COVID’s Collateral Damage - Our Teeth!
Pictured: Team Member Kelly Brucchieri conducts a check-up.
After going over my American Dental Association and Ohio Dental Association morning updates on what’s new this week in Dentistry, I noticed a predominant theme emerge from the content - namely, that Covid causes stress and, in turn, our teeth suffer the consequences as this stress seeks escape from our bodies.
I touched on this topic several weeks back and truly didn’t anticipate returning to it so soon. But I feel professionally obligated, as a member of organized Dentistry, to let you in on dental facts gathered from across the world that just might be of interest to you or help someone in Medina County!
You may also find it comforting to know that you are not alone or going crazy being quarantined with various dental situations.
So back to the permeating dental fact of this week - Covid causes stress and, over the past 11 months, this stress has found several portals of escape from our bodies, with one being through our teeth.
The incidence of cracked teeth, crowns, veneers, bridges, and implants has increased exponentially in dental offices across the world during Covid.
Previously, the average dental patient tended to clench or grind at night. However, during the pandemic, the occurrence of daytime bruxism has developed, it is surmised, as a result of our stay-at-home lifestyle of the quarantine. And now there are some individuals who just brux twenty-four hours a day, seven days a week!
As dentists, we used to recommend the use of night guards for our patients to protect their teeth. Now, we find ourselves looking at day guards and round-the–clock-except-when-eating guards.
Let me make a distinction between the two possible types of bruxism - grinding and clenching.
Grinding leaves wear facets (flat surfaces) on the enamel at the point of contact. As the lower jaw moves past the upper, grinding tends to shear off parts of teeth or restorations and can usually be heard by your significant other as you sleep.
Clenching, on the other hand, tends to cause tooth sensitivity due to the extreme levels of continuous pressure at the focal point of tooth-to-tooth contact. Clenching, I feel, is more insidious, because those around you cannot hear it and most individuals do not even realize they are doing it. I have had patients come in with a night guard cracked in two and the explanation, “I just woke up and it came out of my mouth like that!”
Studies have shown that we normally generate 200-300 psi at our molars, when relaxed. During periods of stress, divorce, death of loved one, and now the pandemic, we can generate 2-3 times that much pressure at a cusp tip of a tooth!
That is truly something that needs to be properly addressed or you probably won’t like the possible outcomes (emotionally or financially). This past Fall I started seeing interesting articles on wearing double splints at a time. Yes, an upper and a lower worn simultaneously. This has been proven in our orthodontic world to extend the life of clear tray retainers by eliminating single focal points of pressure. Interestingly, my Invisalign patients have remarked about the release of pressure on certain teeth and relief from TMJ issues once they were in treatment for several weeks. During Covid, this has been an interesting side benefit for correcting smiles and bites with Invisalign!
Lastly, let’s look at what teeth are most vulnerable to bruxism.
Normal unrestored teeth are protected from normal daily life by having a layer of springy soft dentine to support the rigid glass-like enamel. If the pressure gets high enough from bruxism, even this protection won’t last. The most vulnerable teeth are those having had root canal therapy and not receiving a crown. Once a tooth has had a root canal, it begins to dry out due to lack of a blood supply and basically becomes mummified. The dentin can no longer provide the flexure to support the enamel under stress and it cracks, chips, or some variation of the two.
The number one reason root-canaled teeth are lost is bruxism and, right behind at number two, is chewing ice. The ice reduces the surface layer temperature of the enamel (which weakens it like glass) and then the compressive or shearing force of the lower jaw provides the coup de grâce.
The constant stress of Covid, theoretically, has produced an environment of constant bruxism.
Because of this increase in clenching and grinding, people who may have chewed ice all their lives (with no negative issues) now find their teeth fracturing and in need of repair or replacement. At a cost of several grand for implants or bridges - that, my friend, is very expensive ice! At that price, it’s usually residing on a finger! As I have said before, the reduction of stress is a systemic game-changer for the human body, even for your teeth.
The ADA has provided a bruxism resource on their website for consumers to gain more insight on stress, tooth grinding, mouth guards, etc. Dr. Leopoldo Correa, director of the Craniofacial Pain Center at Tufts University School of Dental Medicine in Boston, feels that chronic stress causes facial muscle tension, which leads to bruxism. He recommends 5 to 10 minutes of jaw and facial muscle relaxation through massaging on a daily basis.
Dr. Correa’s routine is as follows: Keep your teeth apart, bend your fingers and place your knuckles on each side of your face forward and slightly down from your ear opening. In a circular motion, pressing in with your knuckle, give yourself a self-massage. Applying a heat or cold pack for five minutes prior to massaging may also produce positive benefits to the massage by increasing or decreasing the blood flow to the musculature.
After the massage, you know what I always say, head for the great outdoors (bringing along your dog, of course) and keep walking until you feel better! This extended snow pac we’ve been experiencing is super crisp, due to zero moisture from low temperatures, and really has added to some interesting hiking experiences this winter!
This weekend… instead of chewing ice… observe ice! Head for Medina’s Annual Ice Festival and enjoy the artistry of Northern Ohio’s best carvers. Your teeth will enjoy the rest!
Get out and enjoy local,
- Dr. Pfister