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Evaluation of Result & First Periodontal Prophylaxis

This visit takes place in the first 2-3 months following surgery.  Dr. Britten will re-chart and examine the treated area, and confirm that you are stable.  Since personal oral hygiene is compromised while the sutures are in place, a professional cleaning will aid in the healing process by keeping bacteria from getting back under the gums.  This is usually a one-hour visit and may be in addition to your normal cleaning schedule.  Then it is up to you!

Periodontal Maintenance “Cleanings”

Periodontal disease is a chronic condition our goal is to control the disease; we can’t cure it.  Your body has demonstrated that it needs help in keeping destructive bacteria from getting back into your gums.  Once you are stable, professional dental cleaning and examination at regular intervals is critical.

Some patients have questioned why they need to return to our office.  Since we have extensive experience treating patients with severe forms of periodontal disease and in detecting early changes, you will have better long-term stability if you remain under our care for periodic professional cleanings.

Depending upon the severity of your case, Dr. Britten may recommend that you have your teeth cleaned every 3 – 4 months.  These cleanings will alternate with Your Family Dentist. Together we can protect your gums and teeth. The following is an example of an alternating cleaning schedule:

  • January – Cleaning with Dentist
  • April – Cleaning with Periodontist
  • July – Cleaning with Dentist
  • October – Cleaning with Periodontist

Working Together with your Dentist

It is very important that your Family (restorative or general) dentist see you for cleaning visits on an alternating basis.  Both of our offices will provide a professional tooth cleaning at these visits, however, in our office the focus is definitely the gum tissues and health of the bone.  The focus of the cleaning and check-up at your general dentist will be to ensure that crowns, bridges, and fillings are healthy.

Home Care

Adequate home care after any periodontal treatment is crucial if you want the results to last!  Removing the plaque at home will help in preventing destructive bacteria and calculus (or tartar) from reforming between cleaning visits.   We will continue to help you with home care and provide tips and techniques for getting the best results; please ask for help if you need it!

Remember, your long-term periodontal health is directly dependent upon how well you care for your teeth at home and maintain your cleaning visits with Dr. Britten and your general dentist!


“Here in our Clearwater periodontal office, we have noticed that many young people and other patients feel that compared to traditional tobacco use, e-cigarettes are a safer and healthier option,” says Clearwater periodontist Dr. Todd Britten. “I see that companies selling these products are adding attractive and sweet flavoring products to attract young people. However, we are noticing in our dental practice that vaping may be as dangerous to oral health—if not more dangerous for the teeth and gums!”

Dr. Britten explained that E-cigarettes and vaporizers work by heating a liquid to generate aerosol, rather than smoke. The E-liquid in vaporizers and e-cigarettes are usually made up of propylene glycol, glycerin, flavorings, water, and in e-cigarettes, nicotine. One of the major ingredients used in vapes and e-cigarettes is a fluid called propylene glycol. “It is a like a thin sweet-tasting gel,” says Dr. Britten, “which when broken down becomes acetic acid, lactic acid, and propionaldehyde. We know in the dental community that acids are NEVER good for tooth enamel – that is what causes cavities!”  Dr. Britten also explained that it is believed that the water molecules in saliva and the tissues of the mouth will bond to the propylene glycol drying the mouth and its tissues out considerable. “We know well in the dental community how harmful dry mouth is in the development of both cavities and gum disease!”

Another ingredient in e-liquid is a combination of vegetable glycerin as well as flavorings which studies have shown  produces twice as much plaque on the teeth, which is also known as biofilm, and increased the stickiness of the bacteria to the teeth by about four times!  This, he explained, means more cavity-causing bacteria to stick to the teeth and roots and can lead to severe tooth decay as well as an increase of gum disease.

“Even for those who may be quitting smoking by switching to e-cigarettes or vapes, unfortunately, it is not a safer alternative for the teeth and soft tissues inside the mouth,” Dr. Britten says. “Nicotine users using an e-cigarette may have lower concentrations of nicotine in their blood, but we really haven’t seen what vaping and e-cigarettes do to the body long-term.”  But short-term, he says, dentists and dental hygienists are starting to see softer enamel, increased plaque and drier mouths with patients using these products.  Which is not good for patients, because as Dr. Britten says, the plaque bacteria in the mouth cause gum disease and the combination of these bacteria and acid in the mouth, cause dental cavities.

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, which can be very helpful for those needing advanced treatment, suffer from PTSD or have a fear of the dentist.

Questions? Contact us at:

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Intraoral radiographs are the most common type of x-rays taken in dentistry. They include the first two (periapical and interproximal, or bitewing x-rays)

Periapical:  highlight one or two teeth at a time and include the entire length of each tooth from crown to root. We often use them to check for tooth or root problems, or infections at the tip of the root which may require root canal treatment. They can also provide valuable information about bone levels, periodontal ligament problems, and implant health.

Interproximal (bitewing): usually taken to check for bone levels or decay between the teeth. These are most often taken of the back teeth showing upper and lower premolars and molars.

Panoramic:  show the entire mouth on a single xray. The tube head circles behind your head while the film circles in front. Great for seeing impacted wisdom teeth, kids with mixed permanent and baby teeth, cysts in the jaw bone. Sometimes panoramic xrays can detect oral cancer, TMJ problems, sinusitis and even carotid artery blockages.

Occlusal: help highlight tooth development and placement in children. Each xray shows most of the full upper or lower arches. Used frequently by orthodontists.

Cephalometric:  show a person’s profile and the relationship of the teeth to the jaw. Used by orthodontists.

CBCT or Conebeam CT scan: provides a 3 dimensional image. Particularly helpful for helping with implant selection and placement.  Will sometimes detect root fractures and infections that are often undetectable in other films. They are also helpful to provide full mouth information, the TMJ joint and wisdom teeth.

Dr. Britten uses the Green CBCT scanner by VA Tech America which provides innovative technology for low-dose x-rays in 5.9 seconds and minimizes radiation to both patient and operator. It’s an open air scanner which is great for claustrophobic patients. This scanner not only allows for CT scans but also panoramic x-rays and bitewing-pano x-rays. “I have read thousands of CT scans of the jaws but I am still amazed at the fine details that I am now able to see.”

Questions? Contact us.

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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. For more information on effective oral hygiene and plaque control visit our website atwww.brittenperio.com or call the office at 727-586-2681


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Did you know? Periodontal disease is usually more severe towards the back of the mouth and between the teeth because these areas are more difficult to keep clean and free of plaque.  Just look at these very differently shaped molars!

Interdental brushes serve as an alternative or even great addition to brushing and flossing. They can be used daily and can be effective for plaque removal. Proxabrushes, or interdental brushes, are a type of interdental cleaner, meaning it is used to brush between the teeth.  For many patients, they are easier to use than dental floss. There must be at least a small space between the tooth and gum for the brush to pass, so it is ideal for back teeth and/or areas where there has been bone loss, and wider spaces between the teeth.  For most people with treated Periodontal Disease there is no other interdental cleaning aid that works as well as an interdental brush.  A proxabrush typically wears out within two weeks when used daily. A supply of replacement brushes should be kept for ease and speed of brush renewal.

They are available on handles (similar to length of toothbrush handles) or in travel sizes.  A travel proxabrush is covered by a cap that sheaths over the brush. This form of ProxaBrush is conveniently kept in ones pocket or purse, and thus is good for those individuals who want to clean between their teeth during the day, or to take to restaurants or trips.

Who Should Use Them?

  • Anyone who finds flossing difficult
  • People who don’t like to floss
  • People with exposed roots
  • Deep dental pockets
  • Areas of bone loss or gum recession
  • Areas where teeth are missing
  • Previous gum surgery which has exposed more tooth and root anatomy
  • Larger spaces between the teeth
  • Grooves and concavities in teeth and roots
  • People with braces – great around brackets and wires

How To Use Them



For more questions about oral hygiene and interdental care, periodontal disease of dentistry, visit www.brittenperio.com


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“All those bumps and grooves on your tongue are a haven for bacteria and could be contributing to your bad breath because of the gases they give off, says Dr. Matthew Messina, a consumer advisor for the American Dental Association. It’s important to take care of the tongue in addition to regular brushing and flossing.”-from Colgate.com

The front portion of the tongue is pretty self-cleansing, however, the back portion can often collect more bacteria. You can use a toothbrush or a special tongue scraper. Tongue scrapers come in various designs.

Some tips:

1-Clean any area where there is a coating. This is usually found on the back portion of your tongue.

2- Be gentle. Don’t go too far back and stick to the center of the tongue and not the sides which are more delicate and prone to injury. If you have a sensitive gag reflex a tongue scraper will probably work better for you.

3- Do it daily. Just like brushing and flossing, frequency is key. Oral bacteria are constantly reproducing. Once you start doing it daily, you may find that your mouth just doesn’t seem as clean without doing it

If you’re tired of high maintenance and uncomfortable dentures, you might be able to have implants placed to support your denture. An implant-supported denture is used when a person doesn’t have any teeth in the jaw, but has enough bone to support implants. An implant supported denture snaps into place on dental implants. This prevents the denture from slipping or coming loose in the mouth. It also removes the need for denture paste or adhesives. The implant supported denture can be removed at night for cleaning or, if you have a fixed implant supported denture placed, your dentures will act as permanent teeth.

There are two types of implant supported dentures, bar-retained dentures and ball-retained dentures. Both types of dentures require two or more dental implants to be placed and both will provide you with a beautiful, natural smile.

Bar-Retained Dentures

In the bar-retained type of denture, three or more implants are surgically placed in the gums. Attached to these implants is a metal bar that runs along the gum line. The denture then rests on the metal bar and is attached using clips or other types of attachments. This type of implant-supported denture holds the denture in place without the steel studs used in ball-retained dentures.

Ball-Retained Dentures

Ball-retained dentures, also called stud-attachment dentures, use a ball-and-socket design to attach the dentures to the implants surgically placed in the gums. Traditionally, the denture is fitted with sockets and the implants have a ball on top of them. The denture and implants snap together where the ball and sockets meet.

Many patients prefer implant-supported dentures to traditional dentures because they alleviates much of the discomfort and rubbing of traditional dentures. The denture is held in place far more securely and is less likely to come loose. Dr. Britten is a dental implant specialist who can evaluate to see if you are a candidate for implant-supported dentures. Call us today 727-586-2681 or visit www.brittenperio.com




The maxillary sinus is a hollow chamber lined by pseudostratified columnar epithelial cells that make up the Schneiderian membrane.  In a healthy sinus, mucous production helps clear the sinus of foreign particles and microbes.  The base of the maxillary sinus often rests on the bone superior to the roots of the maxillary teeth.

The posterior maxilla consists of bone that is highly trabeculated and often has the lowest density in the mouth.  While the mandibular bone can be as dense as oak wood, in comparison, the posterior maxilla can have the density of pine or even balsa wood.  To further complicate matters, after the loss of the posterior teeth the maxilla resorbs in a palatal and superior direction, and the maxillary sinus elongates down to reduce the available native bone height.

These unique challenges in native bone availability combined with the higher occlusal forces in the posterior jaw lead to the posterior maxilla traditionally experiencing the highest dental implant failure rate.  This is especially true when the limits are pushed, i.e. a very short implant is used with a long crown height.  However, through innovation in bone augmentation techniques patients can have implant restorations in this region now with equal success rates to all other areas of the mouth.  Sinus lift or augmentation surgery can assist implant placement by raising the sinus floor to develop more bone.

Two general techniques for a sinus augmentation exist.  The first, called a crestal approach or indirect sinus “tap” involves drilling the planned implant osteotomy short of the sinus floor, then using an osteotome or other instrument to elevate the remaining bone, add additional bone graft in the site, then place the dental implant.  This technique is appropriate for sites where 7+ mm of native bone remain before the procedure.

The second technique, called a lateral window or direct sinus graft, involves elevating a periodontal flap and creating an osteotomy window at the lateral aspect of the maxillary sinus in order to elevate the sinus membrane and add bone graft.  This may be done as a separate procedure or together with placing the dental implant.

Between 5-8 months is expected for complete healing of the graft.  The lateral window sinus graft is appropriate when 6 mm or less of native bone exist as seen on a CT scan.  Both sinus augmentation techniques are most often done under conscious sedation in our office.

Since 2015, we have added L-PRF technology to all of our sinus grafts.  Leukocyte-Platelet Rich Fibrin is derived from the patient’s own blood. A simplified chairside procedure results in the production of a thin, compressed layer of platelet rich fibrin that is strong, pliable and suitable for suturing. This natural fibrin network is rich in platelets, growth factors and cytokines that are derived from the blood platelets and leukocytes, improving not only bone growth but also natural infection defense.  This is typically combined with a 50:50 mixture of bovine (cow) and human donor bone graft material.  The results have been excellent!  Our lateral window sinus grafts have shown a 98% infection free success rate in that time.  Healing is typically easier than expected and many patients even report that their sinuses actually feel better and clearer than before the surgery!

If you or your team have any question about sinus augmentation procedures, please contact us at any time. As always, we are committed to continuing to work with all of you to provide our patients with the highest level of care available.

Click here for a Zimmer Sinus Augmenation Brochure for Patients

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Dr. Todd Britten performs the latest techniques in gingival grafting, or gum grafting, and other gum recession procedures to treat patients suffering from loose, sensitive teeth and receding gums in Clearwater, Florida. “Recent surgical innovations have made this procedure safer and more effective than ever before,” says Dr. Todd Britten.

Gum grafting involves carefully placing a small amount of new gum tissue in an area where little or no gum tissue currently exists to prevent further gum recession or to cover root surfaces of the teeth that have become exposed. A thin piece of tissue is taken from the roof of the mouth or gently moved over from adjacent areas to provide a stable band of attached gum tissue around the tooth. The tissue used in this procedure may be obtained from a variety of sources: an area of tissue nearby, the hard palate (roof of mouth), or donated tissue from another person, which has been medically processed. The gingival graft may be placed in such a way as to cover the exposed portion of the root, however, the main objective is to re¬establish the protective barrier or layer of the gum around the tooth. Occasionally, a patient may need multiple procedures to achieve the ideal amount of root coverage. The tissue is then delicately sutured (stitched) in place where it’s needed, using very fine suturing material.

Gum recession can occur for a variety of reasons, including genetics or age, oral trauma, and periodontal disease. Patients experiencing signs of gum recession are encouraged to seek treatment right away. Gum recession is not only a cosmetic problem – but it can also affect oral and periodontal health. A successful graft can reduce or eliminate problems like tooth sensitivity and further gum recession, as well as improve the aesthetics of a person’s smile. When a tooth loses the natural protection of healthy gum tissue, they become extremely sensitive to hot or cold temperatures, causing pain when drinking or eating, or even to cold air. Missing gum tissue also makes it easier for bacteria to penetrate the roots and cause decay — or for minor trauma to result in rapid gum recession. The eventual result is often tooth loss.

Dr. Britten offers a variety of modern and effective treatment options for receding gums in his Clearwater, Florida periodontal practice, including gum grafting procedures and the minimally invasive Pinhole® Surgical Technique. For more information on the progression of gum disease, scaling and root planing procedures, or periodontal surgical treatment options, contact us today at 727-586-2681. 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.

1st row:  The top illustrations show abrasions in the enamel at the gumline from using a toothbrush that was too hard. Defects in the enamel at the gumline are also caused by a bad bite from misaligned teeth, or clenching and grinding habits, or can even be from decay. In the top illustration, the teeth are being filled in with tooth-colored filling, known as composite resin.

2nd row:  When bonded to the surface of teeth, porcelain veneers improve the outer appearance by camouflaging discoloration. They can also be used to close gaps or when other cosmetic improvement is needed.

3rd row:  Dental crowns are used to repair and restore larger areas of decay or damage for which tooth-colored fillings or dental bonding will not suffice. The crown covers and strengthens the natural tooth. A crown can be made from a variety of materials, based on the location of the repair and patient needs, including porcelain, ceramic, and zirconia.

We don’t do this type of restorative work in our office, but we like to use illustrations and videos to help our patients understand how the wonderful restorative dentists we work with can fix their teeth. If you have questions about your teeth or gums, contact us today at 727-586-2681 or visit our website www.brittenperio.com