Why You Might Be Grinding Your Teeth More Seriously Lately26/08/2021
This story is a part of Show Your Teeth, a package in which Allure examines dental care (or lack thereof) in the U.S. and what we can do at home to better care for our teeth.
If you're trying to escape thinking of the pandemic — and who could blame you? — this is not the story for you. Yes, you may have clicked because you clench your jaw or grind your teeth. Or perhaps you're just unsure and want more information to help you figure out what's going on in your mouth. Either way, one unanimous sentiment expressed by all experts quoted in this story is that stress is a huge factor that plays into both issues, and — you guessed it — studies have shown that the COVID-19 pandemic increased stress levels for many people.
"[The pandemic] has exacerbated pre-existing conditions of grinding and clenching," says Victoria Veytsman of Cosmetic Dental Studios in Beverly Hills. "What I've noticed in my practice is that there's definitely been an uptick of people coming in with aesthetic concerns." After vaccines arrived, she saw "an increase in the number of people coming in with things like fractured teeth, fractured fillings." She says there are several possible reasons for this: some couldn't get to the dentist during the pandemic, plus stress from working from home, losing a job, and general anxiety about the state of the world exacerbated issues with their teeth.
Sharon Huang, founder of Les Belles Dentistry in New York City, agrees with this sentiment. "During the pandemic, everyone was home anxious, stressed, and they were clenching a lot more," she says. "One of the most common emergencies that we got when we were shut down were people splitting their molars in half."
Keep reading to help identify the root causes and best treatments for both grinding and jaw clenching.
How do you know if you clench your jaw or grind your teeth?
Although these often go hand-in-hand, not everyone who clenches their jaw also grinds their teeth, and vice versa. For starters, there are some clear indicators of how you move your jaw. Usually, grinding presents as alterations to the shape and color of your tooth.
"The most common thing that appears when you are a grinder is that the back teeth are ground down to the point where the enamel has worn down," says dentist Marc Lowenberg of Lowenberg, Lituchy & Kantor in New York City. He explains that enamel is white or translucent and the second layer of tooth structure — dentin — has a yellowish brown color to it. "People that grind severely grind down the enamel, and you can see the discoloration on the surface of the tooth," he says. "They've ground through the enamel and now the yellow/brown dentin is showing through."
The shape of your teeth may also be a giveaway that you grind. Instead of the tooth appearing round or having a curve, the grinding motion will flatten the teeth down and even shorten them in some cases.
"People who clench and grind their teeth, their teeth are really flat," says Huang. "Teeth are supposed to be [like] a lock and key. Patients who grind their teeth, they're usually really flattened out and they're also shorter to a lot of people in the front — you can see them getting significantly shorter, you can see little chips."
Huang also mentions that for patients who clench their jaw and grind their teeth, they almost always have microscopic craze lines — the industry name for vertical cracks of the tooth's enamel — on their teeth as a result. “These [craze lines] are actually microfracture," she explains. "It could be fine for 10 to 15 years, but you bite on something, the wrong spot at the wrong time with the perfect timing, the tooth could crack — the tooth could split."
If you clench your jaw, it may be a result of an overactive masseter muscle, which may alter the shape of your face. "For patients who are clenching because of an overactive muscle, then they present with a squarish face. From the face, you see the muscle getting bigger over time," says Huang. "[It's like] you're on your tippy-toes all night and your calf muscles are going to be really, really prominent and growing over time because it's an exercise."
One issue that isn't as commonly known is how grinding and clenching can affect the gums. "Grinding and clenching can cause receded areas at the gum line," says Veytsman. "That's because the neck of the tooth is really the thinnest part of the tooth. So it takes the most of the stress of that pressure, which causes recession." She explains that many of her patients think their bleeding gums or gum sensitivity are a result of brushing too hard, when in fact it's from clenching and grinding.
Another clue you could be grinding? Tooth sensitivity. "Oftentimes, people who are unaware that they grind their teeth come in, especially in emergencies, claiming they have acute sensitivity to cold and sweets on their teeth," says Lowenberg. "And they think they have a cavity. But it's really because the clenching and grinding have inflamed the nerves around the teeth and make the teeth super sensitive to cold or sweets."
Lastly, if you tend to get headaches, it may be worth mentioning to your dentist — it could be another indication you're clenching or grinding.
Common Causes of Clenching and Grinding
It's important to see a dentist to identify the root cause of why you clench or grind, which can include overactive muscles, stress, an unstable bite, or even sleep apnea.
"If someone has a really square face and we look in their mouth and the front teeth are intact, but the back teeth are worn, that means [the cause is] overactive muscles," says Huang, which can be a result of stress. For this, they'll start with a form of physical therapy for the mouth, including warm compresses and relaxing the muscle. If that doesn't work, the second step is forcing the muscle to decompress through things like muscle relaxers or even Botox." Huang explains that this is a temporary fix, but it does keep the muscles from firing off.
If your bite is off — perhaps the teeth are crowded or they aren't in the right place — your jaw can continue to move subconsciously to try to find the "right" bite. Veytsman notes that this is common for people who've recently had orthodontic work; their jaw may still be adjusting to the new placement of the teeth, which can lead to more clenching and grinding to try to find a stable bite.
And then there's sleep apnea. Since it's more common for people to clench and grind while they're asleep and unaware, your sleep habits can play a huge factor in your clenching and grinding journey. Talking to your dentist about your sleep habits as part of a thorough dental exam can be a total game-changer.
"When someone sticks out their tongue, I look at their airspace in the back," says Huang. "Patients who don't have space almost always clench your teeth. Because when we fall asleep, we're on our back sleeping, all the muscles relax, including the tongue, which is a huge muscle. When the tongue relaxes, what does it do? It flaps back and covers your airway, and some people actually struggle to breathe in their sleep." Huang goes on to explain that part of the coping mechanism to deal with this is that the jaw slides forward to allocate more space for the tongue, creating the grinding motion.
She also says it's powerful in helping them diagnose patients with airway issues. The lack of oxygen that can result from sleep apnea can, at best, interrupt a good night's rest and, at worst, cause impaired breathing. To prevent this, your jaw may grind back and forth to keep the airway open, which can result in restless sleep.
How to Treat Jaw Clenching and Teeth Grinding
Going back to the topic of stress, Lowenberg suggests that many cases of grinding and clenching are a result of anxiety or nervousness that you can't instantly change about yourself. “It is a function of your temperament, your personality. You can be hypnotized, you could go into psychotherapy, you could drink warm milk before you go to sleep — [but] if you're a grinder, you're going to grind," he explains.
"The way I explain it, it's like people who bite their nails," says Huang. "No matter what you put on their nails, when they get nervous or when they're concentrating, they're biting. It's a subconscious habit."
A night guard is often the first treatment option a dentist will offer for someone who grinds and clenches. The guard will work like a shock absorber to help take the pressure off the teeth. It won't stop the movement, but instead will make it so the teeth glide over each other effortlessly so there’s less force from the muscle and can help prevent future degradation.
If you have dental insurance, Veytsman and Huang both explain that some providers will cover the partial or full cost of night guards and that you can choose to pay for one through an FSA/HSA if not. However, if you don't have dental insurance, these customized guards can be costly, usually ringing in somewhere between $600 and $1,200. Vetysman says even having a generic guard is better than no guard, as long as it fits well, but that a custom guard is always best.
"There are over-the-counter night guards that are popping up on Amazon and they're not designed with your teeth in mind," says Huang. She explains that these molds aren't precise, and her concern is that they lock the jaw so you’re actually causing more grinding, using extra force to get out of the "lock."
Botox is another popular treatment for clenching and grinding. You may have heard of getting injections "for TMJ" — which isn't quite accurate. Temporomandibular disorders (TMD) affect the jaw muscles and temporomandibular joint (or TMJ). Clenching and grinding don't necessarily indicate you have TMD. According to Huang, TMD is typically diagnosed during a dental exam in which your dentist will take a look at your head, neck, jaw, and face muscles to identify tension or stiffness, a joint exam to see if there is clicking or popping, plus a teeth exam to see if there are signs of wear and tear from clenching and grinding.
A dermatologist can administer masseter injections, as can oral surgeons and plastic surgeons, but be aware that these injections are off-label, so they require precision and extensive experience to avoid issues with chewing or smiling. These injections are also rarely covered by insurance unless your policy covers Botox as a medical necessity. In that case, getting coverage still usually requires documentation of chronic pain, failed other treatments, and possibly a formal TMD diagnosis. Check your individual plan to see if they specifically offer benefits for TMD and what is required to receive those benefits.
Corey L. Hartman, a board-certified dermatologist and founder of Skin Wellness Dermatology in Birmingham, Alabama, says many of his clients are pleased with these injections not only because they help with the clenching, but they also reshape the face by contouring the jawline. That said, it's important to keep in mind that overdoing it with these injections can cause issues down the road.
"I like to be very conservative with the treatment because when you are affecting these muscles and stopping them from being quite so active, there's a risk for long-term atrophy of the muscle over time," says Hartman. "We're talking about tiny doses, three times a year. When done appropriately, and under guidance, you really don't have to worry about too much. But if you overdo it and use too much or do it too frequently, then you can — just like in any other part of the face — start to cause muscle atrophy."
For these injections, similar to getting Botox in other areas of the face, it doesn't take immediately, meaning you won't notice immediate results. "When it comes to the masseter muscle, I usually tell those patients not to expect full improvement for maybe two or even three weeks," says Alicia Zalka, a board-certified dermatologist in Danbury, Connecticut. "With that said, it generally lasts a little bit longer [than Botox in other areas]. Depending on their needs, I'll ask patients to see me twice a year if they want to maintain it."
Both Hartman and Zalka suggest starting slowly with injections by asking for fewer units than what may be typical, booking a follow-up to check in on the progress, and being sure to ask your dermatologist how often and how long they’ve been injecting.
If your bite is misaligned, this could require something like braces or Invisalign to help with crowding to fix the damage done to the bite. "When your teeth are not in their ideal position, either too crowded, or space, or just misalignment, your body subconsciously will look for that," reiterates Huang. She notes that Invisalign helps evenly distribute the force of your jaw. "The mouth is built to be supported by all the teeth, not just the teeth that are touching," Huang says.
In more serious cases, dental reconstruction may be needed. "Teeth have cusps," says Veytsman.
"The purpose of cusps is to sort of serve as bumpers so that the teeth know where to stop when you're chewing. When those are flat from grinding, that causes more grinding. [With full mouth reconstruction], we rebuild the anatomy of the teeth that have been lost to create a more stable position to the teeth." Veytsman says she sometimes utilizes porcelain restorations on almost every tooth to open up the bite because people who clench and grind tend to lose volume in the teeth.
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