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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 periodotnal 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.




Dental implant placement: Implants are versatile. If you are missing only one tooth, one implant plus one replacement tooth will do the trick. If you are missing several teeth in a row, a few strategically placed implants can support a permanent bridge (a set of replacement teeth). Similarly, if you have lost all of your teeth, a full bridge or full denture can be permanently fixed in your mouth with a strategic number of implants.

“TYPES OF GUM DISEASE (from Mouth Healthy.org)

Untreated gingivitis can advance to periodontitis and can eventually lead to tooth loss and other health problems.

Gingivitis is the mildest form of periodontal disease. It causes the gums to become red, swollen, and bleed easily. There is usually little or no discomfort at this stage. Gingivitis is often caused by inadequate oral hygiene. Gingivitis is reversible with professional treatment and good oral home care.

Factors that may contribute to gingivitis include, diabetes, smoking, aging, genetic predisposition, systemic diseases and conditions, stress, inadequate nutrition, puberty, hormonal fluctuations, pregnancy, substance abuse, HIV infection, and certain medication use.

Untreated gingivitis can advance to periodontitis. With time, plaque can spread and grow below the gum line. Toxins produced by the bacteria in plaque irritate the gums. The toxins stimulate a chronic inflammatory response in which the body in essence turns on itself, and the tissues and bone that support the teeth are broken down and destroyed. Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Often, this destructive process has very mild symptoms. Eventually, teeth can become loose and may have to be removed.

There are many forms of periodontitis. The most common ones include the following.

Aggressive periodontitis occurs in patients who are otherwise clinically healthy. Common features include rapid attachment loss and bone destruction and familial aggregation.
Chronic periodontitis results in inflammation within the supporting tissues of the teeth, progressive attachment and bone loss. This is the most frequently occurring form of periodontitis and is characterized by pocket formation and/or recession of the gingiva. It is prevalent in adults, but can occur at any age. Progression of attachment loss usually occurs slowly, but periods of rapid progression can occur.

Periodontitis as a manifestation of systemic diseases often begins at a young age. Systemic conditions such as heart disease, respiratory disease, and diabetes are associated with this form of periodontitis.

Necrotizing periodontal disease is an infection characterized by necrosis of gingival tissues, periodontal ligament and alveolar bone. These lesions are most commonly observed in individuals with systemic conditions such as HIV infection, malnutrition and immunosuppression.”

From Mouthhealthy.org (American Dental Association)

Most of our patients can tell the difference in how their teeth and gums feel when they switch to a power toothbrush. Dr. Britten and his team can also typically tell when a patient uses an electric toothbrush versus a manual toothbrush – as there is usually a noticeable difference in the amount of plaque present as well as a patient’s gum tissue tone and color.

Improving oral health will improve overall health, a reason most patients will be happy to make the extra investment for a powerbrush. An electric toothbrush (our favorite professional-grade brands typically run from $150-200) is only a fraction of what it costs to complete most dental procedures. In the end, investing in a good power toothbrush, changing brush heads every 90 days, and using the proper technique will save you money!

Why choose a powerbrush?

Power toothbrushes usually have built in features with an advantage for better oral health.

Timer – Many brands feature a timer to ensure patients brush for a full two minutes, and may also have a pressure indicator to pause brushing or to let patients know if they’re brushing too hard and possibly damaging their gums. The Phillips Sonicare, one of our favorites, hesitates every 30 seconds, to help a patient distribute their brushing in all four sections of the mouth.

More effectively disrupts and removes harmful bacteria in the mouth.  The sonic vibrating or oscillating of bristles from an electric brush remove sticky plaque bacteria effectively and stimulate the gum tissue, reducing inflammation. Electrics brushes operate at 30,000 strokes per minute while a manual is only 200 strokes.

Simpler technique.  With a power toothbrush, all you have to do is move the brush from tooth to tooth, spending a few seconds at a time.   The professional line of powerbrushes from Phillips Sonicare are definitely our favorite because they can penetrate below the gum line to disrupt the bacterial environment formed by plaque.  Other brands, most notably the Oral B have brush heads that oscillate in a half-circle motion to remove biofilm (plaque) from the tooth surface.

Gentle and safe at the gumline.  Using a powerbrush with the correct technique will help prevent gum recession, enamel abrasion (wearing away) and tooth sensitivity from improper brushing as well as tooth decay and gum disease. Even with their phenomenal power, power toothbrushes such as the Sonicare are still very gentle on the teeth and gums. If patients have gum recession, they can just place the brush on the tooth without using a scrubbing action, which can traumatize and wear away more thin and delicate gum tissue.

Stain removal.  Electric toothbrushes help with stain removal, which is attractive to patients who really want a bright, white smile. Some Sonicare models come with a “whitening” setting or even special polishing brush heads.

Helps those with dexterity issues.  Elderly patients or others with dexterity issues can also benefit from electric toothbrushes.  Many patients can’t move their hands the way they need to, so if they use a manual brush, they’re likely leaving plaque behind. Powerbrushes help remove plaque from the teeth for them, so as long as they get it close to where it needs to be, it’s going to remove plaque and help prevent problems.

Great for kids.  Electric toothbrushes are also great options for children, especially if they have braces!

Less time brushing, with a better result! In two minutes, a power toothbrush will remove plaque and massage and stimulate gum tissue more effectively than the minimum of four minutes you would need to brush with a manual toothbrush.

Proper Technique for Effective Power Toothbrushing

Divide your mouth into four quadrants. This can help ensure that you brush each section of your teeth and mouth cavity.

Place toothbrush bristles along gum line. Hold your toothbrush at a 45 ­degree angle to your gum line with a Sonicare or 90 degrees with an oscillating brush such as the Oral B. Applying gentle pressure, keeping the bristles in contact with your tooth surface and gum line, which can help ensure you get the most effective result possible. Stay on each area for a few seconds, moving the brush only when it is time to go to the next area. Once you’ve completed this procedure for a quadrant, move to the inner surfaces of your teeth and repeat the same procedure.

To brush behind your front teeth, tilt the brush vertically using only the front half of your brush. Clean biting surfaces, your tongue, and soft palate. This can help remove debris and other odor ­causing bacteria.



If you’ve undergone treatment for periodontal (gum) disease, you know how involved it can be, whether your treatment required nonsurgical therapy, surgical therapy or a combination of both.

Following gum surgery or scaling and root planing, a nonsurgical periodontal therapy, plaque and calculus (hardened plaque deposits) are removed and as they heal swollen, red gums finally begin to regain their healthy pink color.

Treatment does not stop there. If it does, there’s a high chance of a re-infection of the gums.

Periodontal maintenance (PM) is important for gum disease patients after treatment. Plaque, a thin film of bacteria and food particles responsible gum disease, continue to grow again on your tooth surfaces as it did before. Diligent, daily brushing and flossing to curb that development.

It is also important to keep up regular dental visits for advanced cleaning to remove hard to reach plaque and calculus. For patients with gum disease it is usually four but for some advanced gum disease patients, six times a year, especially just after treatment. Many of our patients alternate visits for periodontal maintenance between our office and their general dentist so that their periodontal condition is closely monitored, as well as the health of their teeth.

Our goal is to reduce the chances of re-infection. To do this, we’ll thoroughly examine your teeth, gums and any implants for signs of disease (as well as an oral cancer screening). This includes an assessment the health of your teeth and gums and to see how well you’re doing with plaque control and review your recommended customized daily oral hygiene instructions.

Overall, we want to prevent the occurrence of any future disease and treat it as soon as possible if it relapses. Keeping up with homecare and a routine periodontal maintenance schedule will help ensure your gums continue to stay healthy.

If you would like more information on periodontal disease, please contact us or schedule an appointment for a consultation 727-586-2681.

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What do you need to know before visiting a periodontist?

The procedures we perform are very safe and the side effects are usually minimal. Here at Britten Perio, we are proud to use a gentle touch as well as the latest and most trusted techniques and technology. Most patients anticipate severe discomfort after deep periodontal cleanings or surgery, which is generally not true. When necessary, we will give you the medications necessary to reduce swelling, pain, prevent infection, and help keep things clean. Our patients routinely comment that the procedure was not nearly as bad as they imagined.

Remember, the benefits of keeping your own teeth are tremendous and although they might need some work now, the end result will be well worth it!

Some things we always need to know about you when you visit:

Your normal medications and that you will be taking them unless otherwise instructed by
If you are taking aspirin daily
If you are on blood thinners
If you are diabetic or have special diet restrictions
If you have a prosthetic joint less than 2 years old
If you have an artificial heart valve or history or endocarditis
If you have been on bisphosphonates for osteoporosis, longer than 5 years

For more information, visit us at www.brittenperio.com, call us at 727-586-2681 or message us today!

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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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How does a wisdom tooth become infected? What can happen? What can be done? Watch the video with sound for answers to these questions.

Dr. Britten normally refers to an oral surgeon for the extraction of wisdom teeth, unless gum surgery is being performed to treat other areas right next to a problematic wisdom tooth.

We work cohesively with the best dentists, prosthodontists, orthodontists, endodontists, oral surgeons, and pedodontists to provide you with the best care possible. We have a team of dentists that focuses on the area that they are trained and most skilled at and work together to provide the best care. The advantages? We strongly believe you will receive a higher quality of care and better end result.

If you have any questions about wisdom teeth or any aspect of dentistry, contact us today!

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How scaling and root planing procedures can help treat gum diseaseThe human mouth is filled with bacteria.  These bacteria, along with mucous and other particles form a sticky film called plaque is constantly forming and which adheres to the teeth.  This plaque can be removed by brushing and flossing.  When the plaque is allowed to remain on the teeth, the bacteria involved become more harmful, and more difficult to remove, creating an environment that is more toxic to the tissue.  The plaque itself can harden creating a cement like substance (calculus) that cannot be removed with brushing and flossing alone.

Your gum tissue does not attach directly to your teeth. There is a space or pocket between the gum and the tooth before it attaches. The pocket gets deeper when plaque, tartar and inflammation are present. This leads to inflammation and gum disease. The gums become irritated and begin to separate from the tooth, creating a periodontal pocket.

The bacteria and infection causing the detachment needs to be addressed.

Scaling and Root Planing

Non Surgical Periodontal Therapy includes a very important option known as scaling and root planing or “a deep cleaning” This is often recommended as the first step in periodontal therapy. Treatment is usually done by one of our hygienists using local anesthesia to provide comfort for the patient as the root surfaces in deep periodontal pockets are debrided to remove calculus or “tartar” and to smooth the root surfaces to remove bacterial toxins. This may take more than one visit with the hygienist and is followed up with a visit with Dr. Britten in four to six weeks to evaluate the periodontal tissues.

If you have any questions about gum disease or its treatments, please contact our team or make an appointment. Our incredible staff will give you the best dental care possible.

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