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Dr. Britten is highly concerned about his patients who smoke. The likelihood of developing advanced periodontal disease or gum disease can be up to six times higher in smokers. Periodontal disease is an extremely serious condition affecting not only the gums, but also the membranes and ligaments and bone supporting the teeth.

Many studies on smoking and periodontal disease have concluded that smokers have:

  • Deeper probing depths and a larger number of deep pockets in the gums.
  • More attachment loss including more gingival recession
  • More alveolar boneloss & tooth loss
  • Less gingivitis and less bleeding on probing
  • One of the major problems with smoking is that it tends to mask the damage being caused to teeth and gums. This damage can be difficult to detect, producing very few early warning signs of advanced periodontal disease. For years it was thought that nicotine being a vasoconstrictor was causing less blood flow to the gums, causing less infection-fighting white blood cells to reach the area.  Newer studies are showing that smoking appears to have a long-term affect the inflammatory lesions, or diseased gums of smokers, which have less blood vessels in them than in non-smokers.
  • More teeth with furcation involvement (where the bone levels have been destroyed below the area where the roots of the teeth meet, leaving this area exposed, making it prone to further destruction as well as decay.
  •  Additionally, nicotine affects saliva, causing it to become thicker so it is less able to wash away acid created after eating. As a result heavy smokers can be more likely to suffer from tooth decay than non-smokers, even though they may practice good oral hygiene.Smoking has a profound effect on the immune and inflammatory system. Smokers have more infection-fighting cells in their body, but fewer of these helpful cells make it into the gingival pocket. Studies also show that these good cells have a decreased ability to accomplish their function, which is to destroy harmful periodontal bacteria. Adhesion molecules are being found within smoker’s tissues, in the white blood cells, in the inflammatory lesions, and even in the supporting gingival tissues. Studies have shown impairment in defensive functions of other defensive blood cells, even those using smokeless tobacco due to the high concentrations of nicotine.Smoking also impairs the healing of dental implants and even in the healing from all other aspects of peroidotnal treatment including non-surgical treatments (including scaling and root planing or “deep cleaning”), surgical treatment, bone grafting and tissue grafting. Studies have shown that tobacco smoke and nicotine affect blood vessels in the gums, healthy bone-building cells, connective tissue matrix, the jaw bone and even the root surface itself. Tooth root surfaces in smokers have actually been shown to be contaminated by products of smoking such as nicotine, cotinine, acrolein and acetaldehyde, which may inhibit the gum tissue from healing around the roots of teeth as they should.  Smoking has been shown to affect human bone, and is a risk factor for osteoporosis, which is also a risk factor for periodontal disease.

    As a periodontist, Dr. Britten is a specialist in treating advanced periodontal disease and is able to provide patients with the very latest techniques and treatments to help slow down this condition. Where teeth are lost then one option is to replace them with dental implants, but smoking is not advisable during this treatment because it does slow down healing.

    If you do currently smoke and value your smile, it’s worth thinking about quitting.

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Dr. Todd Britten cites recent scientific studies when urging patients to seek gum disease treatment before periodontal disease begins affecting overall health.

Dr. Todd Britten, a periodontist in Clearwater, Florida, cites recent scientific studies to help educate people about the connection between unhealthy gums and different systemic health conditions. Citing the ever-increasing studies linking periodontal (gum) health to overall systemic health, Dr. Britten continues to educate his patients about the benefits of seeking gum disease treatment before it begins affecting overall health.

Dr. Britten states that recent research demonstrates that inflammation may be responsible for the association between periodontal disease and other diseases. Dr. Britten states, “There is strong evidence linking periodontal disease to several systemic diseases, such as diabetes and cardiovascular disease as well increasing the risk factors and complications of other diseases such as osteoporosis, respiratory disease, stroke and even cancer.”

A recent study in an October 2016 report in the Journal of Periodontology titled “Periodontal Disease and Incident Lung Cancer Risk: A Meta-Analysis of Cohort Studies,” (attached) found that individuals with periodontal disease have an increased risk of developing lung cancer. Study participants with other risk factors such as frequent alcohol use, smoking, and diabetics demonstrated even a slightly increase in lung cancer risk and that women with periodontal disease are more likely than men to develop lung cancer. A related cohort study stated that oral bacteria may be involved in the development of cancer cells in the lungs, while another study indicates successful treatment of periodontal disease may lead to a substantially reduced lung cancer risk. “This report can be added to the body of literature that associates periodontal disease with other conditions in the body, including diabetes and heart disease,” says president of the American Academy of Periodontology (AAP) Wayne A. Aldredge, DMD. “While additional research is needed on the possible links between lung cancer and periodontal disease, we know for sure that taking care of your teeth and gums can reduce periodontal disease risk and possibly the risk of other systemic conditions.”

A 2013 consensus report from the American Academy of Periodontology (AAP) and the European Federation of Periodontology (EFP) finds that periodontal health may play an important role in the management of diabetes. The report outlines clinical recommendations for dental professionals to use when treating people with diabetes and emphasizes the importance of annual comprehensive periodontal evaluations (CPE) as part of an effective diabetes management program. The consensus report is based on a large body of scientific evidence that suggests periodontal health may be helpful in controlling diabetes.

“There are many studies which provide evidence indicating a relationship between periodontal disease and several other systemic diseases, including chronic kidney disease, cognitive impairment, obesity, chronic kidney disease and metabolic syndrome. A new study has even revealed a relationship between chronic periodontitis and lacunar infarct, a type of cerebral small vessel disease that can lead to a stroke.” Dr. Britten wants patients to know that while additional research is required to gain a more thorough understanding of many of these relationships between systemic disease and periodontal health, patients should be aware that the associations do exist.

Periodontal disease affects one of every two Americans age 30 and older and is 2.5 times more prevalent than diabetes. Caused by an inflammatory reaction to a bacterial infection below the gum line, periodontal disease can lead to swelling, irritation, receding gums, and tooth loss if left untreated. Dr.Britten’s Clearwater, Florida practice offers many disease treatment options, including traditional or laser gum surgery, replacing missing or diseased teeth with implants, scaling and root planning, and periodontal regenerative procedures such as bone grafting and tissue grafting.

To read more about the findings in recent American Academy of Periodontology reports, visit http://www.perio.org/perio.org/consumer/EFP_AAP_Workshop_Proceedings and to learn more about effects of periodontal disease and treatment options, please visit Dr. Todd Britten’s website at http://www.clearwater-periodontist.com.

Britten Periodontics is a periodontal practice offering patients personalized dental care in periodontics, laser therapy and implant dentistry for Clearwater, Florida. Dr. Todd Britten received his Bachelor of Science and Doctorate of Dental Medicine and Master’s Degree and Certificate in Periodontology and Implant Dentistry at the University of Florida. He is a Diplomate of the American Board of Periodontology. He has completed extensive continuing education coursework, including training at the Pankey Institute, Pikos Institute for Advanced Bone Grafting, Misch International Implant Institute and LANAP Institute for advanced Laser Dentistry. His Professional Associations and Memberships include American Board of Periodontology, American Academy of Periodontology, American Dental Association, Florida Association of Periodontists, Academy of Osseointegration, Upper Pinellas County Dental Association, Pinellas County Dental Association, Top Dentist 2015, Florida West Coast Dental Association and he completed extensive training at the Institute of Advanced Laser Dentistry. Dr. Britten is part of the one percent of dental professionals offering the FDA cleared laser procedure for gum disease treatment.

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Dr. Britten is highly concerned about his patients who smoke. The likelihood of developing advanced periodontal disease or gum disease can be up to six times higher in smokers. Periodontal disease is an extremely serious condition affecting not only the gums, but also the membranes and ligaments and bone supporting the teeth.

Many studies on smoking and periodontal disease have concluded that smokers have:

  • Deeper probing depths and a larger number of deep pockets in the gums.

  • More attachment loss including more gingival recession

  • More alveolar boneloss & tooth loss

 

  • Less gingivitis and less bleeding on probing

One of the major problems with smoking is that it tends to mask the damage being caused to teeth and gums. This damage can be difficult to detect, producing very few early warning signs of advanced periodontal disease. For years it was thought that nicotine being a vasoconstrictor was causing less blood flow to the gums, causing less infection-fighting white blood cells to reach the area.  Newer studies are showing that smoking appears to have a long-term affect the inflammatory lesions, or diseased gums of smokers, which have less blood vessels in them than in non-smokers.

 

  • More teeth with furcation involvement (where the bone levels have been destroyed below the area where the roots of the teeth meet, leaving this area exposed, making it prone to further destruction as well as decay.

  • Additionally, nicotine affects saliva, causing it to become thicker so it is less able to wash away acid created after eating. As a result heavy smokers can be more likely to suffer from tooth decay than non-smokers, even though they may practice good oral hygiene.

Smoking has a profound effect on the immune and inflammatory system. Smokers have more infection-fighting cells in their body, but fewer of these helpful cells make it into the gingival pocket. Studies also show that these good cells have a decreased ability to accomplish their function, which is to destroy harmful periodontal bacteria. Adhesion molecules are being found within smoker’s tissues, in the white blood cells, in the inflammatory lesions, and even in the supporting gingival tissues. Studies have shown impairment in defensive functions of other defensive blood cells, even those using smokeless tobacco due to the high concentrations of nicotine.

Smoking also impairs the healing of dental implants and even in the healing from all other aspects of peroidotnal treatment including non-surgical treatments (including scaling and root planing or “deep cleaning”), surgical treatment, bone grafting and tissue grafting. Studies have shown that tobacco smoke and nicotine affect blood vessels in the gums, healthy bone-building cells, connective tissue matrix, the jaw bone and even the root surface itself. Tooth root surfaces in smokers have actually been shown to be contaminated by products of smoking such as nicotine, cotinine, acrolein and acetaldehyde, which may inhibit the gum tissue from healing around the roots of teeth as they should.  Smoking has been shown to affect human bone, and is a risk factor for osteoporosis, which is also a risk factor for periodontal disease.

As a periodontist, Dr. Britten is a specialist in treating advanced periodontal disease and is able to provide patients with the very latest techniques and treatments to help slow down this condition. Where teeth are lost then one option is to replace them with dental implants, but smoking is not advisable during this treatment because it does slow down healing.

If you do currently smoke and value your smile, it’s worth thinking about quitting.

For more information, contact us today at 727-586-2681.

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April is Oral Cancer Awareness Month

While smoking and smokeless tobacco use is certainly a major risk factor for Oral Cancer, there are other lifestyle, genetic and even viral causes that contribute this often disfiguring and sometimes deadly disease.

Your dentist, dental specialist and dental hygienist are your first line of defense for early detection of Oral Cancer. Dr. Britten routinely performs systematic examination of all the soft tissues of the mouth, including the tongue, floor of the mouth, as well thorough examination of the borders of the tongue, and the lymph nodes surrounding the oral cavity and in the neck.

If you have any questions about Oral Cancer, please feel free to contact us via email at healthysmiles@brittenperio.com or call at 727-586-2681.

 

https://www.youtube.com/watch?v=NJKf3nwx8hw

Immediate dental implants are often necessary due to a non-restorable fracture of a tooth. In some cases, there may be infection associated with the cracked or fractured tooth. The procedure begins with an exam, 2-D and 3-D x-rays. A diagnosis is made and treatment options are discussed. An immediate dental implant is the treatment of choice. Any pre-operative study models that are needed are taken.

Surgical Procedure:  The patient is generally well sedated with either oral or IV sedation. Just like any other procedure, topical anesthetic is applied prior to local anesthesia administration. Impressions of the teeth are taken if necessary prior to the tooth extraction. The fractured tooth is removed very carefully to minimize any damage to any surrounding bone. At the time of surgery, Dr. Britten can determine if immediate implant placement is possible. This is the part you don’t always know until you get there. Additional bone grafting is often necessary to fill the voids between the dental implant and the remainder of the extraction socket. In addition, a membrane, soft-tissue graft or platelet graft (L-PRF) may be used to protect the bone graft.

As an implant specialist, Dr. Britten is highly trained and experienced in the most advanced and current technologies used for long-term implant health and success. He believes in using the best diagnostic tools as well as the highest quality implants in his practice. Dr. Britten works closely with the best restorative dentists in the Tampa Bay area to obtain the best possible outcome for his patients’ implants.  For more information, contact us at 727-586-2681

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What is antibiotic prophylaxis or “premedication” for a dental procedure? How do I know if it applies to me?

Antibiotic prophylaxis, or premedication, refers to giving a patient a loading dose of antibiotics in preparation for a dental surgical procedure, dental hygiene visit or other dental treatment dealing with the teeth or gums. During some dental treatments, bacteria your mouth can enter your bloodstream. In most people, the immune system kills these bacteria. But in some patients, bacteria from the mouth can travel through the bloodstream and cause an infection somewhere else in the body. Antibiotic prophylaxis, or dental premedication may offer these patients extra protection. Patients that normally require antibiotic prophylaxis have fallen under 2 categories: those with joint replacements or certain heart conditions. Some other health issues such as breast implants, brittle diabetics or organ transplant patients may require dental premedication, based on a physician’s recommendations.

Up until 2012, antibiotics were recommended for two years after joint replacement surgery or for a lifetime. Since that time, physicians and dentists have become more concerned about the potential harm of antibiotics including risk for anaphylaxis (allergic reaction), antibiotic resistance, and opportunistic infections such as Clostridium difficile (C-diff) were included in creating the new recommendation.

The 2015 American Dental Association stated that “In general, for patients with prosthetic joint implants, prophylactic antibiotics are NOT recommended prior to dental procedures to prevent prosthetic joint infection.” However, many orthopedic surgeons are still recommended premedication with antibiotics for their patients for 2 years or a lifetime.  In patients with a history of complications associated with their joint replacement surgery, prophylactic antibiotics or premedication with antibiotics should be considered after consultation with the patient and orthopedic surgeon.

If you have a joint replacement and are unsure whether you should premedicate for your dental appointments or not, it is best to contact your orthopedic surgeon to determine what is best for you.

In patients with certain heart conditions, dental premedication is recommended to avoid infective endocarditis.  Infective endocarditis (IE), also called bacterial endocarditis (BE), is defined as an inflammation of the endocardial surface of the heart. Endocarditis generally occurs when bacteria or other germs from another part of the body enter and spread through the bloodstream and attach to damaged areas in the heart. If left untreated, endocarditis can damage or destroy the heart valves and can lead to life-threatening complications.

The American Heart Association says that premedication for dental procedures is required for the following conditions:

  • “A prosthetic heart valve or who have had a heart valve repaired with prosthetic material.
  • A history of endocarditis.
  • A heart transplant with abnormal heart valve function.
  • Certain congenital heart defects including:
    • Cyanotic congenital heart disease (birth defects with oxygen levels lower than normal) that has not been fully repaired, including children who have had a surgical shunt and conduits.
    • A congenital heart defect that’s been completely repaired with prosthetic material or a device for the first six months after the repair procedure.
    • Repaired congenital heart disease with residual defects, such as persisting leaks or abnormal flow at or adjacent to a prosthetic patch or prosthetic device.”

Patients that have had stents placed in their hearts or a history of coronary artery bypass surgery no longer require to premedicate with antibiotics prior to dental procedures under the American Heart Association’s guidelines. Numerous scientific evidence concluded that the risk of adverse reactions to antibiotics generally outweighs the benefits of prophylaxis for many patients who would have been considered eligible for prophylaxis in previous guidelines. Concern about the development of drug-resistant bacteria also was a factor for the simplified guidelines.

The 2014 American Dental Association & American College of Cardiology guidelines add that optimal oral health is maintained through regular professional dental care and the use of appropriate dental products, such as manual, powered, and ultrasonic toothbrushes; dental floss; and other plaque-removal devices.

Antibiotic dosage and schedule

  • 1 hour before the procedure to allows the antibiotic to reach adequate blood levels. However, if the dosage of antibiotic is inadvertently not administered before the procedure, the dosage may be administered up to 2 hours after the procedure.
  • Patients not allergic to penicillin: oral amoxicillin 2g (50 mg/kg for children)
  • Patients allergic to penicillin or ampicillin: oral cephalexin 2g (50 mg/kg for children) or clindamycin 600 mg (20 mg/kg for children)

If you have questions about whether you need to premedicate for your dental procedures, we will be happy to answer any questions you may have. It is best to carefully consider this matter with both you and your physician or surgeon and we are always happy to communicate with both.  Contact us today 727-586-2681 with any questions.

 

The most successful treatment for Obstructive Sleep Apnea is a CPAP appliance, however, 60% to 83% percent of users cannot tolerate this device.

With the high rejection rate of the CPAP, the American Academy of Sleep Medicine designated dental sleep oral appliances as the No. 1 nonsurgical alternative for the CPAP intolerant. Numerous sleep appliances are available to the public and distributed through dentists.

Your dental professional can help you identify if a sleep appliance may help you. If you have any questions about OSA or dental sleep medicine, contact our office today at 727-586-2681

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Did you know?

Your dentist or dental hygienist may be able to tell if you have diabetes before you even know you do? Clues in the mouth, medical symptoms you are experiencing and reporting to them, and even a chairside test done right in the dental office can help your dentist determine that further testing for diabetes is necessary

A dentist can examine your mouth for clues of diabetes. There are signs in the mouth associated with diabetes:

-Periodontal disease
-Dental caries
-Burning mouth syndrome
– Oral candidiasis (common in those with poor glycemic control)
-Salivary dysfunction
-Neurosensory disorders
-Soft tissue abnormalities such as stomatitis or lichen planus
-Xerostomia
(Source: http://clinical.diabetesjournals.org/content/32/4/188.full)

Also, a patient that has 26% of periodontal pockets measuring 5 mm’s or greater or 4 or more missing teeth (not including the third molars), has a 72% chance of having a metabolic challenge. Diabetes is considered a metabolic disease.

Patients often see their dentist or dental hygienist more often than any other healthcare professional. Make sure to answer their questions thoroughly and accurately about your health.

Health risk factors for diabetes:

– Overweight or obese – BMI greater than 25
– High blood pressure
– Familial history of diabetes
– High cholesterol
– History of heart disease
– Other symptoms or complaints may include thirst, urinating frequently, constant fatigue, weight loss (Type 1), blurred vision, and uncontrolled infections even within the mouth (poorly controlled Type 2 diabetics).

Effective January 1, 2018, a chairside diabetes HbA1c (Hemoglobin A1c) test may be able to be performed by your dentist right in their office if they suspect diabetes or prediabetes. A patient with a test result of 5.7 or greater indicates a 92% chance the patient is metabolically challenged. At this point, your dentist can refer you to a physician for further testing.

Periodontal disease and diabetes have a direct effect upon one another. It is important to Dr. Britten to improve not only the oral health, but the overall health of each and every one of his patients. For more information on oral health and diabetes contact us at 727-586-2681.

 

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Did you know that 90% of pre-diabetics are unaware of their condition and 25% of Type II diabetics are unaware they have the disease? Many patients see their dentist or dental hygienist more often than they see their primary care physician. This is particularly true for people with periodontal (gum) disease, who require more frequent dental hygiene visits or gum treatments. Your dentist or dental hygienist should take a thorough medical history at each visit.  Some of the things they should look for which could indicate diabetes or prediabetes. Risk factors that indicate a potential for diabetes or pre-diabetes include:

  • Overweight or obese – BMI greater than 25
  • High blood pressure
  • Familial history of diabetes
  • High cholesterol
  • History of heart disease
  • Other symptoms or complaints may include thirst, urinating frequently, constant fatigue, weight loss (Type 1), blurred vision, and uncontrolled infections even within the mouth (poorly controlled Type 2 diabetics).

There are also dental clues that may indicate diabetes.

  • A patient that has 26% of periodontal pockets measuring 5 millimeters or more or 4 or more missing teeth (not including wisdom teeth), has a high chance of having a metabolic problem – and diabetes is a metabolic problem.
  • Periodontal disease
  • Dental caries
  • Burning mouth syndrome
  • Oral candidiasis (common in those with poor glycemic control)
  • Salivary problems or dry mouth
  • Neurosensory disorders
  • Soft tissue abnormalities such as stomatitis or lichen planus
  • Dry mouth

A chairside diabetes HbA1c (Hemoglobin A1c) test may soon be able to be performed in our practice, or if you have had a recent test with your doctor showing a result of 5.7 or greater indicates a 92% chance the patient is metabolically challenged. At this point, the patient should be referred to their physician.

If you are concerned about your oral health or are experiencing symptoms in your mouth or health that could be related to diabetes, contact us today 727-586-2681.

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