Dr. Todd M. Britten and the team at Britten Periodontics & Implant Dentistry is gearing up for their 7th annual Free Dental Day for Veterans. The event is scheduled for November 12, 2021.
“Veterans make the ultimate sacrifice for our country,” said Dr. Todd Britten. “Many of us ask ourselves, ‘What can we do?’, ‘How can we make a difference?’” Dr. Britten said that is exactly what he asked himself in 2015. “I am aware that dental coverage for veterans was very hard to attain, so we hit the ground running trying to deliver periodontal care to as many veterans as we could.”
The inaugural year of this event was 2014 for the the Clearwater, Florida based periodontal practice. Many others in the community have helped out each year since then. Dr. Britten stated, “Having local dentists involved enables us to provide more comprehensive care to our veterans. Being a periodontist, my specialty is really the surrounding structures of the teeth; roots, gum and bone. My job is to help with the foundation. Having restorative specialists involved helps us to treat the whole mouth and really deliver comprehensive care to these veterans.”
“This year’s event filled up right away again!” Said a staff member at Britten Periodontics. “We look forward to greeting veteran’s, old firends and new, for this year’s event.”
Britten Periodontics & Implant Dentistry is a periodontal practice offering patients personalized dental care in implant dentistry in Clearwater, Florida. Dr. Todd Britten offers sedation dentistry. For more information, visit https://brittenperio.com
Dental implants are fantastic, but like anything biologic or placed in or on the human body can NOT always be completely predictable or guaranteed all the time. One of the long-term risks associated with dental implants is a condition called Peri-implantitis.
Peri-implantitis is an infectious disease that causes inflammation of the surrounding gum and bone of a dental implant, and can lead to the loss of supporting bone. This condition is very difficult to treat.
Fortunately, most patients receiving dental implants never develop this condition. Sometimes, for a variety of reasons, bone can be lost around a dental implant. This will often occur without a patient ever being aware of it. Some dental implants will develop bone loss very early after having the implant crown is placed or it can happen many years down the road. Most patients are unaware that they have bone loss around the dental implant. Peri-implantitis generally begins painlessly and without symptoms. Once peri-implantitis becomes advanced, symptoms can develop and the patient will notice.
There are several risk factors for peri-implantitis, especially smoking. Smoking definitely causes constriction of blood vessels which leads to bone loss. Medical issues such as Diabetes, Osteoporosis and a weakened immune system are more at risk for developing bone loss around dental implants. Those with a history of gum disease are more at risk.
Good home care is critical. Brushing twice a day for 2 minutes or more with an electric toothbrush, flossing once a day and using adjuncts such as a rubber tip or implant floss every day! Grinding your teeth is another risk factor for dental implant bone loss. Factors related to the surgical procedure can also cause peri-implantitis to later occur: Soft bone, lack of tightness when the dental implant is placed, bone that was grafted in a vertical fashion, implant size too big, overheated bone, and many others.
Signs of Peri-implantitis
• Deep periodontal pockets around the implant
• Pus comes out from the implants and gums
• Bleeding at the gumline
• Appearance – Gum tissue may appear red, or slightly purplish bluish, and tartar/plaque build up is noted
• Progressive loss of supporting bone on x-rays
• Metal thread exposure
• Long tooth
Again, peri-implantitis is not always symptomatic and typically there is no pain. Some patients will complain of a dull ache or tenderness when they brush or touch the area. A bad taste can develop if infection or pus has developed around the implant. If this infection around the implant becomes very severe, the glands in your neck may become swollen and the dental implants may begin to be noticeably loose.
The first thing an implant specialist will usually check around the implant is to make sure the crown or bridge was made properly. An x-ray, or sometimes a 3-D Cone Beam CT scan is necessary to see the inside surface. Extra cement can often be the cause of peri-implantitis. The cement oozes beyond the abutment and gets down below the gum near the bone and becomes an irritant. There is often good reason to make crowns held in by screws rather than cement in some cases. The technique of cementation and choice of cement used is a big factor on implant success!
This is why it is important to work with an experience implant specialist and restorative dentist in implant placement.
Occasionally a loose abutment screw may be present which may not have been torqued properly or it has broken, sometimes due to a patient’s heavy bite. Patients with heavy bites need to have their crowns designed to protect the implants.
How an implant crown is made is critical for the longevity of the dental implant in the bone. Low-budget implants have poorly designed screws or may move (even microscopically) when you chew.
Sometimes gum disease on nearby teeth can stimulate peri-implantitis to start on the implant. Generally some type of exploratory surgery needs to be done to find out the cause of peri-implantitis along with a simultaneous bone graft to save the implant. Not all implants that have developed peri-implantitis can be saved.
Treatment
The long-term goals are to stop the progression of bone loss and maintain your dental implants! Generally speaking the area will need to be cleaned thoroughly using dental instruments. Sometimes antibiotics will be prescribed or special antibacterial agents will need to be applied to the implants itself such as iodine or tetracycline.
Sometimes a laser procedure can be performed around the implant, called LAPIP, to sterilize the implant. Most peri-implantitis dental implants require surgery and bone grafting. This means that the dental implant surgeon has to open the gum tissue in order to detoxify the implant. All of the bacteria will be killed in order to have bone re-grafted onto the implants. The physiology and the type of bone that is used is critical. Sometimes your implant surgeon will recommend using your body’s own helpful blood products such as PRF/ PRP. The best way to prevent peri-impantitis is to have the implant properly placed by a specialist and restored by a highly experienced restorative dentist. Oral surgeons and periodontists have extensive training and have also developed more predictable implant placement technique. When an implant has had too much bone loss, a success rate can be as low as 35 to 50%. Some severe cases of peri-implantitis are better off removing the implant and placing a new one if detoxifying and regrafting do not seem to have a good long-term prognosis. If one implant fails or develops bone loss, it doesn’t mean the second one will. Time will tell if the procedure works. There are no guarantees on grafting around implants that have pre-existing bone loss. It is far more successful if the bone missing is in the shape of a moat rather than an entire wall missing.
Correction of dental implants with problems should be performed by an implant specialist and highly trained restorative dentist who routinely performs this procedure. Dr. Todd Britten is a periodontist and implant specialist practicing in Clearwater, Florida. As periodontist, Dr. Britten specializes in the prevention, diagnosis, and treatment of periodontal disease, the placement of dental implants and bone grafts, and treatment of oral inflammation. Periodontists also perform cosmetic periodontal surgery. Dr. Britten has received an additional three years of specialty education and surgical training beyond dental school and has experience in treating this very difficult condition. If you have any questions regarding implant placement, contact us at 727-586-2681 or email us at .
Wisdom teeth — the third molars in the very back of your mouth — may not need to be removed if they are:
Healthy
Grown in completely (fully erupted)
Positioned correctly and biting properly with their opposing teeth
Able to be cleaned as part of daily hygiene practices
Many times, however, wisdom teeth don’t have room to grow properly and can cause problems. Erupting wisdom teeth can grow at various angles in the jaw, sometimes even horizontally. Problems can include wisdom teeth that:
Remain completely hidden within the gums. If they aren’t able to emerge normally, wisdom teeth become trapped (impacted) within your jaw. Sometimes this can result in infection or can cause a cyst that can damage other teeth roots or bone support.
Emerge partially through the gums. Because this area is hard to see and clean, wisdom teeth that partially emerge create a passageway that can become a magnet for bacteria that cause gum disease and oral infection.
Crowd nearby teeth. If wisdom teeth don’t have enough room to come in properly, they may crowd or damage nearby teeth
Impacted Third Molar Causing Bone Infection
Some dentists recommend removing wisdom teeth if they don’t fully emerge. Many dentists believe it’s better to remove wisdom teeth at a younger age, before the roots and bone are fully formed, and when recovery is generally faster after surgery. This is why some young adults have their wisdom teeth pulled before the teeth cause problems.
According to the American Dental Association, wisdom teeth removal may be necessary if you experience changes in the area of those teeth, such as:
Pain
Repeated infection of soft tissue behind the lower last tooth
Fluid-filled sacs (cysts)
Tumors
Damage to nearby teeth
Gum disease
Extensive tooth decay
The decision to remove wisdom teeth isn’t always clear. Talk to your dentist or an oral surgeon about the position and health of your wisdom teeth and what’s best for your situation.
Thomas J. Salinas, D.D.S. (Mayo Clinic Online Article)
There are actually several negative consequences of missing some or all of your teeth. First, missing teeth will affect the esthetics of your face. Not only will your smile be affected by the gaps from missing teeth, but if you’re missing too many teeth, the skin around your mouth won’t be supported properly and will start to sag, making your appear older than you are. Additionally, missing teeth will make it more difficult to chew your food properly and may even affect the way you speak. Finally, missing even one tooth may have emotional consequences; many people feel less confident about their smile when they are missing teeth. If you are currently missing any of your teeth, consider replacing them with dental implants, which can look and feel just like natural teeth. For more information about implants, browse perio.org or talk to your periodontist.
Q: I have big gums and short teeth, so when I smile you can almost only see my gums. I don’t smile very often anymore because I am so self conscious of my gums. Is there a way to improve my smile?
A: Yes, there may be a way to enhance your smile. It’s a good idea to discuss your options with a periodontist first. He or she can explain the best way to create the smile you want, as well as answer any questions that you may have. For example, one procedure that can remove excess gum tissue is called crown lengthening. After the excess gum tissue is removed, the gum line is then reshaped in order to create the right proportion between gum tissue and tooth surface. Your general dentist and periodontist may also work together to coordinate additional treatments such as veneers or crowns. However, your periodontist and general dentist will recommend the best procedure to improve your smile.
Regular examinations are very important to keep track of the present status of your disease and any disease progression over time. Your periodontist will work with you to create a maintenance schedule depending on how advanced your periodontal disease is at that time. Based on many variable factors such as your overall health, the severity of bone loss, and risk factors such as smoking and genetics, your periodontist will constantly tailor your care so your periodontal disease does not progress further. He or she may recommend exams every six months for mild periodontal disease, or every few months for more advanced stages.
Do not blow your nose. Avoid things that will make you sneeze or cough. Do not blow your nose hard or vigorously inhale. If you have to cough or sneeze, do it with your mouth open. This will allow the pressure to go out the mouth, not the nasal sinuses.
Take the prescribed Motrin or ibuprofen every 8 hours, for a minimum of one day. Take stronger pain medication as needed. Discontinue as discomfort subsides.
Take antibiotics as prescribed, finishing prescribed dose.
Apply ice to site 20 minutes on, 20 minutes off.
Avoid extremely hot beverages for the first 48 hours, cold is encouraged.
Do not create positive pressure in mouth (for example, drinking through a straw or SMOKING).
Expect minor bleeding.
Expect a minor nose bleed.
Rinse with Peridex as instructed.
Do not exercise for the first week.
You may be aware of small granules in your mouth for the next few days. This is not unusual, as your graft is mainly made of particles and some excess particles will be lost.
If you feel congested, you may need to use antihistamines or decongestants. If you do, use over the counter product such as Sudafed, Tavist-D, or Dimetapp. I would also suggest that you avoid nasal sprays unless they are saline.
SINUS AUGMENTATION – DETAILED INSTRUCTIONS
ACTIVITY: After leaving our dental office today, we suggest you consider relaxing or at least limiting your activity as much as possible for the remainder of the day. Avoid strenuous activity or aerobic exercise for the next 2-3 days.
DISCOMFORT: Some discomfort may be present when the anesthesia wears off. You may have been given a prescription for an anti-inflammatory (NSAID) analgesic. Please take this every 4-6 hours or four times per day for at least the first day. This drug will greatly decrease the possibility of post-surgical swelling and pain, and has shown to accelerate healing. Should more significant discomfort occur at any time after the surgery, please take the narcotic medication (if one has been prescribed for you), as directed. You may take both the narcotic and NSAID together. Their analgesic effect will be synergistic.
INFECTION: Please continue taking your antibiotic until gone. If you notice that after a few days, pain or swelling are increasing, or that you are experiencing an elevated temperature, or after one week are seeing yellow or green discharge from your nose, please call our office.
ANTIHISTAMINE USE: Antihistamines should be taken every 6-8 hours, or 2-3 times per day for a least the first 4-5 days, particularly if you are having any symptoms of “stuffiness” or tendency to sneeze. Antihistamines can make you drowsy. If this is the case, then reduce the dosage, i.e., take them twice a day instead of three times a day. Continue to use saline nasal spray, one puff every 6-8 hours for the first three days, or longer, if symptoms of “stuffiness” and difficulty breathing through your nose are present.
SWELLING: It is normal to experience some facial swelling after surgery. To minimize this, apply an ice bag wrapped in a light tea towel or handkerchief to the outside of your face over the operated area. This should be left on your face for about 20 minutes, then removed for 20 minutes, or alternated from side-to-side, between operated areas, for 2-3 hours after surgery. The use of both ice and the NSAID analgesic as described above will reduce facial swelling.
BLOWING YOUR NOSE: Do not under any circumstances, blow your nose for the next 4 weeks. This may be longer if indicated. You may sniff all you like, but NO BLOWING.
Do not blow or sneeze holding your nose. Sneeze with your mouth open. Do not drink with straws and do not spit. Scuba diving and flying in pressurized aircraft may also increase sinus pressure and should be avoided. Decongestants such as Drixoral, Dimetapp, or Sudafed will help reduce pressure in the sinuses. Avoid “bearing down” as when lifting heavy objects, blowing up balloons, playing musical instruments that require a blowing action or any other activity that increases nasal or oral pressure. Smoking must be stopped.
BLEEDING: It is common to have slight bleeding for a few hours following surgery. Most of the blood you may see in your mouth is actually a little bit of blood mixed with a lot of saliva – blood is a very strong “dye” and a little bit of blood will color your saliva dramatically. If bleeding persists, apply a tea bag to the surgical site with gentle pressure for 15-20 minutes. Let yourself rest for 15 minutes then repeat the application of the tea bag for a second time if you still have slight bleeding. If excessive bleeding continues, please call our office or the doctor after normal office hours. You may experience some blood discharge from your nose. If so, lie down, with your head slightly elevated and apply an ice pack over your midface-nasal area. If this bleeding does not stop within 30 minutes, telephone our office.
ORAL HYGIENE: Brushing and oral hygiene procedures should be done as usual in all untreated areas. The exposed operated areas will be cleansed by rinsing with Peridex (Chlorhexidine) at bedtime and again in the morning after breakfast.
EATING AND DRINKING: High protein foods and liquids are desirable for 3-5 days following surgery. Semi-solid foods may be eaten as long as this may be done comfortably. Eggs, custard, yogurt, pasta, steamed vegetables, casseroles, cooked cereals are some thing that you might consider eating during the first few days following your surgery. Avoid spicy, salty, acidic, very hot or very cold foods or liquids. Also, avoid nuts, chips or other crunchy or fibrous foods which may become caught between your teeth. Please refrain from drinking alcoholic beverages the day of surgery.
USE OF REMOVABLE DENTAL APPLIANCES: If you normally wear a removable appliance which replaces missing teeth, and it rests on the operated area, it is best to minimize use of this appliance as any pressure on the surgical site could be detrimental to healing and cause discomfort.
Dr. Britten is genuinely concerned about your well being and postoperative healing. If you experience any symptoms, which you feel are unusual, please feel free to contact us any time. After hours, Dr. Britten can be reached at his emergency number listed on our office voicemail message 727-586-2681.
INTERDENTAL BRUSHES AND SOFTPICKS
OTHER IMPORTANT ORAL HYGIENE AIDS:
