Clearwater FL Periodontist Dr. Todd Britten Shares: Is it worth investing in a power toothbrush?

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 Philips 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.

For more information on the proper technique for healthy teeth and gums using a power toothbrush (and other helpful oral hygiene tips) visit http://brittenperio.com/oral-health/oral-hygiene/

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Clearwater FL Periodontist Dr. Todd Britten Shares Do I need to premedicate for my 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.