…I am worried my teeth have moved and will continue to move and go all over the place again. I am not sure what to do?”
– Question from Sam of Stafford in Brisbane
Dental Hygienist, Jessica Nethery replies:
A great deal depends on your level of comfort with the current cosmetic appearance of your smile. Following orthodontic treatment (particular a long time after) some people can experience different levels of relapse.
Braces 20 – 30 years ago? The good old days of Orthodontics
In the ‘old days’ of orthodontic treatment, retention was approached in a completely different way to now. It’s not unusual that patients were told: “wear this retainer full time for 6 months and then throw it away.” We have since realised that that approach to retention just does not work.
Today the trend is toward long-term ‘life-time’ retention. This will help Orthodontic patients get the longest life out of their Orthodontic treatment.
So does that mean I have to get braces again?
It depends on how severe the relapse is as to whether we would recommend a repeat Orthodontic treatment, ie getting braces or an alternative Orthodontic treatment, or simply commence some more active retention.
There is a common misconception with Orthodontic treatments that they end once the braces come off. That is not the case, when the braces come off then the treatment moves to a more passive form of treatment.
For our patients in this situation Dr David Kerr will usually start with retention, which can be done in a number of different ways including:
bonding a wire to the back of the teeth
a clear overlay plate similar to those used with Invisalign
So does that mean I have to wear a retainer forever?
Not at all. When approaching a situation like this with a patient we would start by telling them to wear a retainer full time for three months, then we have another look and see what has happened, how it feels and how good they have been at wearing it.
Then, if we are achieving good progress at this stage then we might drop back the frequency and only wear the retainer at night time for the next three months. Then we take another look, see if it is tight and lessen the amount of time they wear it again.
Ultimately, we want to keep on top of it for that individual and what frequency suits their mouth best. As a rule of thumb we would recommend that if your retainer is getting tight then you should start to wear it a little more regularly.
So who is returning to Orthodontics now?
We are now seeing a number of patients who are ‘returning’ to Orthodontic treatment. This can be for a number of reasons:
Didn’t follow up their original treatment: some patients, when they were younger just didn’t wear their retainers as requested after their original treatment
Some people are more prone to teeth movement: while the main period of movement is when we are young and the jaw and mouth are growing there are other reasons why teeth can experience movement after your twenties:
o Loss of a tooth which leaves a gap
o Tooth grinding and clenching
o Bad habits such as chewing pens and pencils or sucking thumbs
o Those with large jaws can also be prone to movement
Though ultimately most of the people we see now returning for orthodontic help are those that could have been helped by applying a longer term approach to Orthodontic retention.
“Since she was 1 it has slowly chipped away to the gum, I have taken her to other dentists who tell me to wait for it to fall out. However today I noticed that her gum above it is going black – what should I do? Is it affecting her adult tooth?
She has had bad breath and swollen gums too so I am worried she might also have gum disease. I don’t want to take any risks with her teeth.”
– Question from Jamie of Northlakes in Brisbane
Dental Hygienist, Chanelle Winterburn replies:
I think you are right to be concerned about the changes in the appearance of the gums and other tissues around your daughter’s broken baby tooth.
When we see changes such as these there is always the concern of abscess formation and infection. The gum and oral tissues should be naturally a light pink colour when healthy.
Why do gums change colour?
Tissues that are dark in colour tend to be infected or diseased rather than the adult teeth in the gum.
Typically the baby incisor teeth are not lost until the age of seven when the adult teeth come down into position.
Care of baby teeth is important
If there is infection present in the gums or the jawbone around the baby incisor tooth then there is a risk of damage to the development and eruption of the adult tooth that is forming under it.
It would be prudent to take your child to have this area assessed properly because should any disease or infection be present, it can then be treated before any serious or permanent damage occur.
More information about caring for your child’s teeth
My colleague at Today’s Dentistry, Dr Darryl Marsh, has written a useful blog series relating to caring for your baby and children’s teeth and you may find some more useful information in these articles:
This is also not the first question we had had to our Ask a Dentist feature about caring for children’s teeth. Make sure you also check out what we had to say about children’s toothpaste and why they advise not to swallow them.
“I have a wisdom tooth that is coming through with an exposed nerve that is causing me a great deal of pain.
Do I have to have something done now, what would the cause of action be and how much would it cost? I’m also pregnant so what does that mean?”
– Question from Sonya of Chermside, Brisbane
Dr David Kerr replies:
When most people think wisdom teeth they think that they are going to have to be removed but in actual fact, in about 30% per cent of cases patients can have wisdom teeth that don’t need to be removed.
The reason why many people have to have their wisdom teeth removed is due to the fact that their jaw is mismatched to their teeth. Therefore when their wisdom teeth try to come through they simply cannot fit and become impacted against the teeth in front of them. This can result in a number of things:
Cavity in the adjoining tooth: impacted wisdom teeth can often come so close to the tooth in front of them to cause a cavity in them. This is a shame as it can lead to the patient loosing more teeth than just their wisdom teeth.
A cyst develops around the wisdom tooth: if a cyst develops then it can eat away at the jaw bone causing damage, pain and naturally more dental work to remedy the situation
Looser gums around wisdom teeth: The way that the gum attaches around the wisdom teeth is not as tight as it is to the other teeth This sets up the perfect situation for bacteria to breed and then the tooth and gum to become infected. Patients who are experiencing this report swollen gums, exposed nerves or the sensation like the “tooth is moving up and down”. This isn’t actually the case it just feels like it because of the problems with the surrounding gum.
Pain: When wisdom teeth start to cause pain the problems listed above are already well underway. I have been asked what would happen if someone did nothing about their wisdom teeth? The answer is that if your wisdom teeth become impacted the pain and infection would eventually become so great that you would not be able to stand the pain any longer. If you wait this long then it is likely that other teeth next to your wisdom teeth are beyond saving as well – there are cases where we have had to remove 8 teeth rather than 4 had the procedure simply been carried out earlier.
What about the cavemen?
So what would have happened back in the day of the caveman? Well they would have eventually died from the infection, though this wouldn’t have happened as much back then as it would do now if we didn’t have dentists – and we can thank evolution for that.
We have evolved to have smaller mouths than early man. The genes that control teeth and jaw size are on different chromosomes so they have not shrunk over time proportionately.
Wisdom teeth that break up
By virtue of the shape and placement of wisdom teeth, in addition to the fact that they often have only partially erupted, I have found that it is nearly impossible to keep clean and bacteria free. By the time patients report their wisdom teeth are ‘breaking up’ then the decay is so great that the tooth is literally falling apart. It is important to get these teeth treated by a dentist as soon as possible.
What ages are wisdom teeth a problem?
It is common for us to deal with wisdom teeth with patients in their late teens although this can be as late at 25 years of age.
My colleagues and I have seen an interesting trend recently towards more patients requiring treatment for wisdom teeth earlier, say between 13-15 years old.
As with all dental care and dental problems it is important to identify the ‘right time’ to treat your wisdom teeth as this will give you a number of benefits:
Lowest cost: wisdom teeth that are removed at the right time means the least complicated treatment, recovery time and most importantly cost!
Less pain: caught at the right time wisdom teeth can be treated with minimal pain.
We identify the ‘right time’ for wisdom teeth by monitoring them at our patients’ active maintenance visits.
Will I need to see a specialist for my wisdom teeth?
This all depends on your particular situation, how badly the wisdom teeth are impacted and how advanced any subsequent problems have advanced. Your dentist will be able to assess all of these aspects and recommend the best course of action in your case, and if cost is an issue then there are payment plans as an option.
Otherwise there are always ways to treat a pregnant patient and the best time for this is in the second trimester, as it is often too uncomfortable for a patient in their third trimester to sit in the dental chair for a long period.
I had a bad experience at a dentist where my heart started racing and I felt like I was going to pass out.
“Basically, I am very scared of the dentist and have been as long as I can remember.
It’s now been a long time since my last dental visit and I now have several teeth that need. Can you tell me about the steps you take with nervous patients and how you achieve ‘no pain’?”
– Question from Jamie of McDowall in Brisbane
Dr. Darryl Marsh replies:
I see this quite often and there are a number of possible reasons
Anaesthetics often contain adrenaline
A number of dental anaesthetics have adrenaline in them so it's possible that if you are having an injection it could nick a blood vessel and the anaesthetic can get into the blood giving you a spike in adrenaline. Also, the anaesthetic can be absorbed through the tissues into the bloodstream anyway. This can give some patients the feeling that their heart is racing.
Not always a fight or flight reaction that triggers adrenaline
In reality, the amount of adrenaline that might be absorbed from the anaesthetic is only a small fraction of what the body can produce. Most of the ‘heart racing’ reaction, while some of it may be triggered by the adrenalin in the injection, is mostly from the patient’s own body as a consequence of their anxiety.
A fear so great that people don’t go to the dentist
We recently saw a person who was in her thirties and it was their third visit to the dentist. They had been once as a child, once as a teenager to have wisdom teeth removed, and then this appointment in their thirties with a painful toothache.
The longest time between dental visits of all the patients I have seen is 26 years. Unfortunately, a lot of damage can occur in 26 years as pain only comes about once the damage gets very deep whether the tooth is abscessed or decayed.
When does fear of the dentist turn into a severe anxiety disorder or PTSD?
I have treated a number of patients over the years that have had panic attacks, and it isn’t always at the beginning of the treatment. Sometimes it can be as we are finishing up.
Recently a gentleman told me how much he had to talk himself into not only making the appointment but also to walk in the door. He was so worried that his fear would result in him passing out.
Dental fear is anchored in the past
Many times these sorts of fears are anchored in a childhood dental experience, just like you associate some feelings or memories to a smell or sound. As these feelings are ones based on a bad experience they can be extremely deep-seated.
Even my own sister, before she comes and sees me will get a nervous rash on her neck and chest. I have been her dentist for 25 years but she says this all stems back to a bad dental experience she had when she was 10 years old.
What is the best thing for patients who are afraid to do?
The very best thing a patient can do is talk to us and let us know how they feel. In my experience, the biggest help is having someone who is empathetic, listens without judging, and tries to understand how you feel. Then, together you can explore all the options. In many cases, building of trust and confidence of someone can set a patient's mind at ease enough to get past their dental fears.
For some patients, where the thought of the dentist is far worse than the reality, we can prescribe Valium before the appointment to ensure they get a good night's sleep the night. It is amazing the difference a full night of sleep can make before they come and see us and hop in the chair. Sometimes we will suggest Ibuprofen or anti-inflammatory medications before the appointment to reduce discomfort and swelling in the tissues. But remember to always tell your dentist about any medications you may have taken before you see them.
Once they are in the appointment we can use Nitrous oxide (also known as ‘Laughing gas’) during the appointment to really put them at ease.
Terrified? Pain has a high emotional component
Now while a lot of this treats the nervous symptoms you have to remember about pain is that it has a very high emotional component. If you are up tossing and turning the night before, worrying about what is going to happen, then you will be in a worse state in the morning.
In reality, we can control 99% of any physical sensations you experience during the appointment using topical anesthetics and the other drugs we mentioned but as dentists, it is important that we treat that emotional component as well.
Any dentist can treat their patients with a near pain-free approach. For us at Today’s Dentistry it comprises of two things:
Attitude: you have to want to treat your patients without causing pain. This often takes a little longer. With injections, like many other dental procedures, quick can often be more painful. You have to spend the time with your patients to understand them and then you have to give the time needed to proceed through any treatment with a gentle touch. Slowly and gently is comfortable. Any dentist can do this, they just have to want to.
Modern tools and techniques: Modern dentistry affords us the tools to give our patients a nearly pain-free experience.
The one thing you can do to make the biggest difference
Ultimately the most important tip I have is to make an appointment with the dentist to discuss your concerns and just check them out. By making a non-clinical appointment, talking with a dentist, you will quickly see if there is a personal connection there, if you trust them and have confidence in them then that will make a big difference to your fear.
I believe dentists have to earn their patient's trust, it isn’t something that we get automatically. We encourage people in this position to just come into our practice, meet our staff and check out the place. I cannot overstress how important it is to be non-judgmental about how long it has been since patients last went to the dentist or what treatments they may have chosen in the past. The dentist’s role is to make them feel as relaxed and comfortable as possible so we help them get the very best out of their dental health.
The short answer is that if you use a toothpick, wooden or plastic, gently and carefully then it may not damage your teeth – but it is more likely to damage the gum.
There may be a better solution than a toothpick
There were some cleaners, which were produced as an alternative to floss called ‘Interdents’. Also known as Interdental cleaning sticks, these were very soft sticks like balsa wood that were recommended by dentists. They are not recommended anymore, simply because there are products on the market now that will do a better job of removing food stuck between the teeth, such as floss or interdental brushes.
If you do it gently then toothpicks are OK but there are better things, such as floss to get food out.
Naturally the greater the frequency with which you use a toothpick, then the greater the chance of damaging your gums. However, if you are regularly getting food caught in between your teeth then you really need to check with your dentist as to why this might be. It really isn’t healthy to regularly get food stuck in between your teeth.
Getting food stuck in between your teeth often?
The possible reasons for getting food stuck in between your teeth on a regular basis could be: fillings that aren’t shaped properly, teeth that have shifted or even a hole in a tooth that is allowing food to get jammed in there. If these problems, particularly the last one, are not rectified then they can lead to greater problems such as decay on the root of teeth and that can progress really quickly.
If you do use toothpicks often then your dentist will also be able to check if you are causing any damage to your gums.
Personally, toothpicks are my least favoured way of cleaning food stuck between teeth – the best solution for cleaning in between your teeth is floss or an interdental brush.
Best practice flossing techniques
This is a great opportunity to recap on the best way to floss your teeth. Wrap the floss around your index fingers and slide it gently between the teeth.
Once the floss is in between your teeth it is important to pull the floss against the side of each tooth. Rather than a straight up and down movement you want to wrap the floss around the tooth towards the front of the mouth and slide it up and down 3-4 times. Go as deep as you can under the gum as you can without hurting yourself all the way up to where the tooth makes contact with the adjoining tooth.
I recommend flossing daily at a minimum – twice a day is even better. The interdental brushes are something that your dentist can show you and tell you which size will best fit your mouth.
Although you can buy them completely at your Pharmacy or Chemist, we will tell our patients which size is best for them, give them one to try for which they can then get the refills from their local Pharmacy.
Is it possible to have mini implants and not be toothless for a few months?
“I have a right back tooth and a bottom left tooth (both noticeable when I talk) requiring attention. These are currently crowned, but the crowns keep breaking off and I lose some of the original tooth each time. Thanks.”
– Question from Bob in Bridgeman Downs, Brisbane
Dr David Kerr replies:
That is an excellent question, Bob – you’ve obviously done your research into mini implants!
Yes, you can use mini implants, however I would not recommended them as an interim solution due to two technical limitations.
Firstly, when placing the definitive implant, you need a certain amount of bone and space between the implant and the tooth, so you can be limited by the amount of space that you have, and this is linked to the second limitation.
Secondly, if the mini implant actually integrates within that interim period, which means the bone grows onto them, (which you eventually want to happen with your full implant), then you’ve got a huge problem, because then we would actually have to cut out a cylinder of jaw bone to get a mini implant out, which is a painful exercise.
The short answer is yes, but…
You can put mini implants in, but with these technical considerations I would recommend that you sit down with your dentist, take measurements, and have them go through all the ins and outs and alternatives with you.
Generally implants will integrate after 3 months,but some can start much sooner than that.
Going with mini implants is a much more expensive approach than other options, for instance using a denture, so it may not be the best interim solution for you.
Instead…
We would probably recommend a partial denture, or a bonded restoration – glued into position using the teeth either side. There’s far less possibility of complications, it’s cosmetic and much less costly. It’s a nicely balanced temporary measure to get through the process towards your implants.
Remember that every situation and person is different, so naturally I would recommend consulting with your dentist.
When a child swallows toothpaste, it gives them a ‘spike’ or high concentration of fluoride in their blood supply. This can affect the development of their teeth.
When you have fluoride in the water supply, (like we do here in Brisbane), it gives a low dose of fluoride over a long period of time. This also affects the enamel formation of teeth - but in a positive way.
But you can have too much of a good thing…
If you have too much fluoride in your blood then it can disrupt the cells that are forming the adult teeth.
Spitting out toothpaste helps maintain this positive effect of low dose fluoride.
Swallowing toothpaste is not harmful to the rest of the body. So don’t worry – they aren’t being poisoned!
Are there toothpastes that are better than others?
Children’s toothpastes have a lower fluoride concentration for the reasons given above. So the best thing to do is to get the toothpaste appropriate to the age of your child and follow the directions given on the pack.
A baby’s first tooth will usually come through at about 6 months, and it is at this stage the front adult teeth start forming in the gum, then the adult molars follow.
This process of the adult teeth forming in the gum takes about 4 and a half to 5 years and these are the teeth that can be affected by ‘too much flouride’. There are teeth developing after this so we would recommend using the specific toothpaste for the child’s age till about 6 or 7 years of age.
What do you think of Organic toothpastes?
There is a range of organic toothpaste available. Each with differing ingredients to each other, so it is difficult to comment on the group as a whole.
Most of them don’t contain fluoride. Which means you are missing the protection for your teeth that this provides. However the toothpaste we use is only one part of our dental health puzzle. If you have a healthy diet and lifestyle, avoid sugars and there is fluoride in the water etc - then an organic toothpaste may suit you fine.
All these factors come into it. It is best to talk to your dentist about particular products and your individual situation.
One thing we do like about the organic toothpaste is that it doesn’t have Sodium Lauryl Sulphate. Which is an ingredient that scientists are taking a second look at.
Other thoughts about Toothpaste
The latest thing in toothpastes which we am trying at home at the moment, is a Pro-biotic toothpaste. The idea is a nice one, just as you take Pro-biotics to keep the bacteria in your gut balanced, a Pro-biotic toothpaste aims to maintain a balance of the bacteria in your mouth and around your teeth.
The downside is that the consistency is more like mud, it tastes awful and it is very expensive. These things do evolve quickly though so Pro-biotic toothpaste might be one to look out for in the future.
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Since 1988 We Have Been Treating Our Brisbane Northside Patients According To Our Philosophy Of Being Open, Honest And Plain Speaking. Meet Us And See Our Approach For Yourself By Watching One Of Our Videos!
Caitlin received her Bachelor of Oral Health from Charles Sturt University.
Prior to joining Today’s Dentistry Caitlin worked within rural communities in New South Wales and Victoria.
Caitlin enjoys giving back and has done some dental volunteering in Cambodia.
“Working with patients of all ages continues to ignite my passion within dentistry and I strive to provide a gentle, supportive and positive environment for every patient I work with. ”
Chanelle Winterburn
B. App Sci (Oral Health)
Chanelle graduated from the University of Queensland in 2005.
Before joining Today’s Dentistry, Chanelle worked at a family based dental practice on the Brisbane Northside for five years
Chanelle is particularly interested in working with children and families.
“I enjoy seeing the delight that our patients show when they realise how easy dental care can be! Our team at Today’s Dentistry work together to make every patient feel completely comfortable.”
Dr Sharon Chen
Dr Sharon's commitment to excellence has shown itself right from the start of her dental career, when she graduated from the University of Queensland with Class I Honours. Her commitment to her craft is reflected in the numerous professional development courses she participates in, with a desire to get the best possible outcomes for her patients.
Dr. Sharon is passionate about empowering patients through education about their dental conditions, supporting them through overcoming dental anxiety, and helping them achieve their dental goals.
Away from the clinic, Dr. Sharon is an avid baker, a keen photographer, and a fitness enthusiast aiming to conquer the Bridge to Brisbane run in 2023.
Brittany Hancock
I always loved going to my own dental visits, and one day I honestly just though ‘why don’t I give dental assisting a go’. I applied for a job and got a call back straight away, and have been in the industry ever since!
I studied my Cert 3 in Dental Assisting online alongside working full time in my first dental job. I chose to do it online so I had more time to work as I am more of a hands on learner.
I LOVE smile makeovers. I love seeing the joy, and happiness it brings patients and the amount of confidence they gain by having their dream smile.
I love feeling like I am making some sort of impact on people’s lives. Whether it is helping them with their smile makeover, holding their hand during a procedure or just being an ear to talk to and a shoulder to cry on.
The team, they are all so wonderful and both Darryl and David are so great to work for. But also what our core value is – which is patient care. I think we are a really great team at making sure our patients come first and their experience with us is a positive one each and every time.
Sarah Gollagher
Brisbane born and bred, Sarah’s passion for dentistry began during her orthodontic treatment in her teens. After graduating from highschool, Sarah began working as a dental nurse and decided her true calling was as a dental hygienist. She graduated from the University of Queensland in 2006 and has worked in both the private and public sector since then.
Sarah’s focus is on prevention and education. Her goal is to empower her patients so that they can achieve and maintain the best possible oral health for life.
In her free time Sarah can be found spending time with her two sons, hiking, attending a pilates class or exploring Brisbane and the surrounds looking for new restaurants to eat at or adventures to have.
I have been a proud part of the Today's Dentistry team for 20 years now.
My journey to get here though was anything but straight forward and I can probably thank my own childhood family dental visits in Newcastle NSW for my interest in this area of care. It too was a very special practice that took the time with their patients young and old and truly cared about them.
Having my own great experiences as a patient I was thrilled for them to accept me for my Year 10 work experience as a dental assistant and fell comfortably into the role. Due to life as it was back then and lack of public transport my career took me in a whole different direction and I had many years at the Aluminium Smelter in Kurri Kurri.
Once my children were at school I applied for a position as a receptionist at the local Dental Practice only to be told it was actually for an assistant and was I still interested? Silly question! Hands on training the old school way which put me in great position for further learning when our family moved to WA for a couple of years and then finally finding my way to QLD and Darrly and David.
Dentistry to me is a package of many very important parts, the precision and artistry of the actual treatment, the person behind the treatment and understanding of not only their dental needs but emotional drivers and the communication and care to put this all together. Although I now find myself not chairside but doing the behind the scenes administration I still get to talk with our patients and be confident that they are in good hands with my wonderful team.
Robyn qualified with the University of Queensland in 2005 as dux of her year.
Prior to joining Today’s Dentistry in 2010, Robyn worked at dental practices throughout the north of Brisbane.
Robyn loves working with children and has an extensive knowledge of gum disease.
“I love the professionalism and challenge at Today’s Dentistry. It is great to work at a practice that believes in quality patient care”
Dr Darryl Marsh
Founder and Principal Dentist
Qualified at Queensland University and practicing since 1984.
Founding dentist at this practice in 1988.
Continuing dental education in advanced techniques in Australia & US.
Darryl enjoys family life with his wife and three adult children.
“I value the many loyal patient relationships that I have built over the last 25 years and enjoy witnessing the procedures I have done stand the test of time.”
Carlene qualified with University of Queensland in 2006.
Before joining Today’s Dentistry, Carlene worked in private practice in Brisbane’s northern suburbs.
Carlene is an active member of the Dental Hygienist’s Association.
“I have worked in Dentistry in one form or another since I was 16 years old. I love this profession and making a difference in others lives.”
Dr David Kerr
B.DSc (Hons) B.Sc (Hons)
Qualified at University of Queensland and practicing since 1998.
Dental partner at this practice since 1999.
Continuing dental education in advanced techniques in Australia & US
David has a particular interest in Orthodontics.
David enjoys rugby union, golf, food and spending time with his young family.
“Although I love the scientific side of dentistry, I also get a great deal of satisfaction from helping our patients and surprising them with what modern dentistry is capable of.”
A great deal depends on your level of comfort with the current cosmetic appearance of your smile. Following orthodontic treatment (particular a long time after) some people can experience different levels of relapse.
My colleague at Today’s Dentistry, 
When most people think wisdom teeth they think that they are going to have to be removed but in actual fact, in about 30% per cent of cases patients can have wisdom teeth that don’t need to be removed.
Wisdom teeth that break up
The longest time between dental visits of all the patients I have seen is 26 years. Unfortunately, a lot of damage can occur in 26 years as pain only comes about once the damage gets very deep whether the tooth is abscessed or decayed.
The one thing you can do to make the biggest difference
That is an excellent question, Bob – you’ve obviously done your research into mini implants!
Going with mini implants is a much more expensive approach than other options, for instance using a denture, so it may not be the best interim solution for you.
