Bruxism: the impact of COVID-19 on the nation’s oral health

Dr Ahmed Hussain and Zainab Al Mukhtar discuss the rising problem of bruxism during the pandemicDr Ahmed Hussain and Zainab Al Mukhtar discuss the rising problem of bruxism during the pandemic. 

Have you seen a spike in cases of bruxism during the pandemic?

AH: Yes. I have seen an increase in patients attending with jaw pain and cracked teeth.

ZAM: Yes, I certainly have seen this. More people presenting with pain in the TMJ, tense muscles of mastication, increased signs of tooth wear and in some, enlarged masseter muscles and complaints of wider looking jaws.

Why do you think teeth grinding has increased?

AH: Increased stress during pandemic; the stress of the risk of getting the virus, stress of not finding a job after the furlough scheme, financial strain. Or just being at home all day with the kids whilst schools we’re closed!

ZAM: Stress, anxiety and uncertainty around all this underpins this. This could be due to financial strains, out of routine, health fears, parenting challenges or lack of regular childcare etc.

What can practices do to help educate patients who may be experiencing this?

AH: Encourage patients/prospective patients to see a dentist who will be able to advise them about wearing a bite guard at night. This will release the pressure on the jaw joints and reduce the risk of tooth fracture.

Immediate treatment for acute bruxism:

  • Bite guards to wear at night
  • Jaw exercise
  • Heat packs
  • Soft diet
  • Avoid yawning
  • NSAIDs
  • Anti-anxiety/anti-depressants
  • Botox injections

Treatment for severe bruxers:

  • If severe, then full mouth rehab to restore lost tooth structure, either with composite bonding or crowns.

Other help:

  • CBT – referral to see a psychiatrist, psychologist, mental health nurse or GP to help patients’ deal with their thoughts and changed behavioural patterns
  • If patients don’t like/want to talk to a therapist there is an online CBT (NHS app)
  • Botox injections (botulinum toxin A) relaxes the jaw muscles. My partner in the practice provides facial aesthetics and has successfully used Botox to treat many cases of bruxism
  • Associated disorders such as sleep apnoea (sleep related disorder) are common. Addressing this may improve sleep bruxism.

Lifestyle suggestions include:

  • Reduce stress – listen to relaxing music. I play this in my surgery and patients literally fall asleep in the chair
  • Take a warm bath
  • Practice good sleep hygiene (no phones, screens, TV, in the bedroom)
  • Exercise
  • Avoid stimulating substance in the evening, such as caffeine
  • Try and encourage a good night’s sleep.

ZAM: You may find value in practising jaw exercises for five minutes a day.

  • Close your mouth and make sure your teeth are touching.
  • Do not ‘clench’ your teeth. Place your tongue just behind your upper front teeth, just behind your palate
  • Keeping your teeth gently together, gently run the tip of your tongue back towards your soft palate, and towards the back of your mouth as far as it will go
  • Hold your tongue in position in the back of your palate and slowly open your mouth until you feel your tongue being pulled away. Do not open your mouth any further, but stay in that position for five seconds then close your mouth and relax
  • Repeat the process over the next five minutes.

Other tips include:

  1. Stress relief: meditation/ breathing exercises especially in the evening
  2. Consciously pay attention to stopping day time clenching during times of focus
  3. Take non steroidal anti inflammatory medication for periods of intense pain for a few days, eg ibuprofen
  4. Ice pack for periods of severe pain
  5. Soft diet during periods of severe pain/muscle spasm/limited mouth opening
  6. See a dentist, who will analyse the bite and look for dental triggers (dental interferences), reduce loading of the TMJ by providing a soft acrylic bite guard to begin with, monitor signs of tooth wear, or refer for specialist care if needed. This can involve steroid injections in TMJ, and/or neurotoxin injections to relax hyperactive masseter muscles.

Has the pandemic increased the prevalence of any other oral health issues?

AH: Yes. We have seen an increased prevalence of extractions due to the difficulty in accessing dental clinics during and post lockdown.

ZAM: I’ve had more reports of extractions during or just after lockdown as a result of acute irreversible pulpitis, rather that pursuing root canal treatments to save teeth.

I have personally seen more cases of gingivitis or a progression of periodontal disease due to reduced access to hygienist care. I’ve also seen reduced motivation amongst patients to maintain good oral hygiene measures at home.

This may have been linked to a break in the usual routines or the additional strain of non-stop parenting during lockdown. I have seen this to be more prevalent amongst parents of small children, who may not be aware of the possible long-term consequences of dental neglect. We are now having to work on stabilisation treatments for a bit longer, prior to commencing any definitive cosmetic dental treatments.

What impact do you see the pandemic having on dental health in the long term?

AH: Dental disease such as dental decay and gum disease that could not have been treated during the lockdown now requires further treatment, such as root canal treatments and extractions. which may not have been needed.

Patients are resorting to DIY dentistry, including extracting teeth with local anaesthetic.

Furthermore, access to oral health care is especially limited for populations at high risk for COVID-19. Patients with symptoms of COVID-19 are advised to avoid non urgent dental care, therefore we may see oral health neglect with these patients.

ZAM: It could work two opposite ways. For some, as other strains take over,
dental health may become the least of their concerns and we might see more neglect of good oral hygiene measures at home. We need to reinforce this more to the public.

For some, though motivation for good oral health continues, access to the usual dental care may not always be easy and more patients may begin to accept living with pain symptoms, thereby allowing tooth decay or other dental diseases to progress. This is all the more reason to continue focussing on prevention.

For others, the slower paced lifestyle and greater time for self awareness may finally trigger an interest in having better dental health, including better looking smiles. So there may even be a surge in patients seeking cosmetic dental treatments when they can.

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