Stress and Dental Disease

2020: what a year it has been! I feel reasonably confident in saying that everyone has been confronted in one way or another with change or new experiences as a consequence of Covid-19. Change – especially change that is foisted upon us – can be demanding to deal with. Almost inevitably, many of us experience stress as part of our coping mechanism.

So what are the dental consequences of stress? For many, bruxism or clenching of teeth is one of the more immediate responses. All of us have a propensity for nocturnal grinding of teeth (bruxism). It is readily evident as wear facets on teeth. If you wake up with a sensation of tightness in your jaw muscles, and that your teeth feel as though they’ve been clenched – you’re probably grinding your teeth.

Sometimes there can be discrepancies in your occlusion (the way your teeth come together) that can act as a trigger for grinding - in combination with your stresses. This will often manifest as symptoms in the muscles of the jaw, symptoms in a tooth (that is involved in the discrepancy) or symptoms in your temporomandibular joint (TMJ – the jaw joint that hinges off the base of the skull near your ear).

It is possible to determine the nature of these discrepancies and selectively grind the teeth to eliminate them and create a more harmonious bite. Frequently, this is sufficient.

In some instances, patients suffer from more debilitating symptoms. These symptoms can be focused on the TMJ joint, the muscles involved in moving the jaw and chewing or sometimes symptoms in teeth. For patients with more acute symptoms, I will often discuss the use of a night-guard. This is simply a mouthguard (made from the same elastic material mouthguards are made from) that has been adjusted so that the teeth meet evenly on the mouthguard. This provides an even, cushioned surface for clenching – offering protection to both the joints and the teeth. These kinds of night guards can be worn in times of more severe bruxism (stress) and provide a circuit breaker until the episodes subside.

One of the more unfortunate aspects of bruxism, when it is focused on a tooth, is that its presentation can be very similar to that of a tooth that is about to develop an abscess. X-rays, a careful history of presentation and symptoms as well as an assessment of the tooth can help to determine the diagnosis. There have been instances where, due to a degree of uncertainty, we have delayed the commencement of the initiation of a root canal therapy. Thankfully – the great majority of patients have an innate feeling about the source of the pain – in combination with a careful history, the right decisions can be made.

So, is bruxism avoidable? Yes and no. No, because we’re all programmed to some degree to grind our teeth, especially in the face of stresses. Yes, because there are ways of managing stress. The understanding and management of stress can aid in moderating or significantly reducing bruxism.

This year, I have been implementing meditation into my weekly routines. Meditations focused on acceptance, compassion and gratitude appear to me to reduce stress levels by switching from a “victim or blame” mentality to a “coping or problem solving” mentality (what some may call abundance). This kind of mentality shift is progressive, yet can feel quite profound. I suspect that meditation has other benefits as well. If you’re interested in this topic, I’ve found the book “Changing the Habit of Being Yourself” by Dr Joe Dispenza, an inspirational read.

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DR ALEX HUSZTI BelleDental

Alex has had a career focused on low-biologic cost reconstructive cosmetic dental care – common sense teeth for life.

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