Oone morning around the sixth week of the COVID-19 lockdown, I woke up to find that I had scraped a molar-sized crack in the back of my night guard, the device I wear to protect my teeth from the grinding I do in my sleep . I had worn the acrylic barrier every night for years with minimal erosion, but suddenly I bit through it. Like many Americans who have spent the past few years wondering where the stress and fear building up in their bodies could go, the answer turned out to be my mouth.
Since 2020, dentists and other oral health professionals around the world have seen a sharp increase in the number of patients seeking treatment for problems caused by bruxism, a fancy word for the grinding and clenching of teeth. While bruxism is quite common, as pre-pandemic data suggests as many as 31% of adults were to some extent chronic pain, some large clinics saw almost three times as many bruxers as usual when the lockdowns began. The increase has not yet subsided, some experts say. “My patients who had mild pain and bruxism got worse, and people I’d never seen it before were now in a lot of pain,” says Mark Drangsholt, MD, chair of the Department of Oral Medicine at the University of Washington School of Dentistry.
Most people who have bruxism grind in their sleep, and those without symptoms may never even know they are doing it. Although experts often distinguish between this nocturnal grinding, known as sleep bruxism, and daytime grinding (awake bruxism), in many individual cases the line between the two is blurred by a combination of patterns and behaviors.
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Bruxism doesn’t always cause pain, but when it does, it can be bad. Some models (in particular prolonged squeezing), can lead to chronic temporomandibular joint pain—TMJ for short—located on each side of your face near the ear. These joints, which are often compared to hinges, allow the jaw to move away from the rest of the skull and are directly stressed by bruxism. People who frequently grind their teeth can experience TMJ problems, which include clicking noises or pain when eating, general sensitivity, and even jaw locking.
Then there is the risk to your teeth themselves. Aside from the small amount of time we spend eating, “your teeth don’t really pack much during the day,” says Drangsholt. Even an hour spent grinding at work is a huge amount of extra wear and tear that can put you at risk for cracked or worn teeth.
Bruxism only becomes more dangerous after jumping into bed. Have you ever seen those videos of hippos eating whole watermelons like they were blueberries? It’s basically people’s unconscious superpower. When we’re deep in REM sleep, says Drangsholt, we are able to exert up to three times more force with our bite than we ever consciously could.
Bruxism has always been closely associated with anxiety in the world of dentistry, and recent studies have begun to confirm the stories that clinics tell about the boom in the pandemic. A small one paper published in 2021, which looked at Turkish healthcare workers, found that roughly a third of those without a history of bruxism began experiencing symptoms in the early months of the pandemic. Another study looking at Google search trends globally, we found a significant increase between May 2020 and October 2020 in searches for bruxism, teeth grinding and teeth clenching compared to similar periods from 2016 to 2019.
Some psychoactive drugs can also affect bruxism. Antidepressants such as SSRIs and SNRIs can unlock the beginning of bruxism within a month of use and are one of the first things Drangsholt says he asks new patients when evaluating their symptoms. Most people on antidepressants don’t develop bruxism, but “there seems to be a connection in some people,” he says. “That’s something we’re looking at quite carefully, because if you can go off or change your dosage, then that can be helpful.” Although new antidepressant prescribing rates in the U.S. dropped out in the early months of the pandemic, the overall numbers over the past few years point to a continued growth in the new recipes.
Michelle Schultz-Robbins, secretary of the American Academy of Orofacial Pain and a professor at Rutgers School of Dentistry, says other lifestyle factors may have contributed to the still-growing number of bruxism cases she’s seen. “Covid – it was crazy,” she says. For years, adults and children have been cooped up more in their homes during the day: staring at small screens, working from couches and in bed, and changing their daytime posture habits in ways that could lead to more slouching. “You hold your face differently,” she says. “Now you’re constantly bending over and your jaw isn’t aligned properly and you can start to slouch. You’re a little more tense than that, and when you contract the temporal muscle and masseter muscle, you’ll get a headache.
The effects of stress, she adds, can be overwhelming. “I ended up with a 17-year-old who couldn’t open his mouth more than a finger because he was so stressed,” Schultz-Robbins says. “During COVID, he was the only one supporting his family; both his parents were fired. Schultz-Robbins says she’s seen children as young as 6 come in with pain caused by over-grinding.
This intense psychological connection can sometimes cause temporomandibular joint disorders (TMD). difficult to treat. Something as simple as changing medication doses to improve symptoms requires communication and coordination between psychiatrists and orofacial pain specialists, two specialties that don’t otherwise work very well together. But successful treatment of TMD and bruxism varies from case to case, and combinations of approaches can be extremely helpful in relieving symptoms, says Drangsholt.
On the psychological side, techniques like attentiveness, cognitive behavioral therapy, and other proven anxiety-relieving practices can have an impact on bruxism behavior and TMS pain, and are more accessible than ever thanks to online therapy options. Still, treatment should always begin with an orofacial pain expert, Schultz-Robbins says. The specialist may offer more physical treatment options, such as mouth exercises, night guards that prevent upper and lower teeth from touching, and even regular injection therapies with anesthetics for severe pain.
“The treatment with a real big jump in use recently has been a neurotoxin or botox,” says Drangsholt. Although it’s a more expensive treatment reserved for the most severe cases, regular Botox injections every three or four months can go a long way for some mills. “They don’t break appliances, and they don’t have any of the tooth fractures,” says Drangsholt. “We’re able to reduce their muscle volume in a reversible way.”
As Schultz-Robbins says, “Does your jaw feel like you’ve been partying in your mouth all night? Do you have a headache when you wake up? These are signs that the visit to a professional – namely one from pointer available on the American Academy of Orofacial Pain website—might be a good idea.
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