Teeth could be victims of pandemic-related stress

Cases of tooth grinding have been on the rise over the past year, says Dr. Sherwin Arman of the UCLA School of Dentistry.

As the pandemic lingers on, more people are unwittingly unloading the pressures of the day onto their teeth and jaws while they sleep.

Bruxism, a condition that can be triggered by stress and anxiety, involves grating, gnashing or clenching the teeth, generally during sleep. The results can range from muscle or joint pain to cracked teeth.

Cases of teeth grinding have been on the rise over the last year at UCLA Health and across the country, as COVID-19 has left many on edge about health, finances and politics.

“When you have a pandemic going on, there could be stressors that have led to more anxiety,” said Sherwin Arman, DMD, director of the Orofacial Pain & Dysfunction Program at the UCLA School of Dentistry. “We had an election that was coming up and I had patients tell me that is a big source of their stress. It wasn’t necessarily just the pandemic.”

Some people with bruxism may not be aware of what they’re doing unless a sleep partner points it out or a dentist notices damaged teeth, said Dr. Arman, an assistant clinical professor. Others may realize because they wake up in the morning with jaw pain that dissipates as the day goes on.

“Typically when someone bruxes, the first area of pain is more likely the muscle,” he said. “When you do it enough, then the joint starts to get overloaded. When we have patients get to us, a lot of times we are dealing with both.”

Other symptoms may include tooth sensitivity, headaches, ear pain and difficulty eating.

“You could have pain from the teeth pressing so hard, they get shoved down and the periodontal ligaments get compressed,” Dr. Arman said. “The teeth themselves can be sensitive and in very severe cases the teeth can crack. A patient could need fillings or root canals or crowns.”

Teeth grinding and clenching can also happen when awake. Dr. Arman said it’s common for patients to experience both kinds.

“Although it’s associated with nighttime, when it’s involuntary, a lot of it also happens during the day. When someone is not paying attention, it could become a long-term habit,” he said.

Dr. Sherwin Arman (Photo by Chris Flynn, UCLA Dentistry)

Ironically, as more people have sought treatment for anxiety and depression during the pandemic, some medications used to treat those conditions have been associated with nighttime bruxism. Onset may even occur within the first few weeks after starting a selective serotonin reuptake inhibitor (SSRI) such as Prozac or Zoloft. The medications suppress the brain chemical dopamine, which controls muscular activity.

Dr. Arman said in those cases, patients could discuss with their doctors the option of trying a different medication.

“We try to find the underlying causes whenever we can,” he said.

Mouth guards, awareness, can reduce damage

Reducing stress and anxiety is important for treating bruxism. Cognitive behavioral therapy or biofeedback, which teaches control over involuntary bodily functions, can help. But patients will likely need a range of treatment that could include medications, physical therapy or a custom oral device to absorb and distribute the forces of clenching and grinding.

“If it’s mainly happening at night, wearing a nighttime appliance can be exceptionally protective for the teeth,” Dr. Arman said. “We get referrals where they say, ‘Look doc, I’ve been sent to you to help make me a night guard because my dentist says I’m breaking all my crowns.’”

For those who grind during the day, awareness of the habit and “no clench” apps can be useful.

“There’s certain things we do as a nervous tic or when you’re not paying attention,” he said. “Sometimes just by bringing it up to the patient, they can stop. There are certain apps that will give you a buzz or a beep to remember to keep your teeth apart.”

For newer cases of day or night bruxism, such as those that have developed in the past year, management of symptoms may involve short-term use of anti-inflammatory drugs, moist heat or muscle relaxants.

“If it’s something very new and acute, it’s treated like a painful knee if you’ve gone to the gym and done heavy squats, for instance,” Dr. Arman said. “Chronic pain in general is more difficult to treat. Your brain has really rewired and it’s amplifying the pain.”

Patients with severe jaw pain may require steroid injections, injection of lubricants or Botox injections.

Doctors still don’t understand who is most likely to experience debilitating symptoms or why.

“There are so many people who will brux and clench their teeth but they don’t go to a clinic because it doesn’t hurt. So it’s more a matter of how come some people are susceptible to pain but others are not,” Dr. Arman said. “Bruxism can make those who are susceptible show symptoms.”

While the pandemic has brought patients whose symptoms had been under control back to his office with flare-ups, Dr. Arman said another concern stems from patients who have forgone routine dental care and may not be diagnosed.

“Dental care is health care,” Dr. Arman said. “That’s why, whenever it is safe to do so, I would always recommend to keep up with your health, to see your health care providers, including your dentist.”

For information on patient care, visit the UCLA School of Dentistry.

Courtney Perkes is the author of this article.

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