Feature Article:::...

As stress levels rise, so does teeth grinding

By: Kevin Martin, D.D.S.

Grinding or clenching of the teeth is a very common and destructive habit that is being seen at an ever-increasing rate in dental patients.

Grinding can not only destroy tooth structure as the patient wears away at opposing teeth, but grinding can also damage the jaw joints and cause severe headaches and muscle pain. Grinding (or bruxing) can increase during periods of stress and most often happens at night while the patient is sleeping. Other factors can also contribute to grinding, such as missing teeth, malocclusion (teeth that don’t line up) and even sleeping disorders.

It is estimated that at least a third of the population has a significant to severe grinding habit. With the current economic situation, we have seen grinding increase substantially as patients attempt to cope with increasing stress. Patients’ symptoms often include severe headaches, sore muscles, sore teeth, occasionally teeth that are mobile or moving, and teeth that are very sensitive to hot and cold due to the nerve of the tooth being irritated.

When we examine the teeth we often see, by using an intraoral camera, back teeth that are broken or fractured around large silver fillings, front teeth that are wearing down into the inner portions of the tooth so that they appear to be getting darker on the top edges, and large areas of missing tooth structure along the sides of the teeth next to the gums.

This is all due to excessive lateral forces being placed on the teeth as the patient scrubs back and forth on their teeth. The patient often has clicking or popping of the jaw joints and occasionally difficulty chewing hard foods.

In many cases, however, the patient is not having symptoms and is not aware of his or her grinding habit since it is happening while he or she is sleeping. In these patients, we often diagnose the grinding problem when we find multiple fractured back teeth or areas of teeth that appear to be ground or “polished” flat.

After diagnosing the grinding habit the patient will often confirm other symptoms that he or she was not aware were related to grinding teeth. Such symptoms include sore jaw muscles when waking up, muscle fatigued at the end of the day, and the feeling that the teeth don’t fit together properly upon waking up. Most cases of grinding come and go in cycles, often related to stressful time, but sometimes on a temporal cycle related to hormone levels.

The treatment for nocturnal grinding is usually wearing a “nightguard” or bruxism splint while sleeping. In my practice, I prefer a hard nightguard that is custom-made to fit either all the upper teeth or just the upper or lower front teeth. The nightguard physically protects the teeth. It also reduces or eliminates grinding and allows the muscles to relax.

As stated previously, some grinding is due to a poor bite relationship between upper and lower teeth due to missing teeth, or teeth that are just not in the right position. This causes the jaw joint to be in an uncomfortable position and the muscles to try and grind the teeth down until a more comfortable position is obtained.

The nightguard achieves a more “perfect” bite and thus allows the jaw joint to be more comfortable and the muscles to relax.

If grinding is not addressed in the early stages of tooth wear, the destruction of the teeth and jaw joints can be severe. In many cases, patients have teeth that are broken and very painful. In many cases, not only does the tooth need to be fixed, but the nerve of the tooth must be addressed with a root canal. In extreme cases, so much destruction has taken place that all the teeth have been worn down to the gums and the teeth cannot be restored and are lost. As the patient grinds, the constant movement of the jaw joint and muscles can eventually tear the joint apart and cause irreversible damage to the cartilage and bone that make up the joint.

Teeth grinding is a very common and destructive habit that is becoming more and more prevalent in today’s society as stress levels go up and lives become busier.

It is essential that patients discuss potential symptoms with their dentist and be evaluated for any areas of wear or fractured teeth. Treatment is fairly simple, if caught early, with the use of a nightguard. If the process continues uncontrolled, treatment can become very complicated and expensive.

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Kevin Martin, D.D.S., is a family and cosmetic dentist in Kingsport. He practices at Martin Dentistry with his father, Dr. Tim Martin. E-mail questions or topics of interest to kmartin@martindentistry.net, visit www.martindentistry.net or call 247-8172.