Gingivitis
The first stage of periodontal disease is gingivitis. It is an inflammation of the gingiva or gums and is characterized by red, tender, swollen gums, and halitosis or bad breath. It is a mild form of gum disease that can usually be reversed with daily brushing and flossing, cleaning by a dentist or dental hygienist, healthy nutrition and the cessation of smoking. This form of gum disease does not involve any loss of bone and tissue that hold the teeth in place. Untreated gingivitis can lead to periodontitis.
Periodontitis
The next stage of periodontal disease is periodontitis. It causes irreversible damage to the bone and connective tissue that support the teeth in the mouth. As it progresses the pockets deepen and the body’s immune system initiates an inflammatory response in which the body in essence turns on itself and the bone and connective tissue that hold the teeth in place are broken down and destroyed. If not treated the teeth may eventually become loose and need to be removed. While the initial cause of gum disease is bacterial plaque, there are other risk factors making one susceptible to periodontal disease:
Risk Factors
Smoking
Smoking is one of the most significant risk factors associated with the development of gum disease, and can lower the chances for successful treatment.
Hormonal changes
Hormonal changes in girls and women can make the tissue more sensitive and make it easier for gingivitis to develop. This includes puberty, menopause, and pregnancy.
Diabetes
Diabetes lowers the body’s immune system, making it easier for people to develop infections including gum disease.
Medications
Medications can affect the flow of the saliva which makes the oral tissues vulnerable to infections. Some medications can cause abnormal overgrowth of the gum tissue which makes it difficult to keep the teeth and gum tissue clean.
For more information, visit: https://brittenperio.com/oral-health/periodontal-disease/
If a tooth is too far decayed, broken below the gum line, or has insufficient structure for restoration like a crown or bridge, a procedure called crown lengthening will be needed in order to perform a cosmetic or restorative procedure. This may be the case if. In cases like this, Dr. Britten may be required to lower the gum and bone levels to expose more of the root surface so it can be restored. However, simply trimming back the gum line is not sufficient. Instead, Dr. Britten will need to reshape the gums and supporting bone to allow for adequate room to place a high quality restoration.
Several research studies have suggested that periodontal disease is connected to variety of other diseases, including heart disease, diabetes, and rheumatoid arthritis. Scientists believe that inflammation may be the basis for the link between these systemic diseases. Recent research demonstrates that inflammation may be responsible for the association. Therefore, treating inflammation may not only help manage periodontal diseases but may also help with the management of other chronic inflammatory conditions.
DIABETES AND PERIODONTAL DISEASE
Diabetic patients are more likely to develop periodontal disease, which in turn can increase blood sugar and diabetic complications.
People with diabetes are more likely to have periodontal disease than people without diabetes, probably because people with diabetes are more susceptible to contracting infections. In fact, periodontal disease is often considered a complication of diabetes. People who have poorly controlled diabetes are especially at risk.
Research has suggested that the relationship between diabetes and periodontal disease goes both ways – periodontal disease may make it more difficult for people who have diabetes to control their blood sugar. Severe periodontal disease can increase blood sugar, contributing to increased periods of time when the body functions with a high blood sugar. This puts people with diabetes at increased risk for diabetic complications.
HEART DISEASE
Several studies have shown that periodontal disease is associated with heart disease. Research has indicated that periodontal disease increases the risk of heart disease. Scientists believe that inflammation caused by periodontal disease may be responsible for the association.
Periodontal disease can also exacerbate existing heart conditions. Patients at risk for infective endocarditis may require antibiotics prior to dental procedures. Dr. Britten and your cardiologist will be able to determine if your heart condition requires use of antibiotics prior to dental procedures. STROKE
Additional studies have pointed to a relationship between periodontal disease and stroke. In one recent study people diagnosed with acute cerebrovascular ischemia were found more likely to have an oral infection when compared to those in the control group.
OSTEOPOROSIS
Researchers have suggested that there is a link between osteoporosis and bone loss in the jaw. Studies suggest that osteoporosis may lead to tooth loss because the density of the bone that supports the teeth may be decreased, which means the teeth no longer have a solid foundation. RESPIRATORY DISEASE
Research has found that bacteria that grow in the oral cavity can be aspirated into the lungs to cause respiratory diseases such as pneumonia, especially in people with periodontal disease. CANCER
Researchers found that men with gum disease were 49% more likely to develop kidney cancer, 54% more likely to develop pancreatic cancer, and 30% more likely to develop blood cancers.
Our occlusion (bite) forces are evenly distributed among all of our teeth. When something occurs to alter a healthy occlusion; like loss of a tooth, clenching and grinding, occlusal trauma can occur. There are several signs and symptoms of occlusal trauma including, wear or chipping of the teeth, sensitive crevices on the teeth, gum recession, shifting teeth, tender muscles, headaches, or a “popping” sound when opening and closing your mouth. This trauma places excessive pressure on teeth and these forces can contribute to bone loss and result in the loosening of the teeth. The goal of occlusal therapy is to create an even distribution of these forces allowing the bone and ligaments to heal. This is done by an occlusal adjustment or equilibration to divide the biting pressure evenly across all of the teeth by reshaping the biting surfaces of the teeth and eliminating spots of excessive pressure when the teeth are brought into contact. The use of an occlusal night guard may be needed to control the pressures generated by clenching and grinding.
For more information about non-surgical procedures for gum disease, visit:
When you have periodontal disease, the supporting tissue and bone is destroyed, forming “pockets” around the teeth. Over time, these pockets become deeper, providing a larger space for bacteria to live. Traditionally, gum disease is treated by eliminating these gum pockets and creating a clean environment around the tooth so that the tooth or teeth can be retained rather than lost. The infected gum tissue is trimmed away and uneven bone tissue re¬contoured. Periodontal flap surgical therapy remains one of the most effective ways of treating gum disease.
For more information on the surgical procedures performed in our office, visit our website at:
Important information about Dementia and Dentures!
Over time, dentures may loosen for patients due to both weight loss or as the jaw bones shrink away over the years. On average, dentures will naturally loosen even with no weight loss and dentures often require replacement every 10 years.
For patients with Alzheimer’s or Dementia, if it seems time to replace the dentures, a patient and their family need to assess the likely adaptability i.e., the ease with which someone can tolerate change – or even dental visits – as this will affect the success and comfort of the denture and the denture wearer.
Surprisingly many patients with Dementia can function well without any teeth as long as they can eat and socialize comfortably. In the later stages of Alzheimer’s or Dementia, a person may no longer tolerate their denture, and sometimes even be happier or more comfortable without their denture! At this stage, it is usually more of a difficult issue psychologically for the family and friends rather than the person with advanced Dementia or Alzheimer’s Disease themselves.
Things that may help for loose dentures that a dementia/Alzheimer’s patient can still tolerate wearing:
1) Use a over the counter fixative like Fixodent … Fixatives will not fix so aggressively that you will have difficulty removing the denture!
2) If the person with Dementia or Alzheimer’s is in a care home, please ensure the dentures are kept in labeled box (not in tissues or disposable cups which get thrown away). Maybe even consider a denture box with their name and a photo of dentures on them can help! They should take dentures out at night and clean them for hygiene purposes.
3) Speak to your dentist about relining the denture. Homemade relines may help very temporarily, but if a denture reline is done improperly t can cause some quite complicated changes in the way the teeth meet.
4) Please discuss all options with your dentist so that you are all happy with your outcomes.
Talk to your dental professional about any questions or concerns you have about your teeth, gums or dentures when it comes to yourself or a loved one with Dementia or Alzheimer’s -we are here to help!
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“There’s more to your dental visit than just preventing or treating teeth or gum problems,” states Clearwater Periodontist Dr. Todd Britten. Dental professionals are also on the lookout for a number of potential soft tissue problems that could occur in or around your mouth. “There are many soft tissue conditions of the mouth that we evaluate for during a periodontal or general dental examination, but one of our biggest growing concerns is oral cancer,” says Dr. Britten.
In the last 10-15 years, a type of cancer affecting the head and neck has snowballed. That threat is human papillomavirus, or HPV. This cancer is often found on the tongue, mouth or throat and is caused by the human papillomavirus HPV type 16, which is the same high-risk HPV that causes cervical cancer.
An April 2017 data brief released by the Centers for Disease Control and Prevention (CDC) shows the prevalence of HPV of all types was 7.3% among U.S. adults ages 18 to 69. Four percent of that population carries the high-risk HPV.1
“Most types of oral HPV go away before they cause any health issues,” Britten says. He explains that if a patient develops oral warts, also known as an oral papilloma due to HPV, it can be removed by surgical removal, cryotherapy, which is where the wart is frozen, or interferon alfa-2B (Intron A, Roferon-A), which is an injection.
Although most people who are exposed to the virus clear it, the virus can remain persistent. “Those who are unable to clear it end up having a risk of developing the oral form of this cancer,” says Dr. Richard Jordan D.D.S., Ph.D, professor of Oral pathology, Pathology and Radiation Oncology, University of California San Francisco, who recently presented “HPV: An old foe in a new form” at the March 2017 American Academy of Dermatology (AAD) annual meeting in Orlando, Fla.
“Most of the people that have this virus persisting in their bodies probably picked it up 20 years ago, when they first become sexually active. The virus makes a home in their throats or tongues, sits there for 20 years and eventually develops into cancer in their 40s or 50s,” he says. “This is actually the same story as with the cervix in women… Most women get rid of the virus, but some are unable to clear the virus. They’re the ones that end up getting in trouble with cervical precancers.”
The number of people impacted by the oral cancer due to HPV is growing, but due to regular pap smears, cervical cancer rates have declined. Dr. Richards projects that by 2030 there will be more patients per 100,000 with mouth cancer due to HPV, compared to cervical cancer.
Dr. Todd Britten states that this leads us to believe that dental specialists such as restorative dentists, periodontists, and dental hygienists, who often see their patients for preventative or periodontal maintenance visits anywhere from every 3 to 6 months, are in the perfect position to screen for oral cancer in the hopes of catching it in its precancerous stages.
In under 30 seconds, your dental professional will scan the oral cavity for abnormalities. HPV disease mostly occurs in the tongue and in the tonsil region, so examining the tongue, the sides of the tongue and the base of the tongue and the tonsillar region. An oral cancer screening, including the HPV screening exam includes looking for an ulcer or an abnormal growth. “Patients should also do an at-home screening monthly using a flashlight, and report any sores or growths that seem unusual and do not go away by themselves in two weeks, or constantly reoccur,” says Dr. Todd Britten. If an abnormal growth is detected, Dr. Britten says he is able to perform some biopsies in his Clearwater Florida practice, and when necessary, refer to an oral surgeon.
Sometimes, infection with HPV in the oral cavity has no evidence of sores or growth. Early symptoms of oropharyngeal cancer include trouble swallowing, constant earaches, coughing up blood, unexplained weight loss, enlarged lymph nodes constant sore throats, lumps on the cheeks, growths or lumps on the neck, hoarseness or trouble speaking.
If you notice any of these symptoms and you know or think you may have HPV, make an appointment with your doctor immediately.
Treatment options are available for oral cancer caused by HPV. The treatment and prognosis depend on the stage and location of the cancer and whether or not it’s associated with HPV. Treatment for cancer caused by HPV can include radiation therapy, surgery, chemotherapy, or a combination of these. The good news is HPV-positive oropharyngeal cancers have better outcomes and fewer relapses after treatment than HPV-negative cancers.
Dr. Richard Jordan also reports that non-smokers respond very well to radiation treatment for HPV oral cancers, while unfortunately, smokers tend to have fairly aggressive disease and a poor five-year survival rate, according to Dr. Jordan.
“After five years, about 60% will be dead; about 40% will be alive,” he says. “HPV responds very well to currently available cancer therapies. If the patient doesn’t smoke, the five-year survival rate is extraordinarily high—at 80 or 90%.”
A periodontist is mainly concerned with diagnosing and treating soft tissue problems. Some soft tissue conditions include Lichen Planus, Benign Mucous Membrane Pemphigoid, Geographic Tongue, Burning Mouth Syndrome, Apthous Ulcers and Oral Mucositis from Chemotherapy, among many others. “Oral cancer screenings are part of our regular soft tissue evaluation,” says Dr. Britten. We work with the finest general dentists and oral surgeons to catch any irregular, precancerous or cancerous conditions in our patients’ mouths.
Nightguards purchased online or at the drug store are not custom fitted, they are usual one size fits all or boil & bites. They can be large, unattractive, poorly fitting and may even come out during the grinding.
Your dentist is trained in how a persons’ bite should function, how the teeth should come together and will take into account your specific situation and grinding pattern. Your dentist’s office will take impressions of your teeth so that the dental lab can make a might guard that is the exact match to your teeth.
Although the initial investment may be greater, a custom fit nightguard can be an extremely worthwhile investment in the long run. It is designed by your dentist to fit your teeth exactly and is much more likely than a store bought guard to prevent you from needing more expensive dental work in the future. In many case, dental insurance covers all or part of the cost.
Many people clench or grind their teeth whether they realize it or not. Clenching and grinding can be detrimental to your teeth and to their supporting structures (gum tissues and bone).
It can cause wear on the biting surfaces, root defects, gum recession, contribute to gum disease and tooth shifting and mobility, and cause muscular and TMJ (joint) issues.
Most people are completely unaware that they do it, because it happens while they are sleeping. Many patients do not realize they grind their teeth and find the thought of wearing a night guard very unappealing.
Dr. Britten can check your teeth and bite for signs of abnormal clenching and grinding and work with your dentist to fabricate the right appliance for you. Contact our office at 727-586-2681, or via email at .
There are three main types of tooth discoloration:
Extrinsic — This occurs when the outer layer of the tooth (the enamel) is stained. Coffee, wine, cola or other drinks or foods can stain teeth. Smoking also causes extrinsic stains.
Intrinsic — This is when the inner structure of the tooth (the dentin) darkens or gets a yellow tint. You can get this type of discoloration if:
You had too much exposure to fluoride during early childhood.
Your mother used tetracycline antibiotics during the second half of pregnancy.
You used tetracycline antibiotics when you were 8 years old or younger.
You had trauma that affected a tooth when you were a young child. A fall, for example, may damage the developing permanent tooth.
You had trauma in a permanent tooth, and internal bleeding discolored the tooth.
You were born with a rare condition called dentinogenesis imperfecta. This causes gray, amber or purple discolorations.
Age-related — This is a combination of extrinsic and intrinsic factors. Dentin naturally yellows over time. The enamel that covers the teeth gets thinner with age, which allows the dentin to show through. Foods and smoking also can stain teeth as people get older. Finally, chips or other injuries can discolor a tooth, especially when the pulp has been damaged.
Symptoms
Symptoms include stains on the enamel. They can range from white streaks to yellow tints or brown spots and pits. If the enamel has worn away, and dentin is showing through, you may notice a yellow tint.
Expected Duration
Some tooth discoloration can be removed with professional cleaning. An example would be the stains caused by coffee. Many stains are permanent, however. Teeth sometimes can be whitened with a bleaching gel. In some cases, if the discoloration is severe, a crown or veneer may be required to cover it.
Prevention
Brushing your teeth after every meal will help to prevent some stains. Dentists recommend that you rinse your mouth with water after having wine, coffee or other drinks or foods that can stain your teeth. Regular cleanings by a dental hygienist also will help to remove surface stains.
Intrinsic stains that are caused by damage to a nerve or blood vessel in a tooth sometimes can be prevented. You may need to have root canal treatment to remove the inner part of the tooth (the pulp) before it has a chance to decay and darken. However, teeth that have root canal treatment may darken anyway.
To prevent intrinsic stains in children, avoid too much early exposure to fluorides. Once the enamel is formed, fluoride will not discolor teeth.
Treatment
Many extrinsic stains caused by food and drink can be removed by regular professional cleanings and home care. Good home care includes brushing, flossing and rinsing after meals.
Discoloration often can be removed by applying a bleaching agent to the tooth enamel. One technique is called “power bleaching.” With this method, the dentist applies a light-activated bleaching gel. It causes the teeth to get significantly whiter in about 30 to 45 minutes. Several follow-up treatments may be needed, or take-home bleaching trays may be provided.
It’s also possible to remove discoloration at home. You will use a bleaching gel and a mouth guard given to you by your dentist. The bleaching gels designed for use at home aren’t as strong as those applied by your dentist. This means that the process takes longer — usually two to four weeks.
You also can buy whitening products over the counter. They contain a weaker bleach than the products you can get from your dentist. The whitening agent is applied as a gel placed in a mouthpiece or as a strip that sticks to your teeth. Over-the-counter mouthpieces fit less securely than the kind you get from your dentist, but they will lighten your teeth over time.
Whitening toothpastes may remove minor stains. They do not actually change the overall color of your teeth.
If your tooth has darkened after a root canal, bleaching the enamel won’t help. Your dentist can apply a bleaching material to the inside of the tooth, or you may consider a crown or veneer.
Bleaching will not lighten some stains, such as tetracycline stains. In this case, your dentist may recommend covering the discolored areas. This also may be useful when the tooth is chipped or badly damaged.
A tooth can be covered with a color-matched composite bonding material. Another option is to get veneers. These are thin ceramic shells that cover the outer surfaces of the teeth.
When To Call a Professional
Tooth discoloration is mainly a cosmetic problem. Visit a dentist if you’re unhappy with how your teeth look. Any change in a child’s normal tooth color should be evaluated by a dentist.
On November 1st, Dr. Todd M. Britten and the team at Britten Periodontics & Implant Dentistry held their 5th annual Day of Care for Veterans. Dr. Britten and his team are aware that dental coverage for veterans for major dental surgery can be very hard to attain, so they “hit the ground running” in 2015 trying to deliver periodontal care to as many veterans as they could. Dr. Britten says he owes the success of the event for the last 5 years to the help of local dentists, Clearwater Dental Associates (Dr. Nolan Allen, Dr. Matt Burton, Dr. Jim Hayslett and Dr. Keith Kiskaddon), Dr. Jeffrey Ellenberg, Dr. Ira Berger, Dr. Michael Podlusky and the local Community Dental Clinic.
Dr. Britten provides advanced periodontal surgical treatment and dental implant care for veterans in his Clearwater, Florida based periodontal practice. He offers sedation options and high-tech treatment, which can be very helpful to veterans that suffer from PTSD.
For Britten and his team this event is something they look forward to all year long. They keep in touch with veterans from previous events and this year they were able to provide follow up exams, x-rays and periodontal maintenance procedures, which help prevent reinfection of the gums following treatment. “It is always great to see them again and the progress they have made in their oral health. It is touching to be a part of something that has changed someone’s life in such a positive way,” said one of Dr. Britten’s volunteers.
Dr. Britten explained that local restorative dentists and their teams have volunteered each year to help provide comprehensive dental care to our veterans. As a periodontist, Dr. Britten’s specialty is the surrounding structures of the teeth; roots, gum and bone; i.e., the foundation. The restorative specialists have done fillings, crowns, and even full sets of dentures for veterans at no cost each year. “Our practice alone has provided over $50,000 in periodontal procedures for patient,” said a dental hygienist at Britten Periodontics who has helped to coordinate the event each year.
Dr. Britten says he would like to continue this event for the entirety of his career. “I have always respected the sacrifices that our veterans and their whole families had to make to ensure our safety and freedom. The sacrifices are really innumerable.”
