When stress builds for Terri Hart-Ellis, she subconsciously clenches her teeth like an angry cartoon character.
“My jaws tighten. I bite down really hard and my eyebrows flare,” Hart-Ellis said. “Most of the time, I’m not even aware of it.”
But all that biting and clenching has taken a toll: She chipped a molar in May, and last month pulled off a crown.
Hart-Ellis, 53, is hardly alone: During this year of pandemic stress, the American Dental Association says that dental health is a casualty. An ADA survey found more than 70% of dentists report an increase of patients with teeth grinding and clenching problems — conditions often associated with stress.
“The number of chipped and cracked teeth really started to pick up as people’s stress level picked up,” said Dr. Paul Levine of Levine Dental Associates in Milwaukee.
The unknowns of the coronavirus pandemic
Much of the stress and worry in Hart-Ellis’ life stemmed from all the unknowns of the past year: Businesses shutting down. Kids being sent home from school. Stay-at-home orders. COVID cases by the thousands. Deaths.
“It was overwhelming. Like most people, I was scared,” she said.
Her oldest daughter, Catriona, 21, a senior at the University of Wisconsin-Oshkosh, had to move back home when the campus shut down. Her youngest daughter, Addison, 17, has a rare disease called Rubinstein Taybi Syndrome, and has been learning remotely at home, a task made more difficult because she’s nonverbal.
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“My full-time job is working with Addison, so it’s been a big change for all of us,” she said. “We’re all stressed.”
As a mom who cleans and sanitizes everything, Hart-Ellis said she often feels like she is the last line of defense.
Both her dental problems can be directly linked to teeth clenching brought on by the stress of the pandemic. Before the pandemic, Hart-Ellis said she had very few dental problems.
“I took pride in my smile and teeth. I make sure I brush and floss, so I wouldn’t have any problems,” she said.
One day in April while disinfecting the kitchen, she put a Hershey miniature in her mouth. When she bit down, she heard a crunch.
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“It was really hard, and I opened my mouth and there it was. A piece of my tooth chipped off. I couldn’t believe it because I take good care of my teeth,” she said.
The chipped molar wasn’t painful, so because of the pandemic Hart-Ellis decided to postpone a dentist visit.
Then while flossing earlier this month Hart-Ellis popped her crown off.
“I couldn’t believe it, I was embarrassed but after hearing about the study it all makes sense,” Hart-Ellis said.
“I was totally unaware of my clenching for a long time, and I’m sure this is the case for a lot of people, especially right now,” she said.
Dental problems mount
Out of dentists surveyed, 71% reported an increase in teeth grinding and clenching; 63% reported an increase in chipped and cracked teeth, and 62% reported an increase in temporomandibular joint disorder (TMJ), according to the American Dental Association Health Policy Institute study released March 2.
On Sept. 21, 2020, less than 60% of dentists surveyed reported increases in the same categories.
Most patients are unaware they have a problem until someone points it out, Levine said.
“If you’re sleeping, you may not notice that you’re grinding your teeth, but your spouse or partner may notice,” he said. “It’s the same thing with clenching your teeth.”
Clenching and grinding teeth are two different things.
Clenching is simply forceful, silent pressure on the jaws and teeth between the top and lower rows. Grinding occurs when the lower jaw is tightened and moves sideways against the upper jaw, Levine said.
Grinding teeth often leave distinct patterns of wear that can be seen only during a dental exam.
Sometimes, dentists struggle to persuade patients they have a problem.
“We can tell them that they have a problem and tell them they need a mouth guard, and they say they don’t have a problem, but we end up seeing them back in a month or so and the problem has gotten a lot worse and more expensive,” he said.
Mouth guards can be pricey, ranging from $150 to $700, though some patients find cheaper ones at sporting goods stores for about $20. They will not have a professional fit but may do the job.
Either way, a mouth guard is far cheaper than repairing a chipped or cracked tooth.
Repairing a crown can range from $1,000 to $1,500; a cracked or chipped tooth can cost up to $3,000 in some cases, Levine said.
The price is one of the reasons Hart-Ellis has not been to the dentist.
“I’ve calculated that it may cost me between $1,000 and $1,500, and right now we just don’t have it,” she said.
Mouth guards only treat the symptom. They don’t eliminate the underlying cause.
“Mouth guards are a temporary fix to a much bigger problem of stress from the pandemic,” Levine said. “Addressing the stress and finding ways to deal with the stress is the best way to fix all of this.”
Walks, exercise, yoga and meditation are all good tools, he said.
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‘It didn’t hurt at all’
Gloria Pitchford-Nicholas, 72, of Milwaukee has been a teeth grinder for years, but the problem worsened during the pandemic.
On March 18, she was at Levine Dental Associates having a crown placed on her lower right bicuspid, the pointy tooth located after the top and bottom front four teeth.
She cracked her tooth about two months ago though she didn’t have any pain.
“When I came for an appointment a few years ago, Dr. Levine told me that I was a teeth grinder, which was a surprise to me because I never noticed it,” she said.
During the 20-minute procedure, Levine observed that over time Pitchford-Nicholas’ teeth grinding had completely worn away the point on the crown of the tooth. Grinding eventually caused the tooth to crack.
“I assume it picked up for me during the pandemic because I have never broken or cracked a tooth before. And I have always kept up on my appointments,” she said.
Treatments for teeth grinding can range from mouth guards to Botox injections, usually administered by an oral surgeon. Botox limits the mobility of muscles in the jaw responsible for the grinding; injections typically last for up to six months, according to the ADA.
Levine understands why people avoid the dentist — they fear a procedure could be painful. But if the patient is uncomfortable, steps are taken to minimize or completely eliminate pain, Levine said.
“It didn’t hurt at all,” Pitchford-Nicholas said of her procedure, “And it’s worth it.”
Early warning sign: Jaw pain, fatigue
Most people who crack a tooth think it happens because of something they ate. In reality, the process takes time, said Dr. Patrick Tepe, a dentist who practices in Verona, WI.
“The wear occurs over time, but it can often seem like at that moment whatever you were eating caused the break,” he said.
Tepe, who participated in the ADA survey, said most of the people who have cracked teeth have metal fillings although it has happened with other kinds of fillings.
An early warning sign that you may be clenching or grinding your teeth: jaw pain — and feeling fatigued after waking up in the morning.
“I believe the better quality of sleep people can get results in lower stressors and thus less grinding of the teeth,” said Tepe, a former president of the Wisconsin Dental Association.
To ensure a better night’s sleep, Tepe suggests avoiding caffeine at night from coffee and sodas and investing in a comfortable pillow or mattress.
It’s not only adults who have this problem. One in three kids grind their teeth at night because they are under so much stress, Tepe said.
“We forget that this has been hard for them as well,” he said. Online learning forces many of them to sit in front of a computer for hours without enough exercise and socialization, Tepe said.
He urged parents to talk to their children about stress and find ways to help them to minimize it.
Tepe had one additional tip for everyone: Because people are wearing masks and some people are mouth breathing, it’s important to drink additional water to keep your mouth moist. It’s a key to healthy teeth and gums.
“A dry mouth is a bad thing,” he said. “Drinking water throughout the day helps out a lot.”
Concern for disadvantaged people
While the ADA study didn’t break down the impact of the pandemic on disadvantaged communities, Dr. Brittany Seymour of the American Dental Association said it’s a major concern.
Public schools have routinely provided dental care for students who could not afford it, and for a year some of the state’s most vulnerable students did not have access to that care.
For years, Milwaukee Public Schools partnered with dental clinics to provide free dental care to children, a program created in response to a Centers for Disease Control and Prevention report declaring untreated childhood cavities to be a nationwide epidemic.
Now, Seymour fears the gap between those who can get care and those who can’t has widened.
And for disadvantaged communities, problems with teeth can go beyond oral health, she said. The stigma associated with poor teeth can prevent a person from getting a job or advancing in their current role.
“A chipped or cracked tooth runs much deeper than some of us will ever know,” she said.