Modern life is stressful; expect to see more bruxism
Featured Products Promotional FeaturesPosted by: Dental Design 6th April 2022
Stress and anxiety have an established link to bruxism and temporomandibular disorders (TMDs). Stress can be the cause of bruxism, and aggravate and intensify an existing condition. The ultimate dental impact of a grinding and/or clenching habit is a cracked or fractured tooth. Other impacts include hypersensitivity and failure of restorations. Non-dental manifestations include persistent headache (particularly at the temples) earache, sinus and facial pain, all of which can negatively influence quality of sleep and cognitive function, as well as mood.
Many people find modern life intensely stressful. There is now an acceptance among the general public that stress damages our physical health, as much as our mental health. If evidence of bruxism is found, this can be a signpost for stress, if your patient has not told you already that they are suffering. Stress is not an age-related condition either; it can affect and take its toll on patients of all ages. Dentists can expect to see more people presenting with oral disease and situations that are the result of the patient being under stress, including stress-related bruxism.
A patient can be entirely unaware of how they habitually and repeatedly grind or clench their teeth. Also, bruxism often occurs at night; if someone has disturbed sleep and/or is regularly waking with unexplained orofacial pain, including pain in their neck, they could be oblivious to their nocturnal habit. Even just one night of poor-quality sleep can ruin your day; when it’s chronic it will quickly lead to a constant low mood. Going to bed expecting yet another sleepless night is acutely anxiety-inducing and stressful, and so the vicious cycle begins.
The management of stress is a multi-agency, multi-professional task. But there is much that the dental team can do to help. At oral health consultations, taking a detailed social history can establish if a patient is currently stressed, or prone to anxiety. If they report they are experiencing chronic headache, or pain around the masticatory muscles, this could be the result of stress-related bruxism. A sore face – rather than jaw – can be alienating, especially if the patient has not made a link between this pain, being stressed and a possible case of bruxism.
A thorough oral examination will detect any evidence of abnormal tooth wear. To a patient, this sounds a bit like “wear and tear” but it actually refers to the non-carious loss of substance. Attrition is particularly associated with bruxism-related tooth wear, when the biting surface becomes flattened by the repeated mechanical force on it. Even if an individual knows the grind their teeth at night because they have been told by their bed partner, they need to appreciate that bruxism is more than an annoying habit, and what damage it is doing to their teeth.
There are simple yet practical things that you can recommend to help patients relax and manage stress, which may also result in an improvement in a mild case of bruxism. Improving sleep hygiene is always a good place to start, so direct them to resources that can help. The Sleep Charity recommends changes to a routine should be made over 24 hours, not just before bedtime. Its advice includes things like having a regular wake-up time, engaging in daylight exercise and reducing or eliminating stimulants like caffeine.[i] Sleep deprivation may not be the only source of stress, but a good night’s rest will make anyone ready to face the world more positively. Other complementary therapies can be great stress-busters, like learning how to meditate properly and simple breathing exercises. If their stress/anxiety has been ongoing over a period of time, they should be encouraged to contact their GP, if they have not done so already, who might make a referral to cognitive behavioural therapy (CBT).
For nocturnal bruxism, a splint or mouth guard may be prescribed by the dentist as a preventive measure. Or, you may recommend restorative treatment to repair any damage, including poor aesthetics. If the patient is determined to stop grinding, a beautifully restored mouth can be an excellent motivation for committing to ongoing management. Conservative treatments, that are minimally invasive and preserve healthy enamel, should be delivered using composite materials which are also great shock absorbers if the patient still grinds now and again. For example, Crios composite bloc from COLTENE is suitable for single tooth restorations with exceptional wear resistance and low abrasion. It will repair a tooth and help it withstand further damage. Crios can also be used for a range of other indications, such as inlays, onlays and veneers. Available in two sizes, eight shades and two translucencies, this makes it an incredibly adaptable material to have in your stock.
Stress can cause bruxism; bruxism can affect a patient mentally, as well as leading to dental problems. Early interception and management of bruxism may prevent significant damage, but there are also treatments that will conservatively repair a tooth that has become worn by clenching and grinding. These minimally-invasive solutions are sometimes also key to leaving bruxism behind.
Nicolas Coomber COLTENE National Account & Marketing Manager
For more on COLTENE, visit www.coltene.com,
email info.uk@coltene.com or call 0800 254 5115.
[i] The Sleep Charity, sleep hygiene for adults. Link: https://thesleepcharity.org.uk/information-support/adults/sleep-hygiene/ (accessed January 2022).
