Advanced Family Dental / Dr. Alexander Rivkin

When Stress Takes a Toll on Your Teeth

August 10, 2010

August 10, 2010

When Stress Takes a Toll on Your Teeth

By Camille Sweeney

With economic pressures affecting millions of
Americans, dentists may have noticed a drop in patients opting for a
brighter smile, but they are seeing another phenomenon: a rise in the
number of teeth grinders.

“I’m seeing a lot
more people that are anxious, stressed out and very concerned about
their financial futures and they’re taking it out on their teeth,” said
Dr. Steven Butensky, a dentist with a specialty in prosthodontics
(aesthetic, implant and reconstructive dentistry) in Manhattan.
One of his patients lost hundreds of thousands of dollars
invested with Bernard L. Madoff. Another reported that he had lost a job
with a seven-figure salary. A third, a single mother with a floral
design business on Long Island, said she was working twice as hard for
half as much.
“All three are
grinders, directly affected by what’s going on out there,” Dr. Butensky
said, gesturing outside his Midtown office window.
Dr. Robert Rawdin, another Manhattan dentist with a
specialty in prosthodontics, said he had seen 20 to 25 percent more
patients with teeth grinding symptoms in the last year. And in San
Diego, Dr. Gerald McCracken said that over the last 18 months his number
of cases had more than doubled. They, along with other dentists
interviewed for this article, chalk it up to the economy.
“We’re finding in a lot of double-income families, we have the
people who have lost jobs and are worried, and then we have the spouse,
who still has the job, with the added pressure and uncertainty,” Dr.
McCracken said. “This can cause some real grinding at night.”
With or without economic hardship, 10 to 15 percent of
adult Americans moderately to severely grind their teeth, according to
Dr. Matthew Messina, a dentist in Cleveland and a consumer adviser for
the American Dental Association.
Because it is a subconscious muscle activity, most
grinders grind without realizing it, until a symptom such as a
fragmented tooth or facial soreness occurs.
While many experts believe that genetics may play a
role in bruxism (or teeth grinding), stress has long been known to set
off clenching and grinding in some people, Dr. Messina said. “Recession
breeds stress and our body responds to stressful events so in times like
these, the incidence of bruxism goes up,” he said, adding that over the
last year or so he had heard from dentists around the country who had
seen an uptick in patients with bruxism while also complaining about
financial stress. In his own practice, he said he had treated twice as
many cases in the last year than in the year before.
“Stress, whether it’s real or perceived, causes
flight-or-fight hormones to release in the body,” he said. “Those
released stress hormones mobilize energy, causing isometric activity,
which is muscle movement, because that built-up energy has to be
released in some way.”
The most expensive option for rebuilding teeth damaged
by grinding is with veneers, but this year, dentists say that many of
their bruxism patients are requesting one of the least costly
treatments: a night guard, also known as an occlusal splint.
Manufacturers said sales of these devices had gone up. “Our night guard
sales have increased 15 percent over the prior year,” said Greg
Pelissier, a manager at Glidewell Laboratories, a maker of custom
restorative, reconstructive and cosmetic dental products based in
Newport Beach, Calif.

New drugstore products have also come to market, including a disposable
night guard, Grind-No-More (about $30 for 14 guards). Its makers hope it
will appeal to on-again-off-again grinders.

Stan Goff,
executive editor of Dental Products Report, a monthly publication, wrote
in an e-mail message that all this teeth grinding “may be playing a
role in the introduction of several new products designed to not only
prevent bruxism, but to help fight against tooth sensitivity” and other
conditions that are aggravated by grinding.
While experts believe bruxism is not a dental disorder
per se, but rather originates in the central nervous system, the
condition can greatly affect the teeth and the entire craniofacial
“Normally, we
exert about 20 to 30 pounds per square inch on our back molars when we
chew,” Dr. Rawdin said. “But teeth grinders, especially at night without
restraint, can exert up to as much as 200 pounds per square inch on
their teeth.”
Some nocturnal grinders will grind up to 40 minutes of
every hour of sleep. The relentless wear and tear can quickly erode
enamel (10 times faster than that of nongrinders), fracture teeth,
affect bite and damage the temporomandibular joint at the hinge of the
jaw, and the masseter muscle, which controls the jaws. Jaw and face
pain, as well as earaches and headaches, may also occur.
“I kind of thought I was going crazy,” said Adrienne Lee
Kornstein, 48, a patient of Dr. Butensky, whose floral design business
in Jericho, N.Y., has suffered because of the economy. “A tooth broke
for what seemed like no reason, and by the time I got to Dr. Butensky,
I’d been to my physician, other dentists, even a dermatologist to try to
get relief from migraines and facial pain I was taking painkillers for.
I had no idea I was grinding or that grinding your teeth could even
lead to all that.”
The most common
treatment for the disorder is to wear a night guard, which may not only
alleviate grinding but, in some cases, train someone to stop grinding
Fitted in the dentist’s office, a custom guard is
usually a clear, hard plastic device that runs over the top or lower
teeth from front to back and prevents the top and bottom molars from
making contact. Although not cheap (the price can range from $350 to
$1,000), most dentists prefer a custom guard to over-the-counter guards,
which are usually made of softer material and can encourage chewing and
exacerbate masseter muscle activity.
There are also smaller prefabricated splints that a
dentist can customize. These are generally cheaper than the fitted full
arch guards and require fewer adjustments. But some dentists argue they
are not as effective as the full arch guards.
Many teeth grinders interviewed said they would not go
to bed without their night guards.
“Sometimes I wake
up in the middle of the night and having my guard in makes me more aware
if I’m tensing my body or gripping my jaw, and I can just take a moment
to relax,” said Alisa Fastenberg, 50, a graphic designer in Manhattan.
Other treatments for teeth grinding include
acupuncture, medical massage, hypnosis and Botox injections into the
masseter muscle to relax the muscle enough to stop it from going into
spasms without changing one’s chewing function.
“Grinding is like body building,” said Dr. Alexander
Rivkin, a head and neck surgeon at Westside Aesthetics in Los Angeles,
who has also seen an increase in grinding-related cases this past year.
“The constant workout of the masseter muscle, the largest in the head,
builds up that muscle and that can cause a lot of pain, not to mention
make the face appear more square.”
He added, “For,
I’d say, 85 percent of the people who come to me complaining about
headaches, jaw soreness and pain, Botox injections into the masseter
muscle on both sides of the face is the answer.”
But even something as simple as taking time before bed
to de-stress has been known to help.
“Good sleep
hygiene goes a long way to keeping the mind relaxed and the jaws from
starting to smack together,” said Dr. McCracken, who has studied the
relation of sleep to teeth grinding. “We know that the stress center of
the brain is directly next to the part of the brain that controls teeth
grinding. We’re not sure how it relates to the disorder, but it’s
intriguing. Lately, I even tell my patients, before they go to bed, not
to watch the news.”