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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 3 Main Parts of a Dental Implant

1. The Fixture
The fixture is the bottom of the implant and is the part that is embedded below the gum line, fusing with the jawbone.  It is like the root of the tooth. The fixture is made of titanium and has a cylindrical, screw-shaped design. It is often coated with a material known as hydroxyapatite, which can assist with the process of fusing the implant to the jaw bone. This part is placed first and appropriate healing has to take place before the restorative phase, which includes placing the abutment and crown.
2. The Abutment
The abutment is screwed into the fixture and will eventually hold the actual tooth portion that you see in your mouth. It is a small piece that lies right around the gum line.
3. Implant crown
The crown is cemented or screwed into the abutment. If the prosthesis is a crown or bridge, or snapped onto the abutment if the prosthesis is a bridge or denture.
Dental implants are designed and constructed to be extremely strong and able to last decades, becoming a permanent solution to replace missing or chipped teeth.

If you have any questions about Dental Implants, please contact our team or make an appointment. Our incredible staff will give you the best dental care possible. Contact us today:

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Dental implants have become a vital and mandatory option for tooth replacement in recent years. Modern implant dentistry has seen major advancements in popularity and success, including better diagnostic tools for implant planning, periodontal regenerative procedures for better jaw bone support, and high-quality dental implant systems. Dr. Todd Britten is utilizing advancements in dental implant technology in his Clearwater, Florida periodontal practice.

I am excited about the many advancements in implant planning, placement and technology.

Advances in implant dentistry allow periodontal and dental implant specialist Dr.Todd Britten better tools for diagnosis and implant planning, regenerate lost bone more predictably, and place implants with more accuracy and into more sites than ever before.

Cone Beam Technology

Dr. Todd Britten now uses Cone Beam technology in his Clearwater, FL periodontal office for a better understanding of his patients’ anatomy, allowing him to place dental implants in exactly the right place and more effectively replace missing teeth. Traditional dental x-rays provide a limited picture of the patient’s mouth and jaw. Recent developments in technology have led to Cone Beam imaging, which produces 3D, high-resolution images of the mouth.

Cone beam imaging is different than a traditional dental x-ray because it uses an x-ray beam that is shaped like a cone rather than using a fan shape. After the beam passes through the patient, the remnants are collected on a silicon panel or charge-coupled device (CCD) detector. Hundreds of images are taken and are used together to form a comprehensive image of the patient, including soft tissue.

“This is a very powerful treatment tool in our practice,” says Dr. Britten. “With it, we can work together with our referring dentists to more confidently map our surgical and restorative treatment plans and place and restore implants with accuracy, while protecting our patients and our staff with lower radiation. I have read thousands of CT scans of the jaws but am still amazed at the fine details that I am now able to see in our Cone Beam CT scans.”

Dental professionals often use this type of imaging to determine the precise placement of dental implants. Dr. Britten recommends implants as the leading permanent tooth replacement solution for patients with missing teeth. After evaluating images generated by Cone Beam CT scan imaging, Dr. Britten determines whether or not implants are a good option for each patient, based on factors like jaw bone density. The images will reveal if the patients’ jaw bone is at a healthy enough degree of density to support implants.

Periodontal Regenerative Procedures

If the jaw bone does not have enough support for an implant, other periodontal regeneration procedures can be performed to support an implant. Ridge augmentation uses bone and tissue-grafting procedures to fill in the area where jaw bone has been lost, leaving more bone and better support for dental implant placement. Guided bone regeneration for ridge augmentation has been found to be very predictable. Synthetic growth factors have used for this procedure have improved and we can also use our patient’s own blood to produce materials rich in growth factors, such as L-PRF.

Improved Dental Implant Systems

Once the bone looks healthy enough, Dr. Britten will place the implants by first placing a titanium base in the bone of the jaw. An abutment piece and natural-looking crown will then be attached to the base. Patients will then care for the implants as they would their 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.

Implant sizes, materials and systems continue to improve. The titanium alloy used in dental implants now allows for more compact and biocompatible implants while still providing the needed strength to resist the strong bite forces of the mouth. Implant-supported dentures have also come a long way, and many times four implants can be used to retain a complete upper or lower denture.
Dental implants today are not only considered the gold standard of care for tooth replacement, but are usually now considered to be the superior or ideal treatment option for damaged or lost teeth. Dr. Britten said, “We are excited about the many advancements in implant planning, placement and technology. ”

About The Doctor

Britten Periodontics & Implant Dentistry is a periodontal practice offering patients personalized dental care in implant dentistry in Clearwater, Florida. 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.

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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Occlusal equilibration is a gentle procedure that allows your lower teeth to contact your upper teeth very evenly all the way around your mouth.

The goal of this treatment is to create a “solid bite” that prevents stress on individual teeth and reduces stress on the jaw muscles and jaw joint.

What’s involved? Dr. Todd Britten selectively and precisely reshapes the tiny bumps and valleys of the biting surfaces of individual teeth. Anesthesia is generally not needed, as this procedure is typically pain-free!

We will discuss the need to replace any dental work “that is too big for your bite”, before we begin the equilibration. The adjustments made to your teeth are generally too small to see any change in their appearance.

One or more of the following signs of an active dental problem are present:

1) Temporomandibular joint pain
2) Muscle-tension headaches around the sides of your head or around the jaw joint
3) Severe wear of your natural teeth
4) Loose teeth
5) Chipping teeth
6) Gum recession and other associated problems.
7) Grooves and chips forming at the gum line exposing root surfaces

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. This critical procedure will help ensure optimal results, both immediately and long-term.

Is an uneven bite be related to gum disease?

Absolutely!  Biting unevenly on the teeth would have the same degenerative effect that hopping around all the time on one leg would have to your hip.  Studies have shown that bacteria pockets and bone loss is significantly deeper on teeth with uneven biting trauma.  Recreating biting harmony helps the jawbone heal and maximize results to periodontal therapy.

Fractured porcelain crown from bruxism (night clenching of the teeth) and occlusal trauma


For more information, visit our website at www.brittenperio.com


What is a root canal?
When a cavity, or tooth decay, extends into the root, root canal therapy is often the most effective way to retain the tooth.
This video shows root canal therapy which can be performed by your general dentist, but in most cases referral to a root canal specialist, or endodontist, is recommended. A temporary filling is placed, and then a patient will see a general dentist for a permanent restoration, normally a crown.
At Britten Periodontics and Implant Dentistry, we do not perform root canals in our practice but work cohesively with the best endodontists and general dentists to provide you with the best care possible. This way, you can be seen by 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.

If you have any questions about root canals (endodontic treatment), or any other aspect of dentistry that concerns you, contact our knowlegeable staff today at 727-586-2681.

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Gum recession is the process in which the gum tissue that which surrounds your teeth wears away, or pulls back, exposing the tooth’s root. If left untreated, gum recession may ultimately result in tooth loss.  Most people don’t notice their gums receding because it occurs very gradually. You may notice tooth sensitivity, or that your tooth looks longer than normal. Sometimes a notch can be felt near the gum line with your fingernail.  Gum recession is often caused by periodontal disease.


Aggressive tooth brushing. If you brush your teeth too hard, it can cause the enamel on your teeth to wear away and your gums to recede.  Clenching and grinding of the teeth can also contribute to gum recession and defects in the tooth roots. Many people do not even realize they have this habit, and many do it in their sleep!

Insufficient dental care, Inadequate brushing, flossing, and rinsing with antibacterial mouthwash makes it easy for plaque to harden into tartar or calculus, a hard substance that builds on and between your teeth and can only be removed by a professional dental cleaning.

Gum recession is not something you want to ignore.  If untreated, gum disease leads to the destruction gum tissue and supporting bone that hold your teeth in place.  If you think your gums are receding, make an appointment. There are treatments that can repair the gum and prevent further damage.

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Want to be able to eat ice cream again?
Tooth pain that you experience because of sensitivity to hot, cold, or acidic food or drink can be caused by decay, fractured teeth or worn fillings. But gum disease, causing exposed roots due to a receding gum line, along with with worn teeth or roots can also be the source of the problem.
Healthy teeth have a layer of enamel that protects the crowns of your teeth—the part you can see above the gum line. Below the gum line a layer called cementum protects the roots, and below the enamel and the cementum is dentin. Dentin contains microscopic tubules (small canals). If dentin loses its protective covering of enamel or cementum –or sometimes when gums recede — these tubules allow heat and cold or acidic or sticky foods to reach the nerves and cells inside the tooth. The result can be hypersensitivity.
Sensitive teeth can be treated in a variety of ways. Dr. Britten will recommend the appropriate treatment based on the cause of your sensitivity. Those might include:
– A de-sensitizing or prescription toothpaste containing minerals or compounds that help block transmission of sensation from the tooth surface to the nerve. Repeated applications (4 to 6 weeks) are usually necessary before the sensitivity is reduced.
– Application of a fluoride varnish or Kuraray desensitizing mineral powder, an in-office treatment which strengthens tooth enamel and reduces the transmission of sensations.
– Sometimes gum grafting is needed. This is a surgical procedure to protect the root and reduce sensitivity by replacing gum tissue that has been lost from the root.
Proper oral hygiene can often prevent tooth pain not caused by trauma.  Contact us today if you have any questions about your daily oral hygiene routine or concerns about tooth sensitivity. 
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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
(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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Dry mouth (reduced saliva, also known as xerostomia) is a problems because it creates a:
-Higher risk of cavities, because saliva neutralizes and buffers acids in the mouth caused by foods and bacteria, as well as cleanses the teeth
-Increased risk of oral infections
-Decreased sense of taste and enjoyment of food
-Bad breath
Causes of dry mouth
Medications seem to account for a substantial portion of dry mouth cases, especially among the elderly. Over 400 agents in drugs affect salivary levels, with evidence that the risk of xerostomia rises with the number of medications.
o Commonly used medications include those for those for acne, allergies (antihistamines), anxiety, asthma, depression, diarrhea, high blood pressure, incontinence, nausea, obesity, Parkinson’s disease. Other contributors are muscle relaxants and sedatives.
o Damage to salivary glands (Due to chemotherapy, radiotherapy, neck surgery)
o Dehydration (may be due to fever, sweating, vomiting, diarrhea, loss of blood)
o Habits, such as consumption of tobacco or methamphetamines (“meth”), breathing with mouth open, snoring.
o Diabetes, anemia, hypertension
Treatment of dry mouth should target its causes. For example, if your dry mouth is caused by medication, then an alternative medication or dosage change may help.
If a medication change or a health condition cannot be addressed to help with dry mouth, you can help promote saliva in the following ways:
• Sipping water or sugarless drinks often and during meals
• Avoiding drinks with caffeine, such as coffee, tea, and some sodas
• Professional recommendation for oral care products that will assist in moisturizing the mouth
• Chew sugarless gum or suck on sugarless hard candy to stimulate saliva flow citrus, cinnamon or mint-flavored candies are good choices
• Avoid tobacco or alcohol, which dry out the mouth
• Minimize spicy or salty foods, which may cause pain in a dry mouth
• Avoid sugar and acidic foods
• Using a humidifier at night
It is important to perform daily and effective removal of plaque, which is the main preventable cause of cavities and gum disease.
We have also found in our practice that a combination of over the counter Biotene products (gels, rinses, sprays, lozenges), a product available via prescription called Neutrasal, and PerioSciences’ Anti-Oxidant Gel can also be helpful for our patients suffering from dry mouth. For more information, call us today at 727-586-2681 or visit our website at www.brittenperio.com