One morning around week six of the COVID-19 lockdown, I woke up to discover I’d gnashed a molar-sized crack down the back of my night guard, the device I wear to protect my teeth from the grinding I do in my sleep. I’d worn the acrylic barrier every night for years with minimal erosion, but suddenly I’d gnawed right through it. Like many Americans who have spent the last few years wondering where the stress and fear building up in their bodies could possibly go, the answer turned out to be my mouth.
Since 2020, dentists and other oral health professionals around the world have recorded a sharp uptick in the number of patients seeking treatment for issues caused by bruxism, a fancy word for grinding and clenching your teeth together with force. While bruxism is fairly common, with pre-pandemic data suggesting that as many as 31% of adults were chronic chompers to some degree, some major clinics saw nearly three times as many bruxers as usual when lockdowns began. The increase still hasn’t let up, some experts say. “My patients that had soft pain and bruxism got worse, and the people that I’d never seen it in before were now having lots of pain,” says Mark Drangsholt, chair of the department of oral medicine at the University of Washington’s dental school.
Most people who have bruxism grind in their sleep, and those without symptoms may never even know they do it. Though experts often make a distinction between this nighttime mashing, known as sleep bruxism, and daytime grinding (awake bruxism), in many individual cases the line between the two is blurred by a mix of patterns and behaviors.
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Bruxism doesn’t always cause pain, but when it does, it can be bad. Certain patterns (particularly sustained clenching), can lead to chronic pain in the temporomandibular joints—TMJ for short—found 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 grind their teeth frequently can experience TMJ issues that include clicking noises or pain while eating, general tenderness, and even jaw lock.
Then, there’s the risk to your teeth themselves. Aside from the small bits of time we spend eating, “your teeth don’t really come together much during the day,” says Drangsholt. Even an hour spent grinding at work is a huge amount of extra wear and tear, which can put you at risk for cracked or worn-down teeth.
Bruxism only gets more hazardous once you hop into bed. Ever seen those videos of hippos eating whole watermelons like they’re blueberries? That’s basically humans’ unconscious superpower. When we’re deep in REM sleep, says Drangsholt, we’re capable of exerting as much as three times the amount of force with our bite than we ever could consciously.
Bruxism has always been closely associated with anxiety in the dental world, and recent studies have begun to affirm the stories that clinics have been telling about the pandemic boom. One small paper published in 2021 that looked at Turkish health care workers found that roughly a third of those with no history of bruxism began to experience symptoms in the first months of the pandemic. Another study looking at Google Search trends worldwide found a notable increase between May 2020 and October 2020 in searches for bruxism, teeth grinding, and teeth clenching when compared to similar periods from 2016 to 2019.
Some psychoactive medications may also affect bruxism. Antidepressants such as SSRIs and SNRIs can trigger the onset of bruxism within a month of use, and are one of the first things Drangsholt says he asks new patients about when assessing their symptoms. Most people on antidepressants don’t develop bruxism, but “it does look like there is a relationship for some people,” he says. “That’s something we look pretty carefully at, because if you can switch out or change your dosing, then that can be helpful.” Though new antidepressant prescription rates in the U.S. dropped in the early months of the pandemic, the overall numbers over the last few years point to a continuing increase in new prescriptions.
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Michele Schultz-Robins, secretary of the American Academy of Orofacial Pain and a professor at Rutgers School of Dental Medicine, says that other lifestyle factors may have had an impact on the still-rising numbers of bruxism cases she’s seen. “COVID—it’s been insane,” she says. For years, adults and kids have been confined more to their homes during the day: staring at tiny screens, working from couches and in bed, and changing their daytime posture habits in ways that could lead to more clenching. “You’re holding your face differently,” she says. “You are now constantly bending over and your jaw is not aligned properly, and you may start clenching. You’re a little more tense about it, and when you clench with your temporalis muscle and your masseter muscle, you’re going to get a headache.”
The effects of stress, she adds, can be enormous. “I ended up with a 17 year old who couldn’t open up his mouth beyond one finger because he was so stressed,” Schultz-Robins says. “During COVID, he was the only one supporting his family; his parents had both been laid off.” Schultz-Robins says that she’s seen children as young as 6 come in with pain caused by excessive grinding.
This intense psychological connection can sometimes make temporomandibular joint disorders (TMD) difficult to treat. Something as simple as tweaking medication dosages to improve symptoms requires communication and coordination between psychiatrists and orofacial pain specialists, two specialties who don’t otherwise work together much. But successful TMD and bruxism treatment varies from case to case, and combinations of approaches can be hugely beneficial in alleviating symptoms, says Drangsholt.
On the psychological side, techniques like mindfulness, cognitive-behavioral therapy, and other proven anxiety-easing practices can have an impact on bruxism behaviors and TMJ pain, and are more accessible than ever thanks to online therapy options. Still, treatment should always start with an orofacial pain expert, says Schultz-Robins. A specialist can offer more physical treatment options, such as mouth exercises, night guards that prevent your top and bottom teeth from touching, and even regular injection therapies of anesthetics for severe pain.
“The treatment with the real big jump in use most recently has been neurotoxin, or Botox,” says Drangsholt. Though it’s a more expensive treatment reserved for the most severe cases, regular Botox injections every three or four months can make a world of difference for some grinders. “They don’t fracture the appliances, and they don’t have any of the tooth fractures,” says Drangsholt. “We’re able to decrease the volume of their muscles in a reversible manner.”
As Schultz-Robins puts it: “Does your jaw feel like you had a party in your mouth all night? Do you have a headache when you wake up?” These are signs that visiting a professional—namely one from the directory available on the American Academy of Orofacial Pain’s website—might be a good idea.
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Contributor: Haley Weiss