Cracked teeth and jaw pain: How pandemic stress has us clenching our teeth – and what we can do to fix it
Dentists in Ireland are seeing an influx of cases that stem from patients presenting with problems arising from bruxism – the grinding or clenching of teeth. We consult the experts to find out what we can do to solve this painful problem
A year of living with Covid has set our teeth on edge, and not just figuratively, but also literally. Dentists around the world have reported a rise in patients presenting with stress-related oral conditions over the last year.
Research published in October 2020 in the Journal of Clinical Medicine found a considerable increase in facial pain and teeth grinding. Another study conducted by the American Dental Association reported that the majority of dentists are seeing higher cases of teeth grinding as well as chipped and cracked teeth. This rise has been mirrored in Ireland, too.
“Most dentists would concur that there’s a lot more dental stress presenting to dental offices since the pandemic began this time last year,” says Edel Hurley, manager of the Beacon Dental Sleep Medicine Clinic. “There’s a lot of tooth fracture around and we would have noticed that since the beginning of last summer.”
Clinical director at Dental Care Ireland, Dr Jennifer Collins, observes that patients started piling in as soon as the first lockdown happened. “Often it was patients who didn’t know the cause of their symptoms so they might have had chipped teeth or broken teeth, headaches or jaw aches and they didn’t link it to grinding because they had never suffered from it before,” she says.
“What was most unusual about last year was that it was really across the board so it was young teenagers who were grinding their teeth who were stressed out or worried about the virus; it was adults working from home or who’d lost their jobs, it was elderly people who were worried about getting the virus and upset that they weren’t seeing their children or grandchildren. It was linked to every cohort in society as opposed to a certain few.”
Bruxism, the clinical term for unconsciously grinding or clenching your teeth, is often linked to anxiety and stress, so it’s understandable that the condition is now escalating. However, doctors don’t completely understand what causes it.
“Some people for whatever reason are prone to grinding their teeth, and what triggers it is probably quite different between a range of people,” says Dr Padraig McAuliffe, prosthodontist at Limerick’s Riverpoint Specialist Dental Clinic and an expert on bruxism. “For some people it’s stress and for some people it’s alcohol, smoking or very bad sleep that seems to just tip it over the edge. We don’t really know what the trigger is for people but it’s likely that there is a mix of lifestyle, medical and psychological factors involved.”
Affecting up to an estimated 10pc of people at some point during their lives, bruxism can be classified as awake bruxism, which happens during the day and often unconsciously, and sleep bruxism which occurs at night and is involuntary. In addition to stress, other risk factors for bruxism can include having a misaligned bite, medications such as SSRI antidepressants, sleep disorders like obstructive sleep apnoea as well as tobacco consumption, alcohol, recreational drugs and too much caffeine.
It is also sometimes linked to underlying health issues including Parkinson’s disease and gastroesophageal reflux disease. While symptoms often include headaches, facial pain and jaw tenderness, this is not always the case. Night-time grinders may only become aware of their condition when informed by a partner or roommate and quite often, it’s a routine dental visit that reveals bruxism.
Mild teeth grinding and clenching doesn’t always require treatment but if the problem is severe options include dental approaches to prevent further damage to the teeth, as well as trying to address the underlying cause. One of the common forms of treatment recommended by dentists is a mouth guard or splint which creates a physical barrier between the teeth, although it doesn’t stop the grinding.
Compliance with mouth guards can sometimes be a problem and often patients do not wear their guard for the long term, according to McAuliffe, who is part of the team of Irish researchers that invented SmartSplint. This is an intelligent mouth guard which goes on the market in six months’ time and allows dentists to record detailed data about their patients’ bruxism to optimise dental care.
“Part of what we were doing was trying to develop some technology to give people proof so at least they’d have evidence to continue wearing their mouth guard because they could see there was some kind of grinding activity happening. Or maybe they could see that it’s aggravated by certain times of their life and therefore they would wear the mouth guard at those times in particular, for instance approaching deadline or if their acid reflux is bad or whatever it might be so that they’d have some basis for understanding when they needed to wear it,” he explains.
Dr Collins says that a mouth guard is the most popular treatment for patients with bruxism and that she takes a holistic approach. “I look at the psychological causes of bruxism and the behaviours of the patient, so I’ll often ask what’s going on in their lives, where they’re at, is there a lot of change at the moment so I will encourage mindfulness or relaxation techniques. I will often advise yoga or different routines in the evening that will help calm the mind before someone goes to sleep.”
She also advocates a healthy diet, regular exercise and sometimes suggests alternative treatments like acupuncture and hypnotherapy. “In surgery, I can give people jaw exercises to do and that’s just really to stretch out their jaw as opposed to stopping grinding,” she says.
Botox is a relatively newer treatment route, where a small amount is injected into the muscles for moving your jaw, usually the masseter muscle, and paralyses it, thus reducing tension. It has proven to be effective and doesn’t affect appearance or function — but it is expensive.
While it’s also temporary, Dr Collins has found often that people require Botox less over time as the muscles adapt to not grinding. “It might wear off after three or four months but they might not need it again for a couple of months after that,” she says.
Physical therapy can help alleviate some of the problems associated with teeth grinding and clenching. Physiotherapist Ann-Marie Ennis of Swords Physiotherapy has also noticed an increase in patients presenting with bruxism and temporomandibular joint disorders, which occur as a result of problems with the jaw or jaw joint. Typically patients don’t tell her that they grind their teeth at night.
“They come in and say they’ve a pain in the jaw and the classical clinical sign that would make me suspect bruxism is that the pain is worse in the morning because they’ve been doing it all night,” she says. Redness inside the mouth or facets on the teeth are other indications of bruxism and for these patients, Ennis liaises with a dentist. “I tell patients I can sort out your muscles, but your teeth need to be protected.” Physiotherapy treatment can include manual therapy, exercises and advice on sleep hygiene and stress management.
“A big part of what I would do is trying to re-educate their jaw muscles to open and close correctly,” says Ennis. “I sometimes need to advise on chewing habits and the types of things to chew and not to chew. If the jaw becomes sore it can be very difficult to eat a big Mac or a panini. Biting apples can be difficult because the muscle is so used to being in a state of tension, it can’t relax enough to open the mouth.”
So, if you have joined the ranks of teeth grinders, how concerned should you be? While bruxism could resolve itself on its own, that’s not a given. “For some people it could be temporary. For others, they might do it for two or three years and never do it again and for other people, it appears that it might be a lifelong thing and it appears to run in families a little bit. We don’t really understand that aspect of it,” says McAuliffe.
However, it’s wise to be aware of the potential problems you could face if you ignore your teeth grinding. “It takes a long time to grind down teeth but teeth can snap or chip very quickly. So you might have someone with a lot of heavily restored teeth and all of sudden, they’re breaking off cusps left, right and centre and you can be certain that’s linked to grinding somewhere,” says Dr Collins.
“If it’s not caught early and the damage has built up, the effects of it can be pretty severe and the scope of the work involved in fixing it can sometimes be quite surprising to people,” advises McAuliffe. “They don’t necessarily see that a problem has built up, but sometimes what might seem like a problem that only visibly affects a couple of teeth, actually affects a lot more of them or fixing those few teeth involved requires a broader treatment plan to execute it and the cost of it can really mount up.”
His key message is anyone who is concerned about teeth grinding is to follow their dentist’s advice. “If the dentist advises to wear a mouth guard or a splint at night, it’s very important to do that. The effects of this are too significant in the long term if you don’t.”
