Do you tend to grind your teeth or clench your jaw?  Have you noticed recurring facial pain, or do you feel like your jaw is locking? If so, you may be experiencing bruxism – and you are not alone!

A review published in the Journal of Orofacial Pain reported prevalence of bruxism in the general population to be between 8% and 31.4%.

Bruxism is when you unconsciously clench or grind your teeth. This can be done at night while you are sleeping or during the day. When it occurs during the day, it is called awake bruxism. Seeing as this is done unconsciously, many people donot realize they are doing it until they begin to experience facial pain or damage.

According to Johns Hopkins Medicine, bruxism is often triggered by stress, anger, or frustration. Common signs and symptoms for bruxism include the following:

  • Headaches
  • Damage to the inside of the cheek
  • Jaw locking
  • Facial pain
  • Chipped teeth
  • Dislocation of the jaw
  • Wearing of tooth enamel
  • Temporomandibular disorders (TMD)
  • Temporomandibular joints (TMJ)

Each day we learn more about COVID-19. New strains as well as new symptoms, secondary conditions, and effects on mental and physical health continue to appear. Two of these effects are an increase in stress and, as a result, an increase in teeth grinding (bruxism). Recent research has found that there has been a significant increase in bruxism since the pandemic swept the nation.

Dental professionals play a critical role in identifying bruxism and assisting patients with treatment to prevent permanent damage. However, as many people are not visiting the dentist as often as they did pre-COVID, it’s important to understand the risks and signs of bruxism, as well as self-care practices that you can begin implementing at home to reduce it.

Bruxism and COVID-19

Research conducted pre-COVID identified a relationship between stress, anxiety, and COVID-19. A 2019 study looked at psychosocial predictors of bruxism and found that states of anxiety, perceived stress, and the inability to recognize one’s own emotions increased the likelihood of bruxism. States of anxiety and stress, no matter if they are permanent dispositions or temporary states, increase the likeliness of awake bruxism.

It comes as no surprise that with current lockdown orders, an on-going pandemic, and increasing feelings of uncertainty, there has been an increase in stress and anxiety. The adverse effects of COVID go well beyond physical health. There have been serious consequences and effects on mental health as well.

One of the deleterious effects on people’s health arising from the pandemic is an increasing number of temporomandibular disorders (TMD) and bruxism. In fact, some researchers have dubbed the increase in bruxism cases as an outbreak.

study looked at the prevalence and worsening of bruxism amongst subjects in Poland and Israel. The subjects completed anonymous questionnaires while in lockdown in their respective countries; 1092 questionnaires from Poland and 700 from Israel. The study first compared the occurrence of bruxism and TMD between the countries. Following this, an analysis investigated the effects of depression, anxiety, and concerns of the pandemic, on bruxism and TMD symptoms. The last step involved analyzing variables that would predict bruxism and TMD. After completing the study, the researchers found that COVID had caused significant adverse effects on the participants in both countries. Their TMD and bruxism symptoms had worsened as a result of declining psychoemotional status. The researchers concluded that “the aggravation of the psychoemotional status caused by the Coronavirus pandemic can result in bruxism and TMD symptoms intensification and thus lead to increased orofacial pain.”

Similar results were seen in a comprehensive review that looked at the presence of TMD symptoms and orofacial pain during periods of COVID related isolation. The results of this review found that the looming presence of the pandemic combined with social isolation had generated an increase in anxiety that directly affected patients with TMD and bruxism. It found that the mental stress of the pandemic can worsen bruxism, specifically awake bruxism. The researchers involved in the review said that dentists must become aware of the signs and symptoms of these conditions and should advise patients of self-management strategies. Self-management strategies include good sleep hygiene, meditation, body education, self-massage, and the use of various devices.

Healthcare providers and frontline workers are particularly at risk for declining mental health. In addition to daily personal stress, there has been a significant increase in work-related stress. A survey of frontline medical staff in Italy analyzed levels of emotional distress and psychosomatic symptoms. The workers were asked about their perceived wellbeing, emotional support, hygiene, and safety measures. The results found that roughly half of those who completed the survey displayed medium to high levels of emotional exhaustion. Overall, the workers experienced significant emotional distress and psychosomatic symptoms. With stress as a known bruxism predictor, it makes frontline workers more susceptible to worsening bruxism.

Diagnosis and Treatment

Awake bruxism often goes unnoticed until there is damage or a dental emergency, making diagnosing awake bruxism a challenge. According to a review published in the Journal of Clinical Research in Dentistry, dentists must look at a patients’ medical history and complete a clinical exam looking for:

  • Tooth or teeth hypersensitivity to cold or air.
  • Tooth wear within the normal range or at the eccentric position.
  • Masticatory muscle discomfort, stiffness, or fatigue.
  • Headache in the temporal muscle area.
  • Masseter muscle voluntary contraction or hypertrophy.
  • Cheek or tongue indentation.
  • Tooth mobility.

Clinical Treatment Options

Following a diagnosis, the first objective of intervention should be to manage the psychosocial factors. This may be done by reducing stress through therapy, lifestyle changes, hypnotherapy, yoga, or medication. By addressing COVID-induced stress that is contributing to bruxism, it will be easier to manage. The World Journal of Advanced Scientific Research published a study in October 2020 that referred to COVID-19, stress, and bruxism as a triad. The study stated that in addition to assessing for and diagnosing bruxism in patients, dentists play an important role in referring patients to mental health care providers.

Further to addressing these psychosocial factors, other dental interventions may be taken. One treatment option is the use of occlusal guards. Occlusal guards, which may be custom-made or purchased over-the-counter, will help cushion the patient’s teeth and prevent them from grinding their teeth together. Although this can be an effective option when worn correctly and consistently, compliance often proves difficult, and some people may choose not to wear the guard as often as they should.

Botox is another effective treatment option. A small amount of botulinum toxin is injected into the masseter muscle, which acts as a relaxant. The Botox will reduce teeth grinding and the associated pain because it helps control muscle activity. The effects will last between 3 and 6 months.

A third intervention technique is biofeedback. This helps an individual become aware of their grinding and tension, which reduces it. This is done using an electrodiagnostic procedure, which determines and records electrical activity generated by the muscle. With treatment, the patient will learn how to control their jaw muscles through vibratory, visual, or auditory feedback from electromyography (EMG).

Self-Management

There are some lifestyle changes you can make that will minimize irritation of the jaw, teeth and neck caused by sleep bruxism.  Avoid chewing gum, hard foods like nuts or candies, and sticky foods.  If you are experiencing pain, use an ice pack or hot compress. Additionally, there are also mouth exercises that can be done that will improve range of motion and reduce pain caused by bruxism. Two exercises found to relax the associated muscles are as follows:

Exercise A

  1. Close your lipswhile ensuring your teeth are not touching.
  2. Place your tongue behind the upper front teeth, behind your palate.
  3. Hold this position for as long as possible.

Exercise B

  1. Place your hands where the lower jaw connects, on your TMJ joints.
  2. Slowly open your mouth and hold for 5 to 10 seconds.
  3. Slowly close your mouth again.
  4. Repeat this process for 10 minutes, 3 times a day.

The Journal of Clinical Research in Dentistry review believes that dentists should increase their familiarity with bruxism, diagnosis, and intervention options. Lack of an understanding of bruxism or effective ways to treat it could result in serious oral complications. Bruxism is just one of several dental health effects that have been on the rise since the pandemic hit the UK. A decrease in dental hygiene and an increase in gingivitis and dental decay also co-occur alongside the coronavirus. In these cases, mental health struggles, changes to routine, and the inability to seek dental care are contributing factors.

Fortunately, by increasing your awareness can help prevent long-term and more serious consequences of bruxism. Understanding the risks, consequences, and treatment options will help you make the necessary lifestyle modifications and seek a dental professional’s assistance before lasting damage occurs.

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