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During a dental hygiene visit, patients often ask our hygienists, “Do I have a lot of plaque?” Or, your hygienist or dentist may you that during your exam they are checking your “plaque score” and give you a grade, based on a percentage. This helps them to see how you are doing with your daily oral hygiene and how they can help you improve it to prevent cavities or gum disease.  What exactly is plaque? And what can you do about it?

Plaque is a sticky, colorless film of bacteria that constantly forms on teeth and makes its way down and under the gum line. Plaque contains bacteria that cause cavities and gum disease. If it is not removed by regular and effective brushing and flossing, it can harden into tartar — sometimes called calculus — which is calcified (or hardened) bacteria which attaches to the enamel on your teeth, as well exposed roots and can also travel under the gum line.

Bacteria are constantly growing in our mouths, in fact up to hundreds of different strains. When plaque is not removed from near or under the gum line it will cause inflammation and irritation to the gums around teeth, leading to gingivitis (red, swollen, bleeding gums). Gingivitis is reversible.  But if gingivitis is not treated, it can progress to periodontal disease and, possibly, tooth loss.

Tartar is a mineral buildup. The most common sign of tartar is a white, yellow or brown deposit between the lower front teeth or along the gum line.  Some people notice that they build tartar on the inside of their lower front teeth and can feel it with their tongue. While plaque can be removed with tooth brushing and interdental aids like floss or brushes that go between the teeth, the only way to remove tartar completely is to see your dentist or dental hygienist for a professional hygiene visit.

What we eat and drink remains in our mouths after we are done eating and bacteria also live on these foods – especially sugars and carbohydrates – and produce acids that can attack the tooth surface. If proper flossing and tooth brushing are not conducted efficiently every single day this leads to more plaque and tartar on the teeth.  When plaque builds up on the teeth, the bacteria can infect not only your gums and teeth, which can cause periodontal disease – an immune response by the body which will attack the gum tissue and bone that support the teeth. The acids from foods or drinks in the mouth, along with acids produced by bacteria in the mouth, can cause tooth decay.

When your dental hygienist or dentist checks your plaque score, they are swiping 5 teeth in the mouth along the gum line, counting 4 surfaces (front, back and in between) for each tooth. For every surface that has plaque accumulation just below the gum line, 5 points are added to your plaque score.  A good plaque score would be under 20%, an excellent score would be 5 or 10%. This gives them a good idea of how your brushing is in between each visit, as plaque above the gum line can be removed effectively just before the appointment, but plaque sitting under the gum line has accumulated for a period of time.

To improve your plaque score and prevent tooth decay, gingivitis, and periodontal disease.  Make sure to:

  • Brush thoroughly at least twice a day for 2 minutes with a power toothbrush to thoroughly remove plaque from all surfaces of your teeth. You will need to brush 4 minutes with a manual brush, and probably not do it as effectively. Many studies show power toothbrushes remove plaque much more effectively than a manual brush.
  • Floss daily or use other dental aids recommended by your dentist or hygienist to remove plaque from between your teeth and under your gum line, where your toothbrush may not reach.
  • Limit sugary, starchy or acidic foods, especially sticky snacks.
  • Schedule two to four regular dental visits for professional cleanings and dental examinations each year, depending upon the recommendations from your healthcare provider. Many patients require three to four visits a year due to a high risk for dental decay and to manage periodontal disease.

For more detailed oral hygiene instructions, visit https://brittenperio.com/oral-health/oral-hygiene/

Advanced Periodontal Disease and Tooth Loss in Smokers

Quitting smoking can be very difficult to committing to, even if you know the health risks and potential benefits of giving up. Most people are all too well aware of  the links of smoking to lung cancer and advanced periodontal disease, but one of the major problems with smoking is that it tends to mask the damage being caused to teeth and gums. Reduced blood flow in the inflammatory lesions of smokers makes it harder for the body to fight infection by reducing the flow of essential nutrients to damaged tissues. At the same time the body is also less able to transport toxins away from the infection site. Smoking makes it harder to see the damage being caused to gums, so if you have any signs of active gum disease, then these will be far less visible.

Other chemicals contained within the smoke will combine with plaque bacteria and this is dangerous because x-rays taken of smoker’s teeth often shows that the jawbone has begun to shrink away from their teeth. This damage can be difficult to detect, producing very few early warning signs of advanced periodontal disease.

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.

Developing Advanced Periodontal Disease

This is a major problem and as a top periodontist in Clearwater, Florida, Dr. Todd Britten is highly concerned when seeing patients who smoke. The likelihood of developing advanced periodontal disease or gum disease is 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.

Will You Lose Your Teeth If You Have Periodontal Disease?

In advanced cases, Britten may have little choice but to extract teeth that have already become loose. Smoking masks one of the major signs of gum disease which is bleeding gums and as a result periodontal disease can be very advanced before a smoker notices there is something wrong with their dental health. Although diligent brushing and flossing may slow down deteriorating gums, it’s often difficult for smokers to thoroughly remove all the plaque from the teeth due to smoking decreasing sensations in the mouth, making it difficult for them to detect areas that may not have been properly brushed.

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.

Dr. Todd M. Britten and the team at Britten Periodontics & Implant Dentistry is gearing up for their 3rd annual Free Dental Day for Veterans.  The event is scheduled for November 3rd, 2017. “We all know someone who has served or is currently serving in the military.  We have heard stories, we have seen families living apart during deployments, we have seen veterans with disabilities both physical and emotional, we have seen families devastated by the loss of loved ones.  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.  He and his team were brainstorming idea for how they could use their skill set to pay it forward to others in the Clearwater community.  “Both of my grandfathers served in World War II and I remember hearing stories both from them and my grandmothers about what life was like during those times.  The sacrifices made by veterans and their families are truly astounding.  I was 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.”

Jennifer Daly, a surgical assistant at the practice served in the Airforce, “I am very proud of my service to my country and I am even more proud of this dental work that we are doing for my fellow veterans.”

The inaugural year the Clearwater, FL based periodontal practice provided over $10,000 worth of comprehensive dental treatment to a group of veterans, the following year over $15,000, “As word has gotten out, we have had an incredible response from the community and even were able to get the skilled and compassionate restorative dentists at Clearwater Dental Associates, Dr. Jim Hayslett, Dr. Keith Kiskadden and Dr. Matt Burton on board to help out with our event.” Stated Britten.  “Having the Dentists and staff at CDA 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 the restorative specialists at CDA involved helps us to treat the whole mouth and really deliver comprehensive care to these veterans.”

For Britten and his team this event is something they look forward to all year long.  They even keep in touch with many of the veterans.  “What I’ve enjoyed the most about this event over the past two years is the friends that we have made.  My respect for servicemen and women has simply increased.  Hearing their stories and getting to be a part of their health journey has been a very rewarding experience.”

This sentiment was mirrored by everyone on Britten’s team, “This is such a feel good event.  I really enjoy getting to know all of the veterans. Their stories will bring tears to your eyes, and we are all so grateful to be able to pay it forward,” stated Ellen Byrd, a registered dental hygienist who has been in charge of scheduling and planning the event.  “We have been working closely with the Community Dental Clinic, the Homeless Emergency Project, and social workers from local V.A. Branches.

Britten Periodontics and Implant Dentistry is currently doing initial exams on veterans to get them scheduled for treatment.  “If you know of any veteran in serious need of dental care, please get in touch with their office right away, as these spaces are filling up quickly,” Ellen Byrd said.

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.

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Headaches, neck pain, and frequent jaw tenderness or popping are signs you may be suffering from a TMJ condition.

What is the difference betweenTMJ and TMD?

The TMJ, or temporomandibular joints, are the two  joints on each side of the face that connect the jaw to the temporal bone of the skull. Each temporomandibular joint has a disc located between a ball and socket. The disc provides padding for chewing forces while enabling the jaw to open wide and glide and even rotate.  The TMJ work together during chewing, speaking and swallowing.  They control the lower jaw (mandible) as it moves forward, backward and side to side.  When the TMJ is not functioning properly, it is known as TMD. TMD is a disorder which includes any problem that prevents the joints, jaw muscles, ligaments or jaw bone that work to open and close your mouth from working properly.


A disruption in this complex system of muscles, ligaments, discs and bones from may result in a painful TMJ disorder.  TMJ disorders (or TMD) can be caused by arthritis,  jaw dislocation or injury, tooth and jaw alignment or can be complications due to muscle tension stress and tooth grinding. During a TMJ exam, your dentist will evaluate the joints and muscles for tenderness, clicking, popping, creaking and discomfort . Depending on the severity and cause of  any irregularities, the dentist may refer you to a physician or another dental specialist. There are many options for treatment of TMJ, ranging from very conservative treatments to more invasive surgeries. According to the American Dental Association, the “National Institute of Dental and Craniofacial Research recommends a “less is often best” approach in treating TMJ disorders”.

Treatments for TMD include:

– a soft diet (avoiding chewing gum or nail biting)

-simple pain care such as warm compresses, over the counter anti-inflammatory medications (Nsaids, ibuprofen)

– Relaxation techniques for jaw tension , such as help for stress reduction, meditation or biofeedback.

-physical therapy for jaw exercises or jaw massage. Physical therapy may also include  transcutaneous electrical nerve stimulator (TENS) to use low-level electrical currents to relax joint and facial muscles and provide relief or laser therapy.

-prescription medications for muscle relaxers, pain relief, or anti-anxiety medications,

– a night guard or bite splint to decrease clenching or grinding of teeth.

– sometimes an evaluation and adjustment of a person’s bite by their dentist can help.

-orthodontic treatment may be recommended to change jaw and teeth alignment for a more favorable position for TMJ health.

In extreme cases, surgical intervention may be advisable for TMD treatment. While other joints in our bodies can be treated by complete rest or isolation with a cast or splint… this is not easy with our jaw! Eating and speaking are so important in daily life! For those suffering from TMD, relief begins with a proper diagnosis, understanding of the underlying causes and often trying the more conservative methods first before considering surgical intervention.

If you feel you may be suffering from TMD, contact us today for more information. 727-586-2681

If you have dental implants, you’re expecting them to last a many years, or perhaps a lifetime. In most cases they do, giving patients a fully restored, beautiful, functional smile. Experts estimate between 3-20% of implants fail. This is often due to peri-implantitis – which is a threat to the lifespan of dental implants. Peri-implantitis is gum disease around an implant that is not reversible without intervention by a periodontist or dental implant specialist.


There are two categories of complications with implants: Peri-Implant Mucositis and Peri-Implantitis.

Peri-Implant Mucositis:  This condition is similar to gingivitis around a natural tooth and does not include loss of attachment (bone or gum tissue) and is hopefully reversible at this stage.  Peri-Implant Mucositis is a reversible inflammatory reaction in the soft tissues surrounding a functioning implant.  Treating this condition as soon as possible will prevent peri-implantitis!

Peri-Implantitis:  This is a condition similar to periodontitis with loss of supporting structures (gum and/or bone) around a natural tooth.  Peri-Implantitis is a destructive inflammatory reaction affecting the soft (gingiva) and hard (bone).

Signs/Symptoms of moderate-advanced Peri-Implantitis










The good news is that peri-implantitis is treatable, especially if the infection is treated early. In order to help patients catch peri-implantitis, your Clearwater periodontist, Dr. Todd Britten is sharing what peri-implantitis is and how it can be treated with laser surgical therapy, or the LAPIP procedure.

Peri-implantitis is a bacterial infection of the gum and bone around the implant.

LAPIP® is a minimally-invasive method of laser gum disease treatment for implants that helps regenerate healthy tissue instead of destroying it. For most people who have dental implants, LAPIP® is simply the best solution for gum disease around implants, also known as “peri-implantitis”.

Peri-implantitis is an infection that has much in common with periodontitis, or advanced gum disease. With both diseases, the gums and supporting structures in your mouth are infected and become inflamed. As these diseases progress, pockets of bacteria form below the gum line, creating protected spaces which harbor bacteria and debris, exacerbating the infection. Severe cases of both peri-implantitis and periodontitis lead to bone loss, which can compromise the stability of your teeth or your implant.

If you think you have gum disease, you will need to seek treatment, since both periodontitis and peri-implantitis are progressive diseases which cannot be treated at home. The same daily hygiene used to avoid gum disease can be used to protect against peri-implantitis. You should brush and floss every day, and schedule regular checkups with your dentist, dental implant specialist and periodontist. Finally, certain lifestyle choices, like tobacco use, can increase the risk of gum infections.

Periodontal disease is common, peri-implantitis is less common, occurring in around 1 out of 10 implant recipients. Peri-implantitis is also different from periodontitis because it’s harder to diagnose early. Many patients don’t know they have an infection until serious symptoms develop. More often, peri-implantitis is detected through an x-ray during a regular checkup.

There are several treatment options for peri-implantitis. Surgery or laser procedures are the most common, and of the two, laser treatment is by far the least invasive. LAPIP is similar to LANAP, the procedure used to treat periodontitis. LAPIP, however, is designed to target infection around dental implants.

First, a laser is inserted beneath the gums at the base of the implant, where it targets and destroys bacteria and infected tissue. Ultrasonic tools are then used to remove any remaining bacteria and to make sure the implant is 100% free from dangerous debris. The laser is inserted below the gum line one more time to eliminate any surviving bacteria, and the gums are encouraged to heal around the implant again.

LAPIP treatment offers many important benefits. First, it is less invasive than surgery and does not destroy any healthy gum tissue. The laser is specifically designed to only target infected tissue. This treatment is also quick and effective. Finally, the laser works to stimulate gum and bone growth, allowing your natural bone to increase in both density and mass without a bone graft, protecting the security of your implant for years to come.

Sometimes, the gum tissue surrounding an implant can become thin, and expose the threads of the implant surface below. In this case, Dr. Britten has developed a state-of the-procedure which combines use of the PerioLase laser to destroy bacteria, decontaminate the implant surface and surrounding tissues, and reduce inflammation. Dr. Britten can then perform a procedure to graft tissue around the implant in such a way as to cover the exposed portion of the implant, however, the main objective is to re­establish the protective barrier or layer of the gum around the implant.

If you have implants and think you have peri-implantitis, please contact us immediately. We at Britten Periodontics are committed to providing our patients with the highest level of care available.

If you’ve noticed sores or white ulcerations in your mouth, it’s possible you have a non-contagious disease known as Lichen Planus.  Many patients do not even realize they have it because it may cause no noticeable symptoms.  Many times, you may not even be aware you have the condition unless pointed out during a dental exam.  Although usually benign, it’s still a good idea to have it examined and monitored.  

The lesions of Lichen Planus are similar in appearance to lichen, the algae and fungi organism often found on rocks and trees. It’s believed to be an autoimmune disease, in which the body treats some of its own cells as foreign and reacts adversely to them. Certain medications and substances may also cause a lichenoid reaction. Besides the inner cheeks, gums or tongue, Lichen Planus may also appear on other skin or mucous surfaces on the wrists, legs or fingernails.

Inside the mouth it usually resembles a lacy pattern of white lines or ulceration. Gum tissues may become red and inflamed, with some soreness after brushing or eating. Sometimes it has ulcerations that come along with it.  Although there’s no known cure for Lichen Planus, it rarely causes serious problems.  It may even fade away on its own in time.  Chances are if you have a case of Lichen Planus it isn’t causing you any problems. If it does cause you discomfort, you can take steps to ease your symptoms.

If the lesions do become uncomfortable (painful, itchy or overly-sensitive), we recommend brushing with a soft toothbrush, flossing with soft woven floss (to avoid irritating or traumatizing the tissues).  Effective plaque control is important to keep the condition under control.  It may also be smart to avoid acidic or spicy foods and beverages which have been known to cause flare-ups. Managing stress is also helpful, and a topical steroid may be prescribed for more severe outbreaks.

Perhaps the greatest concern with Lichen Planus, though, is it may resemble more serious conditions, particularly oral cancer. The only way to be certain that it is a benign condition is to perform a biopsy on some of the affected tissue. If you notice a problem, be sure to visit us for a complete examination. And regardless of whether you have the condition or not, regular oral cancer screenings, as well as limits on alcohol consumption and stopping use of tobacco, will also reduce your risk of oral cancer.

 If you would like more information on Lichen Planus and similar oral conditions, please contact us or schedule an appointment for a consultation.


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Dental implants can dramatically improve the appearance and health of your smile.  If you have one or more dental implants in your mouth, it is important to be on the lookout for the signs of peri-implant disease. Bleeding gums, gingivitis, and other issues can be even more severe in dental implant patients. Read more for the signs that you should see a periodontist about your dental implants.

Swollen or Red Gums

Pay careful attention to the health and condition of the gums that surround the implant site. Swollen or red gums are among the first signs that you are developing peri-implant disease. If you notice bleeding when touching, flossing or brushing your implant, that is something to get checked. A periodontist will be able to help you care for your gums and make sure that your dental implant is in good condition.

Pain When Eating or Chewing

A healthy implant will not cause pain or discomfort when you are chewing, eating, or swallowing. You should see a periodontist if you start to experience any of these symptoms around your dental implant. Swollen and inflamed gums can cause pain and discomfort around the implant area. Treating your gums will help you restore comfort to your entire mouth.

Shifting or Crooked Teeth

Periodontal disease can cause your teeth around the implant to shift out of place over time. If you have started to notice that your implant has moved from its original position, it may be time to make a trip to the periodontist. Your periodontist can treat your gums and ensure that your implant has a healthy and properly placed position in your smile.

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Smoking is notoriously dangerous to your health. While the health risks of smoking are well known, you may be surprised to learn that smoking can dramatically impact the health and condition of your teeth and gums. Smoking can aggravate some of the most common oral health problems such as bad breath or gum disease and is a risk factor for oral cancer.

Periodontal Disease

While gum disease can be present for a variety of reasons, smoking can dramatically worsen its symptoms. If a person smokes, he or she may be much more likely to develop tartar buildup, bleeding gums, and other symptoms associated with periodontal disease. When your dentist spots the early signs of gum disease in your smile, quitting smoking can help to slow down the progression of your symptoms.

Oral Cancer

Oral cancer is another serious health concern that is associated with tobacco use. A person who uses tobacco will be at much greater risk of developing oral cancer in his or her lifetime. Smoking during cancer treatment can also lead to the spread of cancer cells to the throat, larynx, or other areas of the mouth. Even smokeless tobacco products have been determined to contribute to the growth of cancer cells in certain patients.

Implant Issues

A person who smokes is also at risk of experiencing issues with his or her dental implants. Dental implants are used to replace broken or missing teeth. Since smoking can contribute to bone loss and other oral health problems, a dental implant may fail when it is placed in the mouth of a person who smokes.

Dr. Todd Britten can address any concerns that you may have about smoking and your oral health. Call us today 727-586-2681.
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Dental implants are often used to replace teeth, but when there is not enough jaw bone to hold the implants, a dental bone grafting procedure may have to be done first.

“After the loss of a tooth, the jawbone recedes, or becomes indented. Bone grafting allows us to fill in this space to have enough bone to place a dental implant.”

For patients with missing teeth who need additional jaw bone support for the placement of dental implants, a periodontal regenerative procedure, or bone grafting must first be performed. Dr. Britten, an implant specialist and periodontist in Clearwater, Florida, also provides the latest technology and techniques in ridge augmentation, ridge preservation, sinus lift or sinus augmentation procedures for patients missing teeth to be able to have dental implants.

Dental bone grafts can come from multiple sources. Autogenous grafts come from the patient, allografts are taken from a bone bank where human bone from cadavers has been donated, and xenografts are taken from animal bone. Local anesthesia is all that is needed in most cases. The new bone is surgically placed in the jaw area where it is deficient in bone and transplanted where the dental implants will be located.

Sometimes Leukocyte Rich Platelet Rich Fibrin is used in addition to bone grafting. (L- PRF) is a by-product of a patient’s own blood that can help healing after dental procedures such as a tooth extraction, as well as promote healing around bone or tissue grafts and dental implants. L-PRF treatments are often used for greater success for necessary procedures for dental implant placement, including socket bone grafts, sinus lifts, ridge augmentation, correcting peri-implantitis, block bone grafts and extraction sites prior to implant placement. Dr. Britten provides both of these technologies in his Clearwater, Florida periodontal practice.

The dental bone graft, or periodontal regeneration procedure, must be allowed to heal completely prior to other procedures, such as the placement of dental implants. This will generally take about four to six months. Once the area has completely healed, the patient can be reevaluated for the placement of dental implants.

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.

Patients interested in these procedures can get additional information by calling 727-586-2681.

On June 2nd, Dr. Britten was honored to lecture at the UF College of Dentistry this week with his brother Dr. Nick Britten. They spoke about how important it is for restorative dentists to work together with their periodontist.  Here at Britten Periodontics, we pride ourselves on our interdisciplinary treatment approach. What does this mean? No one can be great at every aspect of dentistry; there’s so much involved – fillings, cleanings, crowns/bridges, extractions, root canals, implants, grafts, sinus lifts, etc. Therefore, we work cohesively with the best dentists, prosthodontists, orthodontists, endodontists, oral surgeons, to provide our patients with the best care possible. We are proud to work with 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 our patients will receive a higher quality of care and better end result.

Just as you would see a medical specialist for a heart procedure, a mammogram, or a biopsy, we believe patients should see a dental specialist for certain procedures such as grafting, implants and periodontal therapy.

By working with other dentists and specialists, we provide a system of mutual quality control. Our work is constantly viewed and critiqued by other members of the dental community. Together, we hold each other to the highest quality of care possible.

#brittenperio #clearwaterperiodontist #gatorperio — with Meg Britten, Nick Britten, Cody Bertoch andTodd Britten.

 The Drs. Britten, Meg and the kids had such a fun day and got to spend some time with our favorite future dentist, Cody P. Bertoch!!