOPE shined just below the rising full moon– breath-taking!

Along with the luminaria ceremony, the evening program includes testimonials, poems, songs, live music, electric light parade, and late night movies.  9:30 am on Sunday morning, the closing ceremony takes place including the Hokey Pokey.  At 10 am the event closes with a Group Celebration Last Lap.   The goodwill and dedication of the participants, volunteers, donors and organizers is amazing.  A special thanks to the event leadership team headed by Ruth Fitzsimmons and including Lisa Collodi, Tina Hansen, Amanda Clark, Barbara Clark, Janice Chamberlain and Carolyn Foster.

The “no complaints”, “no regrets”, and “move on” attitude of the person with cancer is an admirable quality. Cancer prevention involves basically living a healthy life.  But even living a perfectly healthy life is no guaranty of avoiding cancer. Awareness and funding of cancer is having an effect.  The importance of early detection and screening for cancer and anti-smoking campaigns are leading the way.  Cancer deaths in the United States and Sonoma County have fallen for the last few years after years of steady increase.  Deaths decreased in three major cancers – breast, prostate, and colorectal.  Lung cancer decreased for men but had a slight increase in women.   Combinations of factors are responsible for the cancer death decline, including an increase in early detection, more effective treatments due to continual research and a decrease in cigarette smoking among men.  A wider and earlier screening for colon, prostate and breast cancer among both men and women is particularly significant.

The American Cancer Society [ACS] is the nationwide, community-based, voluntary health organization dedicated to eliminating cancer as a major heath problem, by preventing cancer, saving lives and diminishing suffering from cancer through research, education, advocacy, and service.  Anyone, anywhere can access information and support 24 hours a day, 7 days a week at 1-800-227-2345 or at


George Malkemus has a Family and Cosmetic Dental Practice in Rohnert Park at 2 Padre Parkway, Suite 200. Call 585-8595, or email info@  Visit Dr. Malkemus’ Web site at


2 Padre Pkwy #200, Rohnert Park, CA 94928

Phone | (707) 585-8595

Relay For Life: ‘Celebrate. Remember. Fight Back.’