For many, 2020 ushered in feelings of isolation and fear, as well as new concerns about financial stability, safety, family and how to juggle all of it from home. For some dentists, the stress of the situation has become apparent in their patients’ oral health. As of March, over 70% of dentists surveyed by the American Dental Association (ADA) Healthy Policy Institute reported an increase in patients experiencing teeth grinding and clenching since before the pandemic. That number is up nearly 10% from fall of 2020. In fact, more than 80% of Americans have reported emotions associated with prolonged stress, according to a January study by the American Psychological Association (APA).
“Generally, manifestations of stress go away when the stressing event goes away. That’s where the pandemic comes in,” said Dr. Daniel Croley, DMD, chief dental officer for Delta Dental. “One of the ways that some people manifest stress is by clenching and grinding their teeth.”
Dental conditions related to stress go beyond teeth grinding, of course.
Multiple studies have shown that emotions can play a significant role in periodontal disease. Thanks to an increase in inflammation from stress-induced conditions, the gums can become a hotbed for bacteria, leading to gingivitis. According to the ADA, dentists reported recent upticks in all of the following conditions:
- Chipped teeth
- Cracked teeth
- Temporomandibular joint disorder (TMJ) symptoms
- Periodontal disease
- Oral mucosal lesions
Delta Dental’s claim data also suggests a rise in stress-related conditions. Bite guards, commonly associated with treatment for bruxism and TMJ were prescribed 14.3% more by Delta Dental dentists in the second half of 2020 than during the same period in 2019.
Sleep and ergonomics
During the mad rush to convert homes to offices in the early days of the pandemic, couches and stools took the place of lumbar-supported work chairs. Ergonomic workspaces became less of a priority than merely having a functioning workspace and the resulting poor posture may also be to blame for some TMJ issues. If your patients have been working from home, suggest they read up on proper ergonomics for their workstation.
Likewise, stress and disrupted routines likely hurt the chances at restorative sleep, increasing nighttime teeth grinding. Insomnia and restlessness can result in bruxism and TMJ.
On top of these stress-induced issues is yet another pandemic problem: mask mouth. The facemask has been a staple of pandemic life and has greatly contributed to the slowing of the virus but can come with unfortunate byproducts: bad breath, dry mouth and even gingivitis and tooth decay.
Dental professionals attribute mask mouth to dehydration and mouth breathing when wearing a face covering. Though the ADA found no substantial rise in these specific indicators, the symptoms are preventable through thorough brushings and more regular hydration. On the upside, masks can sometimes help wearers identify their own halitosis, which may stem from more serious problems.
Other reasons for the spike
It is important to note that not all of these conditions are caused solely by anxiety and tension. For instance, a broken tooth could come as the result of anxiety-induced teeth-grinding, but it could also be caused by an accident or prolonged dental problems. Unfortunately, most claim data does not include the cause behind the diagnosis. Without that, it is impossible to say with absolute certainty that stress is the sole reason for a spike in numbers.
“It’s logical to conclude that current stress is leading to those broken and chipped teeth,” Dr. Croley said. “We will monitor and see. As we see broader distribution of the COVID vaccine and our daily lives feel more typical of what we experienced pre-pandemic, we will see our stress subside and as a result the need for bite guards to treat grinding and clenching subside — but our bodies can take some time to re-acclimate. Going back to the typical is still a change from what has been our weird ‘normal’ over the past year, and any change can generate stress.”
Many patients may not realize the correlation between stress and oral health. Educating your patients about how mental health can affect their mouth when signs of stress are detected is an important first step toward solving the issue. The ADA has created a compilation of resources for recognizing and managing stress. These may be especially helpful if you are are working with anxious patients or experiencing stress yourself.