THE WASHINGTON POST – I have been a frequent visitor to my dentist’s office since it re-opened after lockdowns during the initial stages of the pandemic. First came a cracked tooth, then a cracked filling. Both were painful enough to wake me up at night.
It was bad luck, I figured, or maybe just the reality of middle age. My dentist, Jennifer Herbert, suggested otherwise. Ever since the pandemic started, she said she has seen a surge in problems related to tooth-grinding and jaw-clenching. Perhaps, she suggested, pandemic stress was the culprit for my tooth woes, too.
“It’s astronomical,” she said. “I’ve seen more patients with problems from grinding in the last few months than I have in the rest of my career.”
The technical term for disordered teeth-grinding and jaw-clenching is bruxism, and the behaviour falls into two categories, said Gary Klasser, a specialist in orofacial pain at the Louisiana State University Health Sciences Center’s School of Dentistry in New Orleans.
There is bruxism that happens while awake and bruxism that happens during sleep. Each has its own causes and potential solutions, but both appear to be common. Sleep bruxism, which is more well-studied, occurs in an estimated five to eight per cent of adults (and in up to 50 per cent of children, although it usually goes away as they get older). But benign clenching and grinding into adulthood is far more common than that. A full 60 per cent of adults exhibit some amount of rhythmic movement and muscle contractions in their jaws during sleep, studies show.
For most people, jaw movements during sleep don’t cause problems. But as clenching and grinding become more powerful and more frequent, people can start to experience symptoms such as jaw pain, headaches, temperature sensitivity in their teeth or damage to teeth or fillings.
During a 24-hour period, studies suggest that our teeth should be pressed against each other for a maximum of about 10 minutes, Klasser said. Any more than that can become a problem. There is no official data about whether the stress of the pandemic has produced a spike in bruxism and related teeth damage, he said. Scientists have yet to conduct the kinds of experiments that would show definitively that stress can be a cause of bruxism at all, although there are clues that it does make a difference.
For example, plenty of studies have shown that nighttime teeth-grinding commonly occurs in people who experience stress, anxiety, depression or other psychological issues. But most studies have been correlational, which leaves open the possibility that nighttime grinding might be the cause of disrupted sleep and that sleep-disruption, in turn, messes with mood and emotions during the day, said Sylvia Kriebig, a research psychologist at Stanford University in California, who studies the bodily effects of emotions.
It is also well-established that stress, fear and other emotions can ramp up activity in the amygdala, the part of the brain that regulates emotions, causing responses such as sweaty palms, a racing heart and muscle contractions that could include jaw-clenching. But studies haven’t directly linked jaw contractions to those emotions. Still, given the convincing hypothetical links, Kriebig said she would not be surprised to learn that bruxism has become a bigger problem than usual in pandemic times. Stress is a common reaction to what people are experiencing right now – uncertainty about the future, a sense of powerlessness, feelings of being overwhelmed, doubts about the ability to cope. And stress affects the body.
“Given that stress is more prevalent,” she said, “this is a very solid ground for negative emotions to flourish and to affect our sleep and our well-being.”
Stress is far from the only potential cause of bruxism, Klasser added. Clenching and grinding can also result from neurological conditions, gastroesophageal reflux disorder, sleep apnea and other conditions. Antidepressant medications also commonly cause teeth-grinding during sleep, and doctors may prescribe those medications for stress-related mental health issues.
Regardless of cause, if you start to notice symptoms from clenching and grinding, there are things you can do to mitigate the potential negative consequences, experts said.
Daytime bruxism is a behaviour that can benefit from relaxation, mindfulness exercises, and techniques derived from cognitive behaviour therapy, Klasser said. He tells patients to set a timer to go off every hour. When you hear the alarm, he said, pay attention to the position of your mouth, and remind yourself to relax. There should be a bit of space between your teeth, with your lips gently touching and your tongue sitting passively on the floor of your mouth. Doing this every day for four to six weeks can train your jaw to be relaxed instead of active.
“If people could master that, the amount of damage that they would potentially do to their dentition would be greatly diminished,” Klasser said. “If you’re awake, you can control every habit that you have, as long as you’re willing to put the time, energy and effort into controlling that habit.”
Some evidence exists that clenching during the day can carry over into the first couple of hours of sleep, Klasser said. So teaching yourself to relax your jaw might help early in the night, too. For bruxism that persists through the night, many dentists recommend oral appliances, also known as mouthguards or splints. Cheap mouthguards are available at drugstores, but Klasser said that custom-made devices, which are firmer, are usually worth the investment.
A poor-fitting device or a really soft and squishy one bought over-the-counter can backfire, activating the brain to chew and fidget, leading to more muscle-movement instead of less. A well-fitting device, on the other hand, can distribute the force of clenching instead of concentrating it onto specific teeth.
Mouthguards don’t work for everyone, Klasser said, and they don’t cure bruxism. But they can provide an important protective barrier to nighttime grinding and tooth-mashing. It’s easier and cheaper to replace plastic, after all, than it is to replace teeth, crowns and fillings.
I made a plan with my dentist to look out for signs of jaw-clenching over the next few months. We’ll talk about a nighttime mouthguard at my next checkup. Even as the pandemic stretches on, I’m hoping my teeth will remain damage-free.