Why Mental Stress Can Lead to Dental Stress

Original article can be found here. 

Clenching and grinding the teeth can lead to host of problems.

Some Alberta dentists are worried the stress of the COVID-19 pandemic is causing a surge in dental issues like broken teeth and jaw problems.

Mintoo Basahti, president-elect of the Alberta Dental Association and College, says bruxism — the clenching and grinding of teeth — is showing up in more and more patients.

"The triggers and some of the things associated with clenching and grinding, like physical factors, emotional and mental stressors are certainly higher now with a pandemic," Basahti told The Homestretch. "About 10 to 30 per cent of the population will do it anyways, like they're predisposed to that habit, but during the pandemic, we're just hearing more about it."

Basahti said the trend is anecdotal, but he has heard from colleagues around the province who are seeing an increase in cases. He's also read about the trend worldwide, and has seen it in his own practice.

Basahti said bruxism is sometimes referred to as the high blood pressure of dentistry, a quiet, undetected problem. In his practice, he said he sees a lot of men who have not seen any pain or symptoms but are sent in by their spouses who are hearing the grinding in their sleep.

Damage done at night

"Now, some people will do it involuntarily when they're awake. You know, you may catch yourself with your teeth clenched together when you're focusing on something or going through some physical activity. But most of the time, most of the damage is done when we are involuntarily doing it at night, when we're asleep, when we have very little control over it." 

Basahti said the new stresses of the pandemic, including home schooling children and working from home, may be contributing to new habits.

"It's a multifactorial syndrome, but there are different triggers, so physical stress is one," he said.

"We are at home more. We're hunched over our computers, sitting in front of the Zooms. So, people may not be as active as they were before. So they get those bad postures, bad ergonomics, you know, bad back pain, neck pain, which then may lead into clenching and grinding there." 

But it's the mental component that Basahti thinks is really at play during COVID-19 times.

"So there's a physical component to it. And then the emotional and mental component of it. If you're going to bed concerned about, you know, things in your life, that may be a trigger as well."

But over a long period of time, bruxism can cause damage to the teeth.

"The normal bite pressure when you're chewing is about 60 pounds of pressure. People who are clenching can get up to 250 pounds of pressure," Basahti said.

"You can fracture your teeth, you can fracture fillings, you can cause teeth to loosen. And so many things can happen. Also, long term, if it continues, you can start to damage the joint. You hear people saying TMJ (temporomandibular joints) all the time, and TMJ is really just that hinge joint to the side of your jaw. It's the temporal bone in the mandibular bone meeting at that joint." 

Long-term clenching and grinding can cause disc displacement, Basahti said.

"And then the silent killer is undiagnosed. The bruxism where people don't know they're doing it, don't get it attended to, and they wear their teeth down over the years," Basahti said. "So those are the things that can happen."

Find out what's triggering it

The treatment for bruxism begins with diagnosis.

"If they are brushing and they have signs, in terms of they have some pain in the jaw joints, stiffness, headaches, maybe sensitivity that they don't normally have, even to the degree of maybe loose teeth, it's a good idea to go talk to your dentist and get diagnosed," Basahti said.

"Occasionally it'll be your partner who will notice that you clench and grind at night because they can hear you."

Basahti said the approaches to treatment are individual.

"The key is to try and figure out what's triggering it. But you also have to mitigate the damage," he said. "Often one of the simplest things to do is to fit a night grinding appliance."

Dental office backlog

Meanwhile, Basahti said dental offices are busy catching up with a massive backlog of cases caused by the pandemic shutdown.

"We're probably only doing emergency treatments for about two months. So we're seeing, you know, day-to-day things happen. Teeth are in a constant battle with food. So sometimes they lose and, you know, you'll break this or get a cavity. So that backlog is now coming into offices," he said. 

As far as patient safety, dentists have added new layers of protection and have always used PPE, he said.

"Patients feel very safe coming into dental offices (again)," he said. "And then if there is an increase in clenching and grinding, that's just that extra layer of demand that is coming in as well."