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 healthysmiles@brittenperio.com.
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.”
The best way to prevent periodontal disease is to brush and clean between your teeth effectively every day. Regular dental checkups and professional cleanings every 3 or 4 or 6 months are also an important part of maintaining periodontal health; the instruments and techniques used in these cleanings can reach into areas that your toothbrush and floss can’t.
It is also possible to detect early forms of gum disease by evaluating your gingival (gum) tissues, both visually and by examining their attachment levels to the teeth. And the health of your tooth-supporting bone can be assessed by taking dental radiographs (x-rays pictures).
There are other steps you can take: Eating right, reducing stress in your life, and giving up unhealthy habits like smoking will also help ensure that you keep your teeth for a lifetime.
Watch this video about Healthy Gums from Spear Education
A diet high in sugar certainly promotes the formation of cavities, but sugar itself isn’t the only culprit behind tooth decay.
Cavities are formed when bacteria living in the mouth digest carbohydrates left on the teeth after you eat. This includes refined sugars found in cookies, candy or other treats, however they may also come from healthy foods like whole grains, vegetables and fruits.
When digesting carbohydrates, bacteria in your mouth produce an acid that combines with food debris and saliva and forms plaque.
It’s the plaque — not sugar — that directly leads to tooth decay. Plaque starts building up after every meal, and if it isn’t brushed away frequently, it can erode the hard, outer enamel of a tooth, resulting in tiny holes in the tooth’s surface. These holes mark the first stage of cavities and can do a lot of damage to a tooth if left untreated.
Eventually, acid and bacteria in plaque can eat through the other layers of your teeth, as well — from the softer layer of teeth under the enamel, known as dentin, to the third layer (the pulp), which contains your teeth’s blood vessels and nerves. Cavities affecting the pulp of a tooth, as well as the bone supporting the tooth, can cause severe toothaches, sensitivity, pain when eating and even abscesses in the mouth.
It is important to know that the kinds of foods and drinks you consume, and how you are consuming them is also important to oral health.
Sticky foods — like hard candy, breath mints, raisins and dry cereal — can get stuck in the grooves and crevices of your teeth, where they could cause decay. Fruit and yogurt, on the other hand, wash away easily with saliva and are, therefore, less likely to cause plaque buildup.
Quickly finishing a can of soda does less damage to your teeth than sipping on it throughout the day, because the acid created by mouth bacteria stays in the mouth around 20 minutes after eating or drinking. Every time you eat carbohydrates, sugary food, or take a sip of soda, you restart the plaque-production clock and increase your risk of developing cavities.
In addition to a high sugar content, soft drinks and sports drinks also contain phosphoric and citric acids that erode tooth enamel. Eating or drinking highly acidic foods — even healthy foods, like citrus fruits — can lead to tooth decay if oral hygiene is not properly maintained.
None of us can totally avoid eating all carbohydrates, sugars, or acidic foods all of the time but we can limit the amount and more importantly the frequency of consumption. And we can also work on effective and regular plaque control by using oral hygiene aids to remove the plaque colonies which are forming constantly on the teeth.
Dr. Britten recommends brushing at least twice a day with a power toothbrush for two minutes as well as cleaning between the teeth at least once a day using floss or other interdental aids.
While regular brushing, flossing, and checkups allow many of us to maintain our natural smiles for a lifetime, sometimes our teeth just can’t keep up. If you’ve lost a tooth (or a few teeth) due to injury or disease, dental implants can rejuvenate both your smile and your oral health.
An implant is a synthetic tooth root in the shape of a post that is surgically placed into the jawbone. The “root” is usually made of titanium (the same material used in many replacement hips and knees), a metal that is well suited to pairing with human bone. A replacement tooth is then fixed to the post. The tooth can be either permanently attached or removable. Permanent teeth are more stable and feel more like natural teeth.
The ideal candidate for implants is a non-smoker who has good oral health, including a sufficient amount of bone in the jaw and healthy gums with no sign of gum disease.
Dr. Todd Britten received his Bachelor of Science & Doctorate of Dental Surgery from University of Florida, a Master’s Degree and Certificate in Periodontology and Implant Dentistry; and completed extensive training at the Institute of Advanced Laser Dentistry. He is one of the only board-certified periodontists in Pinellas County. He is a member of the American Academy of Periodontology, American Dental Association, Florida Association of Periodontists, Upper Pinellas County Dental Association, Hillsborough County Dental Association, Hillsborough County Dental Research Association and Florida West Coast Dental Association.
To learn more about Dr. Britten and his dental services, call (727) 586-2681 or visit www.brittenperio.com
