During this time of crisis, stress becomes prevalent, and our oral health takes a back seat to everyday life and coping. In this blog, I’d like to talk of two ways our oral health is affected. The first is a chemical assault through acidity. The second is mechanical through grinding and clenching.
We may begin to change our diet to more comfort foods to cope with stress. This may introduce more sugars and acidity to the oral environment that will inevitably cause harm to our teeth and existing restorations (ie fillings and crowns). Teeth are extremely susceptible to decay under acidic conditions. The outer “strong” layer of our teeth, enamel, will begin to demineralize under the constant acidic assault. This demineralization will eventually lead to a softer layer allowing for bacteria to eventually degrade into the nutrient rich dentin and pulp, causing sensitivity and pain. Our restorations (ie crowns, fillings) will also begin to fail under these acidic conditions. The bonds (resin or cement) that hold these restorations will fail and bacteria will gradually seep under these restorations, causing harm to tooth structure under the restorations, hence failure of the restorations. Finally, our root surfaces, that are not as “strong” as the tops of our teeth (enamel) will begin to erode under these acidic conditions, leading to sensitivity and pain.
One extreme strategy to prevent this acidic assault is to not eat the comfort foods. For most, including myself, that would be IMPOSSIBLE! So, what can we do? The most rational approach would be to reduce the acidity after eating comfort foods. Swishing with water (regular, non-flavored, non-carbonated) after acidic foods and beverages (ie. Coffee, wine, juice, soda) would be of benefit to reduce the acidity. Another strategy would be to avoid mechanical abrasion (toothbrushing) for at least thirty minutes to prevent the erosion of root surfaces.
The second way we damage our oral health is the mechanical assault on our teeth. It is not new data that stress causes us to grind and clench our teeth. These forces are detrimental to our teeth and restorations, as they can cause them to buckle under the strain and ultimately fracture. Teeth fracture in three main ways: 1. within the tooth structure, 2. into the nerve, and 3. (the worst way) into the bone. The last way is catastrophic as a tooth can’t be salvaged and would need to be extracted. The first two ways of fracture would cause pain, but there would be procedures to salvage the tooth. Restorations (fillings and crowns) can also fracture during excessive strain. They may also break their “seal,” allowing bacteria to leak underneath, causing the natural tooth to decay. One may not realize this leakage until they start feeling pain or sensitivity. Lastly, these episodes of extreme force cause the bone and gums surrounding the teeth to irreversibly recede. This will inevitably lead to the mobility and sensitivity of teeth.
The cause of grinding and clenching is not so simple to decipher. Figuring out the root cause of these abnormal forces is very important. Muscular tension around the head, neck, and shoulders could contribute to tension that may adversely cause one to clench. Trauma to the jaw may cause the muscles around the jaw to jet out causing one to grind and clench to bring the teeth back into alignment. Missing, broken, and mal-aligned teeth may also lead to these parafunctional movements as the body is trying to balance our bite. There have been studies that link obstructive sleep apnea to grinding and clenching. This is due to the body sending a message to the jaw to advance forward to open the airway when blood oxygen levels have lowered to critical levels. Also, grinding and clenching may be prevalent in individuals that have acid reflux as the bodies natural reflex to limit acidity in the oral environment.
Having yourself properly assessed for the above causes to grinding and clenching would be prudent. If you’ve been fitted for a professional nightguard by your dentist, then make sure to wear it during this stressful time. Just because it says nightguard doesn’t mean it can’t be worn during the day. If you know there are times during the day that you may be grinding (ie. Exercising, watching the news, gardening), then wear the protective appliance. If you don’t have a professional nightguard then look to an over the counter (OTC) nightguard through your local pharmacy or Amazon. These OTC products are not the ideal appliance, as they are one size fits all, but are definitely better than nothing. During this time of shortage with the COVID-19 pandemic even an athletic guard would temporarily suffice, if you don’t have access to an OTC nightguard.
This is not the time for elective dentistry (ie. Cleanings and cosmetic dentistry). Dentists will be available for true emergencies (if you are experiencing pain, infection, etc.). We have had strong recommendations from our governing bodies, (the American Dental Association and California Dental Association) to do this because we can rapidly spread the disease due to the viral aerosols we may create. These aerosols not only infect you, but our staff, whom most don’t have the proper protection (N95 masks, etc.). Plus any N95 masks (my practice does not have any) should be donated to our local hospitals.
Please seek dental work from your dentist ONLY for emergencies during this time until we have a grip on the virus!