Q&A: Uncertain times take their toll on teeth and jaws
If it seems like you've been gnashing your teeth over the woes of the world, there's a good chance that you have been. Dentists are seeing signs that tooth-grinding and jaw-clenching are on the rise during the pandemic, just as they were during the Great Recession a little over a decade ago.
"We've been seeing an increase in the number of patients looking for appointments to replace broken mouth guards" because they've been cracked or chewed through, says Leopoldo Correa, associate professor at Tufts School of Dental Medicine and director of the school's Craniofacial Pain Center. Grinding and clenching—known in the dental world as "bruxism"—are also often the culprits behind migraines and other headaches; face, neck, and temporomandibular joint (TMJ) pain; and cracked teeth, fillings, and crowns.
And stress is often the driver behind it all. "You may resolve a stressful situation in the short term, or it may continue and develop into chronic stress," which can result in symptoms such as fatigue, increased muscle tension, depression, an inability to fall or stay asleep, and bruxism while awake or asleep, Correa says. "According to some data, the amount of force we create when clenching the jaw is around 300 pounds." With a load that heavy, eventually something's got to give.
Tufts Now talked to Correa about bruxism and what you can do about it.
Tufts Now: What are the short-term and long-term consequences of tooth-grinding and jaw-clenching? Since many people grind and clench without realizing it, what signs should people look for?
Leopoldo Correa: Short-term consequences can include facial pain, especially in the morning; difficulty opening the mouth; headaches; neck pain; and certainly TMJ pain, which is a disorder we manage in the pain center. Long-term consequences include fractures to teeth or dental restorations, or, in those who have chronic bruxism, the enamel that protects the teeth can wear down.
Aside from stress, what other factors can contribute to bruxism? What role has the pandemic played?
Ergonomics plays a big role in the development of symptoms, and part of our initial evaluation is an assessment of body posture in general and what the patient does for their profession—do they spend long hours in front of the computer? If people are working from home during the pandemic, what is their work setup like? After several hours at the computer, there is a tendency to move the head forward, and the muscles of the head tend to become off-center. Not only does this create higher tension on the neck muscles as they try to maintain the position of the head, it also increases the contact between the upper and lower teeth.
There is plenty of evidence that a side effect of some medications, such as SSRIs (selective serotonin reuptake inhibitors), is increased muscle activity, including increased jaw-muscle activity, which can be more intense during sleep. So those who are taking some kind of antianxiety or antidepressant medication may see an increase in bruxism.
What can people do to remedy the situation, especially during the pandemic, when it may not be as easy to see a dentist quickly for a non-emergency visit?
The current situation is really very challenging for everybody, including for clinicians and for patients trying to get appointments, because of the limitations required to maintain safety during the pandemic. While a mouth guard that's custom-made is the preferred treatment, an over-the-counter mouth guard can be a useful temporary solution. We do recommend that at some point the patient find a dentist to fabricate a mouth guard specifically designed for the patient's symptoms and the size of their mouth. But there are a variety of over-the-counter mouth guards, and all of them will work on a temporary basis—the main purpose is to assist in separating the teeth and provide some cushion to prevent tooth fracture. They may also reduce joint or face pain.
Dental insurance covers some types of mouth guards, and depending on the diagnosis, mouth guards may even be covered under medical insurance.
In addition, there are exercises for the jaw and the muscles of the face that are helpful, and that anybody can do, even if you can't purchase a mouth guard. Dedicate 5 to 10 minutes in the morning, and especially in the afternoon or the end of the workday, when the muscles are most fatigued. Keeping your teeth apart, bend your fingers and place your knuckles on each side of your face. Give yourself a self-massage, pushing down.
If possible, briefly apply heat or an ice pack to the side of the face before doing the stretching exercise.