Continuing education is a top priority at Britten Periodontics & Implant Dentistry. On April 19, 2018, we held our 4th educational seminar! Over 50 local dentists, dental assistants and hygienists attended. We love partnering with you to deliver exceptional care to our patients. Zimmer, Dentsply and Sonicare for sponsored a great food truck and raffles. Our team worked so hard organizing and planning this event.
The program entitled “Don’t Wait Until It’s Too Late: Periodontal Treatment in 2018” reviewed the basics of periodontal structures in health and in disease, how to perform a thorough periodontal examination, non-surgical treatment options, surgical options, the benefits of a good relationship between the restorative specialist and periodontist, and how we can improve our communication between the periodontist and restorative dentists to provide the best care to our patients.
Dr. Britten was our keynote speaker, and provided a terrific 2 hour lecture, with great pictures and videos of real cases. It was very educational and informative, and so great to network and meet face to face with our colleagues that we work with every day in patient care.
Dr. Todd Britten cites recent scientific studies when urging patients to seek gum disease treatment before periodontal disease begins affecting overall health.
Dr. Todd Britten, a periodontist in Clearwater, Florida, cites recent scientific studies to help educate people about the connection between unhealthy gums and different systemic health conditions. Citing the ever-increasing studies linking periodontal (gum) health to overall systemic health, Dr. Britten continues to educate his patients about the benefits of seeking gum disease treatment before it begins affecting overall health.
Dr. Britten states that recent research demonstrates that inflammation may be responsible for the association between periodontal disease and other diseases. Dr. Britten states, “There is strong evidence linking periodontal disease to several systemic diseases, such as diabetes and cardiovascular disease as well increasing the risk factors and complications of other diseases such as osteoporosis, respiratory disease, stroke and even cancer.”
A recent study in an October 2016 report in the Journal of Periodontology titled “Periodontal Disease and Incident Lung Cancer Risk: A Meta-Analysis of Cohort Studies,” (attached) found that individuals with periodontal disease have an increased risk of developing lung cancer. Study participants with other risk factors such as frequent alcohol use, smoking, and diabetics demonstrated even a slightly increase in lung cancer risk and that women with periodontal disease are more likely than men to develop lung cancer. A related cohort study stated that oral bacteria may be involved in the development of cancer cells in the lungs, while another study indicates successful treatment of periodontal disease may lead to a substantially reduced lung cancer risk. “This report can be added to the body of literature that associates periodontal disease with other conditions in the body, including diabetes and heart disease,” says president of the American Academy of Periodontology (AAP) Wayne A. Aldredge, DMD. “While additional research is needed on the possible links between lung cancer and periodontal disease, we know for sure that taking care of your teeth and gums can reduce periodontal disease risk and possibly the risk of other systemic conditions.”
A 2013 consensus report from the American Academy of Periodontology (AAP) and the European Federation of Periodontology (EFP) finds that periodontal health may play an important role in the management of diabetes. The report outlines clinical recommendations for dental professionals to use when treating people with diabetes and emphasizes the importance of annual comprehensive periodontal evaluations (CPE) as part of an effective diabetes management program. The consensus report is based on a large body of scientific evidence that suggests periodontal health may be helpful in controlling diabetes.
“There are many studies which provide evidence indicating a relationship between periodontal disease and several other systemic diseases, including chronic kidney disease, cognitive impairment, obesity, chronic kidney disease and metabolic syndrome. A new study has even revealed a relationship between chronic periodontitis and lacunar infarct, a type of cerebral small vessel disease that can lead to a stroke.” Dr. Britten wants patients to know that while additional research is required to gain a more thorough understanding of many of these relationships between systemic disease and periodontal health, patients should be aware that the associations do exist.
Periodontal disease affects one of every two Americans age 30 and older and is 2.5 times more prevalent than diabetes. Caused by an inflammatory reaction to a bacterial infection below the gum line, periodontal disease can lead to swelling, irritation, receding gums, and tooth loss if left untreated. Dr.Britten’s Clearwater, Florida practice offers many disease treatment options, including traditional or laser gum surgery, replacing missing or diseased teeth with implants, scaling and root planning, and periodontal regenerative procedures such as bone grafting and tissue grafting.
Britten Periodontics is a periodontal practice offering patients personalized dental care in periodontics, laser therapy and implant dentistry for Clearwater, Florida. Dr. Todd Britten received his Bachelor of Science and Doctorate of Dental Medicine and Master’s Degree and Certificate in Periodontology and Implant Dentistry at the University of Florida. He is a Diplomate of the American Board of Periodontology. He has completed extensive continuing education coursework, including training at the Pankey Institute, Pikos Institute for Advanced Bone Grafting, Misch International Implant Institute and LANAP Institute for advanced Laser Dentistry. His Professional Associations and Memberships include American Board of Periodontology, American Academy of Periodontology, American Dental Association, Florida Association of Periodontists, Academy of Osseointegration, Upper Pinellas County Dental Association, Pinellas County Dental Association, Top Dentist 2015, Florida West Coast Dental Association and he completed extensive training at the Institute of Advanced Laser Dentistry. Dr. Britten is part of the one percent of dental professionals offering the FDA cleared laser procedure for gum disease treatment.
Dr. Britten is highly concerned about his patients who smoke. The likelihood of developing advanced periodontal disease or gum disease can be up to 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.
Many studies on smoking and periodontal disease have concluded that smokers have:
Deeper probing depths and a larger number of deep pockets in the gums.
More attachment loss including more gingival recession
More alveolar boneloss & tooth loss
Less gingivitis and less bleeding on probing
One of the major problems with smoking is that it tends to mask the damage being caused to teeth and gums. This damage can be difficult to detect, producing very few early warning signs of advanced periodontal disease. For years it was thought that nicotine being a vasoconstrictor was causing less blood flow to the gums, causing less infection-fighting white blood cells to reach the area. Newer studies are showing that smoking appears to have a long-term affect the inflammatory lesions, or diseased gums of smokers, which have less blood vessels in them than in non-smokers.
More teeth with furcation involvement (where the bone levels have been destroyed below the area where the roots of the teeth meet, leaving this area exposed, making it prone to further destruction as well as decay.
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.
Smoking has a profound effect on the immune and inflammatory system. Smokers have more infection-fighting cells in their body, but fewer of these helpful cells make it into the gingival pocket. Studies also show that these good cells have a decreased ability to accomplish their function, which is to destroy harmful periodontal bacteria. Adhesion molecules are being found within smoker’s tissues, in the white blood cells, in the inflammatory lesions, and even in the supporting gingival tissues. Studies have shown impairment in defensive functions of other defensive blood cells, even those using smokeless tobacco due to the high concentrations of nicotine.
Smoking also impairs the healing of dental implants and even in the healing from all other aspects of periodotnal treatment including non-surgical treatments (including scaling and root planing or “deep cleaning”), surgical treatment, bone grafting and tissue grafting. Studies have shown that tobacco smoke and nicotine affect blood vessels in the gums, healthy bone-building cells, connective tissue matrix, the jaw bone and even the root surface itself. Tooth root surfaces in smokers have actually been shown to be contaminated by products of smoking such as nicotine, cotinine, acrolein and acetaldehyde, which may inhibit the gum tissue from healing around the roots of teeth as they should. Smoking has been shown to affect human bone, and is a risk factor for osteoporosis, which is also a risk factor for periodontal disease.
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.
For more information, contact us today at 727-586-2681.
While smoking and smokeless tobacco use is certainly a major risk factor for Oral Cancer, there are other lifestyle, genetic and even viral causes that contribute this often disfiguring and sometimes deadly disease.
Your dentist, dental specialist and dental hygienist are your first line of defense for early detection of Oral Cancer. Dr. Britten routinely performs systematic examination of all the soft tissues of the mouth, including the tongue, floor of the mouth, as well thorough examination of the borders of the tongue, and the lymph nodes surrounding the oral cavity and in the neck.
If you have any questions about Oral Cancer, please feel free to contact us via email at or call at 727-586-2681.
Dental implant placement: Implants are versatile. If you are missing only one tooth, one implant plus one replacement tooth will do the trick. If you are missing several teeth in a row, a few strategically placed implants can support a permanent bridge (a set of replacement teeth). Similarly, if you have lost all of your teeth, a full bridge or full denture can be permanently fixed in your mouth with a strategic number of implants.
Untreated gingivitis can advance to periodontitis and can eventually lead to tooth loss and other health problems.
GINGIVITIS
Gingivitis is the mildest form of periodontal disease. It causes the gums to become red, swollen, and bleed easily. There is usually little or no discomfort at this stage. Gingivitis is often caused by inadequate oral hygiene. Gingivitis is reversible with professional treatment and good oral home care.
Factors that may contribute to gingivitis include, diabetes, smoking, aging, genetic predisposition, systemic diseases and conditions, stress, inadequate nutrition, puberty, hormonal fluctuations, pregnancy, substance abuse, HIV infection, and certain medication use.
PERIODONTITIS
Untreated gingivitis can advance to periodontitis. With time, plaque can spread and grow below the gum line. Toxins produced by the bacteria in plaque irritate the gums. The toxins stimulate a chronic inflammatory response in which the body in essence turns on itself, and the tissues and bone that support the teeth are broken down and destroyed. Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Often, this destructive process has very mild symptoms. Eventually, teeth can become loose and may have to be removed.
There are many forms of periodontitis. The most common ones include the following.
Aggressive periodontitis occurs in patients who are otherwise clinically healthy. Common features include rapid attachment loss and bone destruction and familial aggregation.
Chronic periodontitis results in inflammation within the supporting tissues of the teeth, progressive attachment and bone loss. This is the most frequently occurring form of periodontitis and is characterized by pocket formation and/or recession of the gingiva. It is prevalent in adults, but can occur at any age. Progression of attachment loss usually occurs slowly, but periods of rapid progression can occur.
Periodontitis as a manifestation of systemic diseases often begins at a young age. Systemic conditions such as heart disease, respiratory disease, and diabetes are associated with this form of periodontitis.
Necrotizing periodontal disease is an infection characterized by necrosis of gingival tissues, periodontal ligament and alveolar bone. These lesions are most commonly observed in individuals with systemic conditions such as HIV infection, malnutrition and immunosuppression.”
Most of our patients can tell the difference in how their teeth and gums feel when they switch to a power toothbrush. Dr. Britten and his team can also typically tell when a patient uses an electric toothbrush versus a manual toothbrush – as there is usually a noticeable difference in the amount of plaque present as well as a patient’s gum tissue tone and color.
Improving oral health will improve overall health, a reason most patients will be happy to make the extra investment for a powerbrush. An electric toothbrush (our favorite professional-grade brands typically run from $150-200) is only a fraction of what it costs to complete most dental procedures. In the end, investing in a good power toothbrush, changing brush heads every 90 days, and using the proper technique will save you money!
Why choose a powerbrush?
Power toothbrushes usually have built in features with an advantage for better oral health.
Timer – Many brands feature a timer to ensure patients brush for a full two minutes, and may also have a pressure indicator to pause brushing or to let patients know if they’re brushing too hard and possibly damaging their gums. The Phillips Sonicare, one of our favorites, hesitates every 30 seconds, to help a patient distribute their brushing in all four sections of the mouth.
More effectively disrupts and removes harmful bacteria in the mouth. The sonic vibrating or oscillating of bristles from an electric brush remove sticky plaque bacteria effectively and stimulate the gum tissue, reducing inflammation. Electrics brushes operate at 30,000 strokes per minute while a manual is only 200 strokes.
Simpler technique. With a power toothbrush, all you have to do is move the brush from tooth to tooth, spending a few seconds at a time. The professional line of powerbrushes from Phillips Sonicare are definitely our favorite because they can penetrate below the gum line to disrupt the bacterial environment formed by plaque. Other brands, most notably the Oral B have brush heads that oscillate in a half-circle motion to remove biofilm (plaque) from the tooth surface.
Gentle and safe at the gumline. Using a powerbrush with the correct technique will help prevent gum recession, enamel abrasion (wearing away) and tooth sensitivity from improper brushing as well as tooth decay and gum disease. Even with their phenomenal power, power toothbrushes such as the Sonicare are still very gentle on the teeth and gums. If patients have gum recession, they can just place the brush on the tooth without using a scrubbing action, which can traumatize and wear away more thin and delicate gum tissue.
Stain removal. Electric toothbrushes help with stain removal, which is attractive to patients who really want a bright, white smile. Some Sonicare models come with a “whitening” setting or even special polishing brush heads.
Helps those with dexterity issues. Elderly patients or others with dexterity issues can also benefit from electric toothbrushes. Many patients can’t move their hands the way they need to, so if they use a manual brush, they’re likely leaving plaque behind. Powerbrushes help remove plaque from the teeth for them, so as long as they get it close to where it needs to be, it’s going to remove plaque and help prevent problems.
Great for kids. Electric toothbrushes are also great options for children, especially if they have braces!
Less time brushing, with a better result! In two minutes, a power toothbrush will remove plaque and massage and stimulate gum tissue more effectively than the minimum of four minutes you would need to brush with a manual toothbrush.
Proper Technique for Effective Power Toothbrushing
Divide your mouth into four quadrants. This can help ensure that you brush each section of your teeth and mouth cavity.
Place toothbrush bristles along gum line. Hold your toothbrush at a 45 degree angle to your gum line with a Sonicare or 90 degrees with an oscillating brush such as the Oral B. Applying gentle pressure, keeping the bristles in contact with your tooth surface and gum line, which can help ensure you get the most effective result possible. Stay on each area for a few seconds, moving the brush only when it is time to go to the next area. Once you’ve completed this procedure for a quadrant, move to the inner surfaces of your teeth and repeat the same procedure.
To brush behind your front teeth, tilt the brush vertically using only the front half of your brush. Clean biting surfaces, your tongue, and soft palate. This can help remove debris and other odor causing bacteria.
If you’ve undergone treatment for periodontal (gum) disease, you know how involved it can be, whether your treatment required nonsurgical therapy, surgical therapy or a combination of both.
Following gum surgery or scaling and root planing, a nonsurgical periodontal therapy, plaque and calculus (hardened plaque deposits) are removed and as they heal swollen, red gums finally begin to regain their healthy pink color.
Treatment does not stop there. If it does, there’s a high chance of a re-infection of the gums.
Periodontal maintenance (PM) is important for gum disease patients after treatment. Plaque, a thin film of bacteria and food particles responsible gum disease, continue to grow again on your tooth surfaces as it did before. Diligent, daily brushing and flossing to curb that development.
It is also important to keep up regular dental visits for advanced cleaning to remove hard to reach plaque and calculus. For patients with gum disease it is usually four but for some advanced gum disease patients, six times a year, especially just after treatment. Many of our patients alternate visits for periodontal maintenance between our office and their general dentist so that their periodontal condition is closely monitored, as well as the health of their teeth.
Our goal is to reduce the chances of re-infection. To do this, we’ll thoroughly examine your teeth, gums and any implants for signs of disease (as well as an oral cancer screening). This includes an assessment the health of your teeth and gums and to see how well you’re doing with plaque control and review your recommended customized daily oral hygiene instructions.
Overall, we want to prevent the occurrence of any future disease and treat it as soon as possible if it relapses. Keeping up with homecare and a routine periodontal maintenance schedule will help ensure your gums continue to stay healthy.
If you would like more information on periodontal disease, please contact us or schedule an appointment for a consultation 727-586-2681.
What do you need to know before visiting a periodontist?
The procedures we perform are very safe and the side effects are usually minimal. Here at Britten Perio, we are proud to use a gentle touch as well as the latest and most trusted techniques and technology. Most patients anticipate severe discomfort after deep periodontal cleanings or surgery, which is generally not true. When necessary, we will give you the medications necessary to reduce swelling, pain, prevent infection, and help keep things clean. Our patients routinely comment that the procedure was not nearly as bad as they imagined.
Remember, the benefits of keeping your own teeth are tremendous and although they might need some work now, the end result will be well worth it!
Some things we always need to know about you when you visit:
Your normal medications and that you will be taking them unless otherwise instructed by
If you are taking aspirin daily
If you are on blood thinners
If you are diabetic or have special diet restrictions
If you have a prosthetic joint less than 2 years old
If you have an artificial heart valve or history or endocarditis
If you have been on bisphosphonates for osteoporosis, longer than 5 years
For more information, visit us at www.brittenperio.com, call us at 727-586-2681 or message us today!
Immediate dental implants are often necessary due to a non-restorable fracture of a tooth. In some cases, there may be infection associated with the cracked or fractured tooth. The procedure begins with an exam, 2-D and 3-D x-rays. A diagnosis is made and treatment options are discussed. An immediate dental implant is the treatment of choice. Any pre-operative study models that are needed are taken.
Surgical Procedure: The patient is generally well sedated with either oral or IV sedation. Just like any other procedure, topical anesthetic is applied prior to local anesthesia administration. Impressions of the teeth are taken if necessary prior to the tooth extraction. The fractured tooth is removed very carefully to minimize any damage to any surrounding bone. At the time of surgery, Dr. Britten can determine if immediate implant placement is possible. This is the part you don’t always know until you get there. Additional bone grafting is often necessary to fill the voids between the dental implant and the remainder of the extraction socket. In addition, a membrane, soft-tissue graft or platelet graft (L-PRF) may be used to protect the bone graft.
As an implant specialist, Dr. Britten is highly trained and experienced in the most advanced and current technologies used for long-term implant health and success. He believes in using the best diagnostic tools as well as the highest quality implants in his practice. Dr. Britten works closely with the best restorative dentists in the Tampa Bay area to obtain the best possible outcome for his patients’ implants. For more information, contact us at 727-586-2681
