Family Dentistry

In addition to taking extensive training in esthetic dentistry, Dr Toohey also designates a portion of his time for general family dentistry, which was the foundation of the practice.  Dr Toohey continues to include related courses in his ongoing studies.   For a period of time he had considered specializing in endodontics (root canal treatment), and periodontics (gum surgery) and has taken a number of advanced courses in these disciplines. He declined invitations to specialize, preferring a multidisciplinary approach to comprehensive dentistry.

Although a long list of courses and qualifications may sound impressive, parents are generally more concerned about chairside manner, and that little Buford has a positive experience.  Before gaining his expertise in esthetic services, Dr Tim's reputation and identity was: "he's great with children!"

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General Family Dentistry Services Offered:
SEALANTS & PREVENTATIVE RESINS
Sealants are generally placed on permanent teeth shortly after they erupt into the mouth. After removing any stain decay from the grooves on the biting surface of the tooth, a flowable resin is placed into the grooves and hardened with a curing light. This preventive procedure reduces the incidence of decay by approximately 80% on the biting surface of the tooth. The average life expectancy is two - three years as they may chip out or wear depending on clenching or grinding habits of the individual. Your sealants will be evaluated at each check up appointment and touched up or replaced as necessary.

Should I place sealants on my child's baby teeth?
Generally speaking most of the decay we notice on baby teeth occurs between the teeth, in an area where sealants cannot be placed. Flossing is the best preventive measure for cavities between the teeth. Furthermore, properly isolating the teeth with rubber dam or cotton rolls can be overwhelming for a young child. For these reasons we generally do not place sealants on baby teeth; however, there are always exceptions. We will be happy to discuss the suitability of this treatment for your child.

Before
Part of the existing sealant had chipped away with superficial decay developing in the grooves


After
New sealant placed after stain and decay removed.

(Sealants have a very subtle visual result)

MICRO-ABRASION (Stain Removal from Front Teeth)
Teeth that have intense external staining or mottling can often be esthetically enhanced with microabrasion.  Most often this is completed without freezing.  The procedure involves isolation of the involved teeth with a rubber dam and polishing the area with an acid-pumice mixture.  Once the stain is removed, the area is polished and fluoride is applied to the teeth. 

If the stain goes deeper we may consider using a fine diamond bur in a handpiece to dust away the discoloured / defective tooth enamel, and place some tooth coloured filling material to restore the tooth to its original form.

FILLINGS
Clients have a host of materials to choose from when restoring decayed or broken teeth. Many materials rely on healthy surrounding tooth structure to support them. If the filling is quite large, the predictability and prognosis for plastic or silver fillings as well as for the tooth may be guarded. Individuals facing this situation may enhance the possibilities of keeping the heavily restored tooth with an onlay or crown (refer to onlay crown: esthetic dentistry).

For small to medium sized fillings, the four main choices include plastic, porcelain, gold and silver. Material preference is a hot topic in some dental circles with many proponents for and against some of the materials. Many clients feel that dentists who still do silver amalgam fillings are antiquated old school types. To its credit, silver amalgam has been around for over 100 years and is a very user friendly material. Even with questionable moisture control, and poor clinical technique a favorable clinical result can still be achieved relatively inexpensively.

Silver amalgam contains approximately 40 - 50% mercury which is the main issue of contention. Although the material is endorsed by the Canadian Dental Association and Alberta Dental Association, it is not uncommon to see warnings about using it in pregnant women and children. Furthermore, dentists are required by law to dispose of amalgam as a hazardous waste. In addition, an increasing number of individuals are documenting metal sensitivities / allergies which would also include amalgam. We have chosen not to use silver amalgam as a routine restorative material. A web search will provide you with a plethora of reading material about silver amalgam if you desire to know more.

White plastic fillings are not without their liabilities as well. Nevertheless, this is a material we have had good success with when used with proper case selection. In order to achieve a great result, patience, proper clinical technique, attention to detail, and impeccable moisture control are essential. "Usual and Customary Fees" as suggested by insurance companies do not cover the costs required to place these restorations ideally. Rather than compromise the quality of our work, or our integrity, we have adjusted our fees to reflect the time and expertise required to properly place these restorations.

If the plastic fillings extend below the gums and onto the root of the tooth, the prognosis is less favorable as there is no enamel to bond to on the root. If there is something about a particular situation that would compromise the result, we will inform you and let you decide among the options.

Porcelain restorations provide unparalleled esthetics, and are stronger than plastic. Caution should be exercised when placing them in back teeth especially in people showing signs of clenching or grinding.

Gold is the "gold standard". Although many people choose porcelain over gold favouring the natural looking esthetics of ceramic restorations, gold restorations, properly placed will generally significantly outlast ceramic restorations. I have seen many gold restorations that are 25+ years old and still going strong. I haven't seen nearly as many ceramic restorations. One of the interesting things about gold is that it has a coefficient of thermal expansion similar to teeth. For all you analytical engineer types, that means the material expands and contracts similarly to tooth structure when exposed to hot and cold. This thermocycling over time will contribute to marginal breakdown of any restoration.


Silver Amalgam fillings replaced by porcelain restorations and a porcelain fused to gold crown in the middle.

PASSIVE ORTHODONTIC APPLIANCES
We are fortunate to work with a number of skilled orthodontists. Frequently, they will request that we fabricate space maintainer or minor tooth movement appliances for clients. We provide this service as a convenience to our clients. For some appliances, the fee codes for general dentists are considered preventive versus orthodontic, and do not use up the orthodontic benefits that will be required later for braces.

We do not place braces on clients requiring comprehensive orthodontics nor do we provide Invisalign orthodontic treatment. Weekend courses are no comparison to ortho grad school.

TMJ TREATMENT
Understanding principles of TMJ function has been an ongoing learning process as part of the training in esthetics and restorative dentistry. Identifying and managing existing and potential TMJ problems is part of comprehensive treatment planning for our clients. A number of clients have visited us specifically for TMJ related problems. Frequently, we will oversee treatment which may vary among individuals. Occasionally, we will refer to specialists in TMJ dysfunction, or work in cooperation with them.
ROOT CANAL THERAPY
In spite of their reputation, root canals are generally a painless procedure with mild - moderate discomfort afterwards.  This is typically managed with  over the counter ibuprofen for a few days.   I feel the bad rap is the result of a number of factors, including previous filling materials (which are no longer standard of care), and waiting too long to attend to the problem.  The success rate of these procedures is very high and facilitates keeping your own teeth.
INTERNAL WHITENING (For A Single Dark Tooth)
Often times a dark tooth is the result of previous trauma which has become non vital and subsequently had root canal therapy.  Internal whitening involves removing some of the filling & root canal material from inside the tooth, and placing a peroxide based product inside the tooth every 2-3 hours. This is a procedure you complete at home once the access opening is made into the tooth, and a thin custom tray is made for your front teeth.   Most often the tooth has lightened to the same brightness of the surrounding teeth within 24 hours.  As with all whitening procedures, some relapse is likely to happen over time.  For a more permanent result you could consider a porcelain or composite veneer placed over the surface of the tooth to mask the dark colour. (Refer to Cosmetic Dentistry Services for a description of these procedures)
SURGICAL SERVICES:
• Gum Recountouring
• Extractions (Including Wisdom Teeth)
• Laser Release for "tongue tied" patients
• Crown Lengthening
SPORTS GUARDS
According to some US based literature, approximately 5 million teeth are knocked out every year in sports related injuries when mouth guards are not worn.  (The cost for a single tooth replacement with a dental implant and crown ranges from $3000.00 - $5000.00.)  In addition to protecting the teeth, mouth guards also protect the tongue, cheeks, lips and jaws from injury.  Although they are typically required for some sports such as hockey, football, rugby, boxing and lacrosse, they are also recommended and should be considered for people who participate in the following activities, basketball, martial arts, indoor racquet sports (squash, racquetball), skateboarding, skiing, snowboarding, and wrestling to name a few.
PARTIAL DENTURES
For individuals missing a number of teeth and not wanting to have them replaced with implants or bridges, Partial dentures are another option for consideration.  These offer the advantage of relatively low cost and quick turn around time.  They are often an eye opening appliance for people who think they would rather just have their teeth pulled and get dentures.  The main disadvantage is comfort.  Approximately 25% of partial dentures remain in the bedside table drawer.  Many individuals who do wear them regularly do so because they are missing front teeth, and they would rather put up with the discomfort than go without front teeth.  Other disadvantages include: metal clasps that wrap around teeth and are often visible when you smile,  loosening of clasped teeth, and increased plaque retention to list a few.
IMPLANT SUPPORTED COMPLETE DENTURES
Upgrading to implant supported complete dentures is analogous to trading in your tricycle for an automobile.  Research shows that restored dental implants can provide an individual with up to 80% of the functional ability of  someone with healthy teeth.  There are a couple of options an individual can consider depending on the number of implants the denture will rest on.  One option would be to have 2 implants placed in the area of the lower eye teeth.  The lower denture rests on the two extensions that resemble a trailer hitch .  The implants shoulder a significant portion of the biting forces, and provide considerable retention and stability for the lower denture.  No more floating denture! A second option provides a result that resembles having real teeth once again.  Following the placement of approximately five or six dental implants, a set of teeth is made that actually screws onto the implants.  The result is a solid set of natural looking teeth that unlike the moon, doesn't come out at night!
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