En español | We know the coronavirus can take a toll on everything from our hearts to our brains. But dentists are starting to look at whether it may take a toll on our teeth, too.
According to an American Dental Association poll of its members, the pandemic has given rise to a 71 percent increase in teeth grinding and clenching (or bruxism), a 63 percent increase in chipped and cracked teeth, and a 62 percent increase in pain and compromised movement of the jaw and surrounding muscles, known as temporomandibular disorder (TMD).
Matthew Messina, D.D.S., dental clinic director of Ohio State University Upper Arlington Dentistry, notes that he made more bite guards (which reduce teeth grinding) during two months of the pandemic than he made in all of 2019.
Leila Jahangiri, D.D.S., a clinical professor and the chair of the Department of Prosthodontics at the New York University College of Dentistry, reports treating a 62-year-old patient with nine teeth fractures.
So what gives? Could there be a link between the coronavirus and dental issues — like teeth suddenly turning so brittle as to fracture by nearly the dozen? A recent piece in The New York Times raised that very question, citing an array of dental issues — from teeth popping out unexpectedly to suddenly turning gray — among some COVID long-haulers, those who have recovered from the worst of the coronavirus, but still have lingering symptoms.
As of now, dentists seem to be taking a wait-and-see approach. “We do know that coronavirus seems to have many different variations in terms of how it is presenting and how people are responding to it,” says Stephen Shuman, D.D.S., professor and director of the Oral Health Services for Older Adults Program at the University of Minnesota School of Dentistry. “And we do know that oral health and general health and systemic health are linked.”
But, Shuman notes, there may or may not be a direct link between the virus itself and the health of our teeth. “Clearly, we're hearing reports of people under stress, who are grinding and clenching, and causing problems,” he notes. “But that's stress — it's not necessarily the coronavirus doing it."
As Messina explains, that excessive mouth movement is actually part of our body's fight-or-flight response. When we're presented with a threat, the body releases hormones that help us quickly summon energy. Of course, we can't physically fight mental stress, so our body looks for an outlet to burn off that excess energy — for example, clenching and grinding our teeth.
And, yes, older teeth will fare worse in that case. While the outer protective covering known as enamel is stronger than bone when we're younger, it turns more brittle with age. (And pressure from grinding can put up to 250 pounds of force on our already vulnerable choppers.) Initially, hairline cracks are restricted to the outside of the enamel. But there's potential for the cracks to propagate over time, spreading to the inner layer, or dentin. And that is when the problems begin.
Here's how to get the grinding under control, keep teeth strong and fillings intact — and steer clear of the dreaded drill.
Mind your tongue
“Our teeth aren't meant to touch unless we're using them for functional activity like chewing and swallowing,” says Nammy Patel, D.D.S., a San Francisco–based holistic dentist. The rest of the time “your tongue should be resting at the roof of the mouth. That way, your teeth won't make contact.” (An easy way to get into that position: Say the letter “n.") When you find yourself clenching, remember these words — tongue up, teeth apart — and go into the relaxed position.
Keep your posture straight
A lot of us are working remotely from home these days, either slouched in front of a computer in our home office or camped out on the couch. Both bad moves. “When you're slouching, your jaw protrudes forward, causing your teeth to touch,” Patel says. (It's true, try it.) That makes it all the more tempting to start clenching. Every few minutes, check in with your body to be sure you're not falling into bad habits. And keep those jaw muscles limber, says Messina: Every 30 minutes or so, open and close your mouth widely 10 times, then move your bottom jaw from side to side to stretch jaw muscles.
Take frequent time-outs
Being in one position for too long — say, planted in front of your computer — can also cause muscles to tense up, often without us realizing it. Stretching is important for releasing that tension. Every hour, take a five-minute break to let your muscles offload. “There's a phrase in ergonomics that your best posture is your next posture,” says Kate Ayoub, a physical therapist and founder of Own Your Movement, a personalized health and wellness coaching program. “If you're sitting at your desk, working on your computer, make sure you're mixing it up, so you're not in one position all day."
It can be as easy as standing up and touching your toes, Ayoub says. Prefer to stay seated? Interlace your fingers and stretch them over your head, so you're sitting as tall as possible in your seat. Next, keeping fingers interlaced, put hands directly in front of you and push out, while rounding your back. Stretch arms behind you, this time arching your back. And find physical outlets for stress, such as regular short walks around the block, says Cynthia Ackrill, M.D., an Asheville, North Carolina–based life coach.
"Most people don't have the ability to switch off a trigger in their head and say, ‘OK, I'm not going to grind anymore’ — it's an automatic thing,” Jahangiri says. To target the underlying stress that can cause grinding, Ackrill suggests deep breathing exercises (she offers her own on YouTube) or guided meditations. As she explains, things like decreasing your breathing or heart rate can help counteract a sympathetic nervous system that is “revved up” by stress.
Start a bedtime routine
Jaw movements at night are not only normal, they can be beneficial, increasing the spread of saliva around our mouth, which protects our teeth. But if they cross the threshold into grinding, you've got problems. One solution: Create a bedtime routine to put your brain to bed. “Think back to when you put your toddler to sleep,” says Ackrill. “You probably had a regimen to help your little one let go of the day — a series of events that were cues to your child's brain that it was time to sleep, perhaps talking about the good things that happened that day, followed by a bedtime story.” We can do that for ourselves, she says. Slide into a warm bath. Write in a journal. For her own wind down, Ackrill recently purchased a wireless sleep mask with headphones to pipe in soothing music, set with a timer.
Bolster those bones
Demineralization can destroy tooth enamel and potentially weaken the entire tooth structure. Culprits include foods that generate acids — including sugar-laden treats and fruit juice — and dry mouth, which is a common issue as people age and take more medications, Shuman says. A toothpaste with hydroxyapatite, such Boka or RiseWell, can help remineralize tooth enamel.
Bring the heat
Grinding in your sleep adds another six or so hours of jaw-muscle activity. When we wake up, our jaw muscles may be tender or tight because they have been running a marathon all night. “Lactic acid builds up in the muscles when they become overstressed,” says Jahangiri “Applying a heat pad on the jaw and neck can help dissipate some of that.”
Consider a night guard
Sleep bruxism is a little trickier to tame because you're not aware of what your mouth is doing as you sleep. That's where night guards come in. Made of plastic, and usually worn on either the upper or lower choppers, “they act as a kind of bumper for your teeth,” Jahangiri says. “Instead of the enamel of your teeth breaking down, the plastic will wear.”
Only a dentist can make a night guard to precisely fit the dimensions of your teeth. A custom-made night guard, designed from in-office impressions, can be pricey (costing, on average, $300 to $500) but, as Jahangiri points out, crowns, bridges and other dental procedures are even more expensive.
You can also go the (cheaper) over-the-counter route. Of the options, “boil-and-bite” guards are usually the best tolerated. These come with an impression kit that allows you to put the guard in hot water to soften it. It's then placed in your mouth and sets to the shape of your teeth. This type of guard costs considerably less (anywhere from $5 to $80) than its in-office counterparts. But it breaks down more quickly than a custom-fit guard and is best as a short-term solution. You can also find companies online that send you a kit to make DIY impressions that you return to the guard manufacturer.
Before you choose among the options, talk to your dentist. “A night guard has to fit well,” says Messina. One made from material that is too soft will allow you to chew on it, increasing jaw muscle activity. Something that doesn't fit well and hold all of your teeth in place can irritate the gum tissue and can even cause teeth to shift over time, which can lead to dental misery down the road.