One morning around week six of the COVID-19 lockdown, I woke up to discover I’d gnashed a molar-sized crack down the back of my night guard, the device I wear to protect my teeth from the grinding I do in my sleep. I’d worn the acrylic barrier every night for years with minimal erosion, but suddenly I’d gnawed right through it. As many Americans have wondered over the past few years, where did the fear and stress build up? My mouth was the solution.
The number of patients seeking treatment due to bruxism has increased sharply since 2020. Dentists, and all other dental professionals, have noticed a dramatic increase in this condition. Although bruxism has a fairly high prevalence, prepandemic data suggested that up to 31% adults are chronic chompers. However, major clinics see nearly three-times as many bruxers now than they did before lockdowns. The increase still hasn’t let up, some experts say. “My patients that had soft pain and bruxism got worse, and the people that I’d never seen it in before were now having lots of pain,” says Mark Drangsholt, chair of the department of oral medicine at the University of Washington’s dental school.
Most sufferers of bruxism will grind during sleep. Those without the symptoms could not be aware that they have it. Although experts make the distinction between sleep bruxism and nighttime mashing (known also as awake bruxism), many individuals blur the line due to the combination of different patterns and behaviors.
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Bruxism doesn’t always cause pain, but when it does, it can be bad. Certain patterns (particularly sustained clenching), can lead to chronic pain in the temporomandibular joints—TMJ for short—found on each side of your face near the ear. These joints can be compared with hinges. The jaw moves away from the skull, and they are directly stress by bruxism. TMJ problems can be experienced by people who grind their teeth often. This includes clicking or pain when eating and general tenderness.
Then, there’s the risk to your teeth themselves. Aside from the small bits of time we spend eating, “your teeth don’t really come together much during the day,” says Drangsholt. An hour of grinding can cause damage to your teeth.
When you jump into bed, the dangers of bruxism increase. Ever seen those videos of hippos eating whole watermelons like they’re blueberries? That’s basically humans’ unconscious superpower. When we’re deep in REM sleep, says Drangsholt, we’re capable of exerting as much as three times the amount of force with our bite than we ever could consciously.
Bruxism is closely linked to anxiety in dentistry. Recent studies support the claims that dental clinics are telling regarding the pandemic boom. In a small paper, a Turkish study published in 2021 showed that about a third (33%) of people with no history or bruxism started to feel symptoms during the initial months of the pandemic. An additional study that looked at Google Search trends globally found an increase in searches for teeth grinding and bruxism between May 2020, 2020, and October 2020. This is in contrast to the similar period from 2016 through 2019.
Some psychoactive medication may cause bruxism. It is possible for antidepressants, such as SSRIs/SNRIs to trigger the onset or bruxism. These are the questions Drangsholt first asks when assessing patients’ symptoms. Most people on antidepressants don’t develop bruxism, but “it does look like there is a relationship for some people,” he says. “That’s something we look pretty carefully at, because if you can switch out or change your dosing, then that can be helpful.” Though new antidepressant prescription rates in the U.S. dropped in the early months of the pandemic, the overall numbers over the last few years point to a continuing increase in new prescriptions.
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Michele Schultz-Robins, secretary of the American Academy of Orofacial Pain and a professor at Rutgers School of Dental Medicine, says that other lifestyle factors may have had an impact on the still-rising numbers of bruxism cases she’s seen. “COVID—it’s been insane,” she says. Adults and children have spent years confined to their bedrooms during the day, staring at small screens and working on couches or in bed. This has led to an increase in clenching and a decrease in their ability to move around. “You’re holding your face differently,” she says. “You are now constantly bending over and your jaw is not aligned properly, and you may start clenching. You’re a little more tense about it, and when you clench with your temporalis muscle and your masseter muscle, you’re going to get a headache.”
She adds that stress can have devastating effects on your health. “I ended up with a 17 year old who couldn’t open up his mouth beyond one finger because he was so stressed,” Schultz-Robins says. “During COVID, he was the only one supporting his family; his parents had both been laid off.” Schultz-Robins says that she’s seen children as young as 6 come in with pain caused by excessive grinding.
TMD can be difficult to treat due to this intense psychological link. Something as simple as tweaking medication dosages to improve symptoms requires communication and coordination between psychiatrists and orofacial pain specialists, two specialties who don’t otherwise work together much. Drangsholt says that although TMD and bruxism can work in different cases, there are many ways to alleviate symptoms.
Techniques like mindfulness and cognitive-behavioral therapies, as well as other anxiety-easing techniques, can be used to alleviate bruxism and TMJ pain. Online treatment options make it easier than ever. Schultz-Robins states that it is important to consult an orofacial pain specialist before beginning treatment. Specialists can help with more treatments, including mouth exercises and night guards, which prevent the top and bottom of your teeth from colliding, as well as regular injections of anesthetics in severe pain.
“The treatment with the real big jump in use most recently has been neurotoxin, or Botox,” says Drangsholt. Though it’s a more expensive treatment reserved for the most severe cases, regular Botox injections every three or four months can make a world of difference for some grinders. “They don’t fracture the appliances, and they don’t have any of the tooth fractures,” says Drangsholt. “We’re able to decrease the volume of their muscles in a reversible manner.”
As Schultz-Robins puts it: “Does your jaw feel like you had a party in your mouth all night? Do you have a headache when you wake up?” These are signs that visiting a professional—namely one from the directory available on the American Academy of Orofacial Pain’s website—might be a good idea.
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