Dr. Willoughby and staff are frequently asked to explain many of the following topics so in an attempt top better educate our patients about there dental health we have compiled the following information. Dr. Willoughby and his staff believe that a better educated patient can make more informed decisions about their dental care.

The questions we are asked most frequently have been collected below.

1. Silver Amalgam Fillings vs. White Fillings
2. Tooth Whitening / Bleaching
3. Dental Bonding
4. Crowns & Bridgework
5. Invisalign
6. TMJD / TMD
7. Root Canal Therapy
8. Obstructive Sleep Apnea  (OSA) / Snoring

Silver Amalgam Fillings vs. White Fillings

What are the advantages of white fillings over silver amalgam fillings?

• Appearance – Silver / amalgam fillings are a dark grey metal color and over time they become tarnished and leave dark stains on your teeth, and they can show through the enamel. When the filling is placed into an area of the mouth which can be seen when one talks or smiles the metallic filling stands out against the white background of a natural tooth so the appearance can be unsightly.
• Dental health – amalgam weakens the surrounding tooth structure.
• Overall health – the mercury in amalgam is thought by many to give off a vapor in response to hot substances and the pressure and friction created while chewing, which over time is thought to potentially threaten overall health. Mercury is a toxic chemical element and there today there is much controversy over whether or not it is a safe and effective dental filling material – especially around pregnant women and young children.

How does the Amalgam filling material affect the overall health of my tooth?

Silver fillings are a combination (“amalgamation”) of silver, copper, tin and assorted other metals bound together by mercury – this is why they are referred to as “mercurial alloys”. These alloys very sensitive to temperature changes so they expand and contract differently than the surrounding tooth structure when exposed to changes in temperature. Over time this constant pulling effect between the tooth and the metal fillings forms micro-gaps which allows harmful bacteria to get underneath the filling, causing decay and further weakening the tooth.

What about overall tooth strength?

In addition to the constant expansion and contraction due to temperature changes, the design of the tooth preparation itself required to hold the mercury filling in place typically undermines and weakens the surrounding tooth structure. When you add in the tremendous biting pressures exerted on the tooth from chewing and swallowing the result is often cracks and craze lines and broken cusps around these metal fillings which can lead to a phenomenon referred to as “cracked tooth syndrome”.

Are white fillings better?

Yes, we believe so for 3 reasons:

1. Todays composite filling materials are made of incredibly strong and durable resin polymer materials and their matrix is often re-inforced with nano-hybrid glass ceramics which increase the wear resistance and compressive strength of the material. The coefficient of thermal expansion and modulus of elasticity of these composite resin materials is also very similar to that of the surrounding natural tooth structure. Some of the composite resin materials even contain fluoride leaching materials within their resin matrix and nearly all of these materials are bonded to the surrounding enamel and dentine surfaces of the teeth making them very strong and durable.
2.  The preparation of the tooth for a white filling is much more conservative than for a mercury filling and so when tooth decay is removed it means that more tooth structure is left in-tact and therefore the tooth remains stronger and is more durable. Since improved dental has a direct impact on overall health then it is only logical that white fillings are better for your overall health.
3. Amalgam fillings contain mercury. Mercury poisoning can lead to a number of serious long term health problems including damage to the heart, lungs, kidneys and brain especially in un-borne children and infants. There is still much debate as to whether or not mercury fillings give off enough mercury vapor to cause a serious health risk – but many people choose not to take that risk and have their fillings removed. Dr. Willoughby’s philosophy in this regard is simple – we will remove an old amalgam filling when there is clinical evidence that it is impeding normal tooth function and we will not try to dissuade people from having their mercury fillings removed and replaced but we will not suggest that their mercury fillings need replacing simply because of an implied toxic mercury health risk – we can educate them but ultimately the final decision belongs to the patient.

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Tooth Whitening / Bleaching

What are the leading causes of tooth discolouration?

• Stained and tarnished old Mercury metal fillings
• Certain medications like Tetracycline
• Dental trauma
• Root canal therapy
• Smoking
• Excessive Flouride (Flouridosis)
• Food and Drink including coffee, tea, blueberries and red wine.

How does tooth whitening typically work?

Intrinsic tooth color is a result of large natural pigment and stain molecules trapped within the microstructure of the tooth. These color molecules have bonds between atoms called “chromopores” which are what reflect the color stains. The larger these molecules are, the more chromopores they contain, the darker they appear.

ALL bleaching solutions work by forming hydrogen peroxide as their end product which then breaks down into: water, oxygen, hydrogen and hydroxyl radicals – these are the peroxide by-products called “bleaching factors” which lighten teeth by cleaving the chromopore bonds. In order for these bleaching factors to be successful the peroxide products must b fully potent, chemically influenced to produce a high percentage of hydroxyl radicals, and allowed extended time for bleaching factors to be diffused into teeth.

Nearly all peroxide based bleaching solutions on the market today have the following limitations;

1. The way the bleaching material is manufactured, transported and stored the gel is often of low potency due to temperature degradation.
2. The peroxide bleaching solutions do not contain adequate chemical stabilizers so the materials are constantly breaking down.
3. Research has shown that lights and lasers result in no additional lightening of the tooth and may in fact contribute to excessive bleaching sensitivity via heat and dehydration of the dentinal tubules. The preferred method of tooth bleaching is the take home trays.
4. These peroxide solutions are manufactured to be acidic in order to help slow down the degradation of the peroxide but the more acidic the solution the greater the tendency of the reaction is to produce more water and oxygen and less hydroxyl radicals and therefore a less effective tooth whitening process.
5. Conventional at home trays do not effectively seal the peroxide gels with the trays and so the gel is diluted and lost over time to the ingress of damaging saliva and other sulcular fluids which contain high levels of peroxidase which break down peroxide into mostly water and oxygen.

How does the KöR Whitening Deep Bleaching™ System work?

First, a dental professional will make molds of your teeth so you can have your own unique, ultra-comfortable KöR Whitening Trays. Then, you’ll have a simple visit in the dental office, followed by wearing KöR Whitening Trays for two weeks at home while you sleep. The KöR Whitening Deep Bleaching System is completed with a final in-office bleaching visit at the dental office.

How is the KoR system different from ALL the other Bleaching systems?

1. The KoR system uses a specially developed in-office quick acting solution of 34% hydremide peroxide which must be activated by mixing prior to use. This solution has been refrigerated; contains chemical stabilizers and has a higher pH all to prevent degradation of the bleaching factors.
2. The KoR system uses a specially developed take home extended use solution of 16% carbamide peroxide which must also be activated by mixing prior to use. This solution has been refrigerated; contains chemical stabilizers and has a higher pH all to prevent degradation of the bleaching factors.
3. The KoR system uses a specially developed tray which forms a seal around the cervical 1-1.25mm of the teeth, locking in the gels and extending the useful time of the bleaching factors.

How long does KöR Whitening last?

Unlike other whitening methods, with easy periodic home maintenance, the KöR Whitening Deep Bleaching™ System is entirely permanent.

Is it safe?

Whitening products have been clinically studied and safely used on millions of patients without harm to teeth or gums. Whitening is considered entirely safe.

Is there pain or discomfort with the KöR Whitening Deep Bleaching™ System?

With the introduction of the new KöR whitening gel that produces little to no sensitivity. As a result, most patients have no discomfort from whitening when using this technique. Testing has shown that patients who do feel some sensitivity using the KöR Whitening Deep Bleaching System typically feel no more than 10% of the sensitivity they’d feel from other whitening gels.

Does it matter how old I am?

The ideal age to whiten teeth is about 14. The younger teeth are, the more brilliantly they whiten. However, the KöR Whitening Deep Bleaching™ System rejuvenates even older teeth back to their youthful ability to whiten incredibly well, even if you’re 90 years old.

How white will my teeth get?

The KöR Whitening Deep Bleaching™ System whitens teeth dramatically, often lightening them 16 shades or more. Although everyone is different, with the proper KöR Whitening Deep Bleaching system, all teeth will have stunning results. It even whitens tetracycline-stained teeth, previously thought to be impossible!

Will the whitening trays be uncomfortable, difficult to sleep with or will the bleach leak out of the trays?

No. KöR Whitening Deep Bleaching™ trays are very different. They’re comfortable; because they’re thin and form-fitting, you’ll forget they’re even in your mouth. They’re convenient; by wearing these only while you sleep, it doesn’t interfere with your busy day. Also, unlike regular trays, the KöR Whitening Deep Bleaching™ Trays seal the bleach inside the tray, preventing the gel from quickly leaking into your mouth.

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What is dental bonding and how is it done?

Dental bonding involves the use of a tooth colored composite filling material to re-shape a portion of a decayed, missing or weakened tooth, or make cosmetic enhancements to its shape and contour and even improve the color of a tooth or teeth. The composite resin material which is applied to the surrounding tooth structure is contoured and sculpted into place after the tooth surface has been successfully roughened up, cleaned, etched, and bonded using a dental adhesive. A high intensity UV light is then focused on both the adhesive and the filling material, effectively hardening and “bonding” it into place. The composite filling material is then polished and contoured until smooth. Bonding can be used to reshape a tooth much in the same way as a veneer and can sometimes involve the removal of slightly more tooth structure.

Dental bonding can be used for a variety of dental procedures including:

• Build up worn down or ‘short’ teeth.
• Remove and replace small areas of decay and discoloration.
• Replace hypo-calcified tooth enamel.
• Veneer a root filled tooth to lighten and enhance its color.
• Repair tooth chips, cracks and fractures.
• Re-contour misaligned, misshaped or crooked tooth.
• Close spaces and gaps (diastemas).
• Veneer a tetracycline stained tooth or teeth.

When compared to a lab fabricated porcelain crown or veneer, Dental bonding is a more cost effective method of reshaping a tooth and it can be completed in a single dental appointment. Most of the time, it requires very little dental freezing and can do much more than simply improve the appearance of your teeth – it can also be designed to protect the tooth from future damage by covering exposed areas thereby reducing sensitivity and pain.

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Crowns & Bridgework

Why are crowns used?

Typically a crown is made on a heavily filled or root canal treated tooth to prevent it from possible future fracture. Crowns provide more coverage and strength than fillings. A dental crown covers and protects your entire tooth, replacing the outside surface and preserving what remains of the interior. It is colored and shaped to perfectly match your surrounding natural teeth. If a patient is missing teeth and has teeth on either side of the area where the tooth is missing a bridge can be fabricated to replace the missing tooth or teeth. Dental crowns are also placed to:

• Restore a tooth with a broken cusp or heavily worn tooth
• Provide cuspal coverage for a cracked tooth
• Restore a tooth that has a large amount of decay
• Cover a dental implant
• Cover a severely discolored tooth
• Build up a misshapen tooth like a peg shaped lateral or microdont.
• Replace hypo-calcified tooth enamel
• Realign a mal-positioned tooth visa vie ‘instant orthodontics’
• Splint two or more teeth together for increased anchorage and periodontal suppport.

The teeth to be restored with a crown or bridge are prepared by the Dentist using his hi speed drills. An experienced Dentist such as Dr. Willoughby pays particular attention to the internal and external retention of his crown preparations. Sometimes when there is a lack of clinical crown height Dr. Willoughby will suggest the use of his Lasers to help re-contour the tooth and expose more clinical crown height. An impression is then made of the tooth preparation created by the Dentist and a stone model of the patient’s mouth is then made from these impressions. The restoration is then created on the model by a dental lab technician.

Crowns can be made of a variety of materials depending on your needs, the cost and purpose of the crown and the types of crowns which the Dentist prefers. The accuracy of the Dentists preparation and the dental lab technicians work cannot be over-emphasized because this is, in large part, what will determine the long term success of your crown and bridgework. Many of you have seen Dr. Willoughby show you the precise fit of the crown or bridgework on the model before it is permanently cemented into your mouth.

At our Dental Studio, Dr. Willoughby and his team take great pride in designing dental crowns and bridges to closely match the shape and color of your surrounding natural teeth. Dr. Willoughby and his team will always check the marginal fit of your crowns by taking a digital x-ray to ensure the fit is perfect before it is cemented to place. Our pledge to you is simple:

“Dr. Willoughby will never permanently cement a crown or bridge until we are completely happy with the fit and you are completely happy with the shape and color.”

There are various materials which the Dentist can use to make crowns and bridges from. Crowns can be made from metal, porcelain fused to metal, all porcelain and resin. The physical properties of these materials are very different and so this often dictate which is the most appropriate material choice for each particular clinical situation. Because gold crowns can be fabricated with minimal occlusal clearance (less than .5mm) and still remain very strong gold crowns are usually reserved for posterior teeth with minimal clinical crown height and which cannot be seen when the patient smiles. Because of their strength, porcelain fused to metal crowns make an ideal material for a long span bridges while still providing adequate tooth like esthetics. Resin reinforced crowns are tooth colored but are neither as esthetic nor as durable as porcelain crowns and are most frequently used as a long term provisional restoration – when cost is a factor.

In most situations Dr. Willoughby prefers to place bonded porcelain crowns rather than metal reinforced crowns due to their superior esthetics and adhesive bonding capabilities of an all porcelain crown.

If you think you may need a dental crown, please feel free to contact our Bayview Dental Studio serving the Fraser Valley and the surrounding areas of Langley, Cloverdale, South Surrey, White Rock and Campbell Valley.

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Invisalign Clear Aligner Therapy (Orthodontics)

What is Invisalign?

Invisalign straightens your teeth without the need for unsightly braces. Instead, it uses a progressive system of clear aligner trays to quickly and efficiently straighten your teeth. Over 3 Million Patients have been successfully treated with Invisalign.

Dr. Willoughby has been successfully treating patients with the Invisalign Clear Aligner system for 4 years now and has achieved Premier Preferred Provider status with Invisalign.

How does Invisalign work?

Invisalign uses a series of clear aligners trays to gradually move your teeth into ideal alignment. In our Bayview Dental Studio on 16th Avenue, Dr. Willoughby and his team use an iTero machine to take optical impressions of your upper and lower teeth. iTero converts these digital impressions into “DICOM” files which are then used to create a “ClinCHEK file” which Dr. Willoughby manipulates till all the teeth line up and are correctly positioned. This ClinCHEK file allows the patient to view what the final position of their teeth is going to look like before they actually begin treatment.

Once Dr Willoughby has approved the ClinCHEK file the trays are manufactured and you receive an entire series of clear aligner trays. Each pair of trays is designed to exert gentle pressure against selected teeth. After wearing one set of trays for two weeks, you discard the old set and get fitted for the next set in the sequence. In very tiny increments the progressive series of trays will gradually moves your teeth until they are all aligned.

Unlike traditional braces, the invisalign trays are removable for eating, brushing, for playing sports and when it comes time for your regular dental cleanings.

Why should I straighten my teeth?

Besides improving your appearance and boosting your self esteem, Invisalign can help preserve your dental health.

Crooked, crowded teeth can be hard to clean, with gaps and crevices trapping food. It can even be hard or impossible to get dental floss in between them. This can lead to tooth decay and periodontal disease. Crooked crowded teeth can also make it difficult or painful to chew, causing you to constantly bite in places which put your muscles into spasm – eventually leading to TMJD.

How long will it take?

It can take anywhere from six months to two years. Most often it takes about a year. Each aligner is used for two weeks and then you move on to the next aligner. Some people use as many as 40 or 50 aligners in the course of straightening their teeth. The more tooth movement – the more trays required.

Do I have to wear the trays all the time?

You will need to wear them at least 22 hours each day, but you can take them out for eating, drinking, brushing, and flossing. They are virtually invisible and will not detract from your appearance.

Is there a faster alternative?

If you simply want to correct the appearance of crooked teeth, porcelain veneers or dental bonding may be a better option for you. They will not actually straighten your teeth, but they will make them appear to be straight. This is sometimes referred to as “instant orthodontics”

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TMJD

What is TMJD?

Temporomandibular Joint Dysfunction or (TMJD) is a painful and often debilitating neuromuscular condition. It consists of a misaligned jaw joint, usually with misaligned teeth. The jaw muscles continually try to correct the misalignment, but they continually fail, and this builds up chronic tension in the entire jaw and surrounding facial muscles, leading to many painful symptoms. This is a very common problem afflicting an estimated 40-50 million North Americans.

What are the symptoms of TMJD?

• Pain behind eyes and in the temples
• Headaches
• Pain the face or neck
• Numbness in fingers or arms
• Shoulder or back pain
• Unexplained loose teeth
• Painful or loose teeth
• Cracked, chipped or broken teeth and or restorations
• Limited jaw opening or locking
• Congested or stuffy ears
• Ringing ears
• Insomnia or depression
• Snoring or Sleep Apnea
• Clicking, popping and or grating in the jaw joints

These symptoms can be very frustrating if you have not found relief from other healthcare providers, and have just “learned to live with the pain’ or have taken to a variety of anti-depressant medications and pain killers which dull the pain but also cloud your judgment and affect your mood.

At first blush, many of these elusive symptoms do not appear to be dental-related. People don’t think of talking to their dentist about stuffy ears or numb fingers. And doctors rarely consider the possibility of a dental cause.

The relationship of the muscles in your jaw to the other muscles and nerves in your body creates a chain reaction wherein the symptoms spread. Tension in your jaw leads to tension in your neck, causing further headaches and neck pain. Tension in your neck spreads to your shoulder and in the process puts pressure on the brachial plexus, a vascular nerve bundle which between your neck and shoulder and which can affect the normal function of your arm and hand. Wherever chronic muscle tension, inflammation and swelling develop, there is always the potential to compress the nerves in that area, causing pain.

Can TMJD be successfully treated?

Yes, TMJD can be successfully treated! Dr. Willoughby uses TENS to relax the muscles then computerized jaw tracking equipment and sEMG leads to find a specific location for the jaws where the muscles of jaw opening and closing are relaxed. Once a relaxed “isotonic trajectory” has been established, Dr. Willoughby will then use this jaw tracking equipment to take a bite and build a removable neuromuscular orthotic which holds the patients jaws in this zone of comfort so that the jaw joints and muscles can start to repair themselves.

TMJD can be treated effectively with Neuromuscular dentistry. Why suffer needlessly? Give our office a call today.

Dr Willoughby’s Center for Neuromuscular Aesthetic Dentisty in South Surrey serving White Rock, Langley, Cloverdale and the surrounding area of Campbell Valley and South Surrey, brings together the most advanced technology and techniques available in Neuromuscular Dentistry for your dental care. Contact us today to schedule your complimentary Neuromuscular TMJD consultation.

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Root Canal Therapy

What is a Root Canal?

When decay spreads through the enamel and into the deeper layer of dentineto the next layer, the dentin, and through that to the interior of the tooth, more thorough-going treatment is needed to restore the tooth and avoid having to extract it. This is where endodontics comes into play.

What is a root canal?

The root canal is the space inside a tooth. It is a tunnel, or canal, running down from the tooth’s crown area (visible area) through the root, where the tooth in anchored in the jawbone. The term root canal is used in two senses:

• To refer to this interior vertical space; and
• To refer to treatment of that space.

A tooth’s root canal is not an empty space. It contains what is called the tooth pulp, consisting of the tooth’s nerve, connective tissue, and the blood vessels which nourish it. When you get a toothache, it is because decay and infection have entered the root canal and are affecting the nerve.

Eventually the nerve will die, if no treatment is done, and the toothache will disappear. But the bacteria will continue to spread, infecting the gums and jawbone, and possibly entering the bloodstream to carry the infection elsewhere in the body. This is known as apical periodontitis (an abcess or infection in the jaw bone).

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Obstructive Sleep Apnea (OSA) / Snoring

What is OSA and how is my snoring related?

Obstructive Sleep Apnea (OSA) is a serious chronic breathing disorder caused by a narrowing or total closure of the airway. When you have OSA and your airway is blocked, your breathing can be interrupted for periods of time lasting from 10 seconds to over a minute at a time in severe cases. Even worse, a patient may stop breathing hundreds of times each night which means you are literally starving your brain and body of vital oxygen! When your tissues are not being oxygenated normally as is the case in Sleep Apnea, your tissues become hypoxic which forces them to undergo critical changes in cellular metabolism which produces enzymes and chemicals such as isocitrate lyase which inhibit normal connective tissue metabolism which in turn negatively affects normal development function of muscle, bone and vascular tissues including normal airway development!

Snoring and nighttime gasps for air are indications that Sleep Apnea may be taking place. Snoring is no longer something to joke about. Besides keeping others awake, your snoring may be causing serious medical problems if it is caused by Sleep Apnea.

While you are sleeping and without your knowledge, the body spends the entire night struggling for air and you never really get that important restful sleep you need. As a result people with Sleep Apnea wake up tired, often with a headache, are drowsy all day and experience memory loss and have higher accident rates.

The result of Sleep Apnea is a severe stress being placed on your body, especially on your cardiovascular system and metabolism. As a result, Sleep Apnea is frequently associated with the following medical conditions:

• heart disease or irregular heart beat
• high blood pressure
• weight gain
• diabetes
• lowered libido
• depression
• erectile dysfunction
• stoke and even death

The first step is to take a few minutes and perform a simple free screening questionnaire to help determine if Sleep Apnea may be causing your sleepiness. It the screening indicates you may have a problem Dr Willoughby can arrange for an overnight sleep study in the comfort of your own home using a Watch-PAT 2000 device which monitors your breathing and heart rate while you sleep. Dr Willoughby and his team will take the information gathered by this device and send it to your Family Doctor who with the help of a Pulmonologist can definitively diagnose the presence of Sleep Apnea.

What are the treatment options for Sleep Apnea?

• Use of a Controlled Positive Pressure Airway Appliance (CPAP) which is designed to fit over and around your nose and “force” air through your nasopharynx to support and hold your airway open – increasing upper airway volume and reducing collapsibility. The challenge with CPAP is that patient compliance is less than 40% and the devices can shift while sleeping and are quite cumbersome and noisy.
• Oral Appliance therapy using a SomnoDent® which is an ideal alternative to CPAP therapy for patients who suffer from snoring and mild to moderate OSA. The updated practice parameters of the American Academy of Sleep Medicine recommend the use of oral devices such as the SomnoDent® MAS for mild-to-moderate OSA (AHI < 25), or for patients with severe OSA who are either unable to tolerate CPAP or refuse treatment with CPAP.

What is SomnoDent?

SomnoDent® is a custom made removeable oral appliance worn during sleep to increase the upper airway volume and reduce collapsibility. SomnoDent devices each utilize a unique patented fin coupling component, to maximize patient comfort and compliance.

Health Benefits of SomnoDent®

SomnoDent® treatment has also been shown to have a clinically significant impact in reducing patients’ blood pressure and has been predicted to reduce the risk of stroke. In addition, this blood pressure reduction was apparent in the early morning, which is the time of peak risk for acute myocardial infarction. 14 independent studies and over 12 years’ worth of research demonstrate SomnoDent efficacy and significant clinical benefits. Exceptional levels of compliance 88%, treatment efficacy 91% and acceptance 96% of patients with OSA have been cited.

Is the SomnoDent the right treatment option for me?

If you suffer from obstructive sleep apnea (OSA) or snore, the SomnoDent® should benefit you. It will almost certainly put an end to your snoring and will most likely eliminate or significantly reduce your OSA. For your bed partner this means peace and quiet again and a better night’s sleep. For you, it will mean better quality sleep. As a result, you will be less likely to suffer from headaches and daytime sleepiness and your ability to concentrate will improve. If you have tried CPAP and found it uncomfortable, wake up to a brilliant alternative treatment for OSA. The difference in comfort and tolerance will astound you.

The American Academy of Sleep Medicine recommend the use of oral devices such as the SomnoDent for mild-to-moderate OSA (AHI < 25), or for patients with severe OSA who are either unable to tolerate CPAP or refuse treatment with CPAP.

Why is treatment with a SomnoDent Appliance so highly effective?

In order to develop the correct bite position for the SomnoDent Appliance, Dr. Willoughby utilizes a TENS machine to find the most precise forward position of the mandible where the muscles of the jaw are in their most relaxed and de-torqued position. Dr Willoughy confirms this bite position utilizing real time computer driven data to identify where the impression for the Somnodent appliance should be taken. When you wear a SomnoDent oral appliance that has been adjusted to an Isotonic Neuromuscular trajectory the patient can wake up with less muscle stiffness and may experience a better overall tongue position – all of which helps make for a more comfortable appliance.

Download and print an informational brochure, or take our Sleep Apnea Assessment today.

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