STRESS, TMJ, COVID, & DENTISTRY
Stress affects all of us in different ways: emotionally, psychologically, and physically. It feels like times just keep getting more stressful: Many of my patients, friends, and family make this comment often. COVID hasn’t helped either: it has taken a toll on all of us, one way or another.
Although some clenching and grinding may be normal, many people clench and grind their teeth as a result of stress. This can be pathological. Some of us do this during the day, and we are aware of what we are doing. Most of us do this at night, and may not be aware of it at all: sometimes a bed-partner will tell us that we are viciously grinding and gnashing our teeth together.
So what causes this grinding? We don’t always know, but we do know stress can. We also know other items such as medications (for example, a class of anti-depressants known as SSRIs), sleep issues, and poorly aligned teeth are additional culprits.
Many patients and friends comment to me, “I have TMJ.” I ask them how do they know, and most state they were told this by their medical doctor or dentist. If we want to get technical about this, everyone has TMJ. In fact, we have two TMJs. TMJ stands for “Temporomandibular Joint.” We all have two of these joints, which is where the lower jaw (mandible) connects to your skull, in the region called the temporal bone.
What people oftentimes are experiencing is “TMD,” which stands for Temporomandibular Disorder. The disorder can be within the joint itself (internal), but most times, its an issue with the muscles and teeth (external).
Symptoms include: headaches (especially upon waking), face pain, earaches, disrupted sleep (which in turn can cause more grinding and clenching), broken teeth, worn teeth, and sensitive teeth.
Treatments vary greatly: CBT (Cognitive Behavioral Therapy) for stress/anxiety, muscle relaxation exercises/physical therapy, correction to bite issues (occlusion), and mouthguards (properly known as splints).
Regarding mouthguards and splints, people feel they can go to the sports store and purchase an inexpensive guard they place into hot water and mould themselves. Although this will definitely protect teeth, it oftentimes doesn’t do anything for the joints and can make things worse. A splint, although more expensive and more time-involved, will protect both your teeth and joints. I strongly advise you to NEVER use a sports mouthguard for grinding and joint issues. See your dentist.
With respect to the teeth and joints themselves, there is a discipline within dentistry known as Occlusion. Occlusion is the relationship and interaction of your teeth, joints, and muscles. All of these items must be balanced and work in harmony with each other. If they are not, one, or more than one, of these items can suffer. The end result can be an increase in the grinding and clenching, with the symptoms mentioned above coming into play.
Occlusion can be a difficult concept for patients to understand, and it can take years of continued education and experience for a dentist to learn the treatment skills properly. If you have an issue with your occlusion, your dentist will let you know, but you must understand dental insurance will not cover most of your needs: you will have an out-of-pocket investment to address potential problems.
Within the last number of years, we have discovered another aspect of occlusion that goes beyond the joints, muscles, and teeth mentioned above. This is Airway or Breathing. Airway issues can develop from birth or become acquired with time, but they often go undiagnosed for years. The toll these issues can take on your health, or worse, your children’s health, is large. For example, a number of diagnoses of ADD / ADHD are related to these airway issues. Unfortunately, they are often treated by medications, and the underlying issues are missed. For some additional information regarding this, search Karen Bonuck on YouTube, or read some patient stories on Right To Grow: https://www.righttogrow.org/patient_stories
If you can relate to any (or all) of these topics mentioned above, a visit to your dentist for an evaluation may be in order. Regardless, try keeping your stress level in check, and don’t forget to stop and smell the flowers!
About the author: Dr. Ira Goldberg has been a dentist for 25 years, and maintains an extremely well-respected practice in Succasunna, NJ. He performs general dentistry procedures, cosmetic procedures, as well as dental implant procedures. He is a Diplomate of the American Board of Oral Implantology / Implant Dentistry, a Fellow of the Academy of General Dentistry, and a Scholar of the Dawson Academy for Complete Dentistry. He is also a lecturer in the field of implantology. For a free consultation, please call his office at (973) 328-1225 or visit his website at www.MorrisCountyDentist.com