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periodontal disease

Explanation from Britten Periodontics about why many patients need to take antibiotics before their dental visit as a preventive measure.

The reason many patients have to take antibiotics before their dental visit

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.

Diabetes Awareness Month campaign by Britten Periodontics highlighting the link between diabetes and oral health.

Exciting breakthrough: diabetes screening in the dental chair

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
-Xerostomia
(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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Diabetes Awareness Month campaign by Britten Periodontics highlighting the link between diabetes and oral health.

Diabetes Awareness Month: Why your dentist might be the first one to suspect diabetes

Did you know that 90% of pre-diabetics are unaware of their condition and 25% of Type II diabetics are unaware they have the disease? Many patients see their dentist or dental hygienist more often than they see their primary care physician. This is particularly true for people with periodontal (gum) disease, who require more frequent dental hygiene visits or gum treatments. Your dentist or dental hygienist should take a thorough medical history at each visit.  Some of the things they should look for which could indicate diabetes or prediabetes. Risk factors that indicate a potential for diabetes or pre-diabetes include:

  • 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).

There are also dental clues that may indicate diabetes.

  • A patient that has 26% of periodontal pockets measuring 5 millimeters or more or 4 or more missing teeth (not including wisdom teeth), has a high chance of having a metabolic problem – and diabetes is a metabolic problem.
  • Periodontal disease
  • Dental caries
  • Burning mouth syndrome
  • Oral candidiasis (common in those with poor glycemic control)
  • Salivary problems or dry mouth
  • Neurosensory disorders
  • Soft tissue abnormalities such as stomatitis or lichen planus
  • Dry mouth

A chairside diabetes HbA1c (Hemoglobin A1c) test may soon be able to be performed in our practice, or if you have had a recent test with your doctor showing a result of 5.7 or greater indicates a 92% chance the patient is metabolically challenged. At this point, the patient should be referred to their physician.

If you are concerned about your oral health or are experiencing symptoms in your mouth or health that could be related to diabetes, contact us today 727-586-2681.

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Informative graphic by Britten Periodontics illustrating the dangers of smoking on periodontal health.

The Dangers of Smoking and Periodontal Health

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.

Illustration from Britten Periodontics highlighting LAPIP technology used to save and treat failing dental implants

LAPIP, Amazing Technology to Save Your Dental Implants

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.

DISEASE AROUND IMPLANTS MIMICS PERIODONTAL DISEASE

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

SWELLING IN THE GUMS

IMPLANT MOBILITY

BLEEDING GUMS

CHANGE IN GUM COLOR SURROUNDING IMPLANT

 HIGH GUM SENSITIVITY

IMPLANT EXPOSURE (GUM RECESSION PREVENTS ADHERENCE TO THE IMPLANT OR CROWN SURFACE)

MILD TO SEVERE PAIN AROUND IMPLANT SITE

EXCRETION OF PUS FROM THE IMPLANTS SURROUNDING TISSUES

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.

How smoking negatively impacts oral health, according to Britten Periodontics

Smoking: What Happens to Oral Health

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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