Health Team

Dentists are seeing more cracked teeth. Pandemic stress is to blame

Shingles, maskne, migraines and quarantine fatigue: The stress of the pandemic has manifested in a variety of physical ailments. The latest evidence of this is a rise in cracked teeth.

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Kristen Rogers
CNN — Shingles, maskne, migraines and quarantine fatigue: The stress of the pandemic has manifested in a variety of physical ailments. The latest evidence of this is a rise in cracked teeth.

"We have seen an increasing amount of fractured teeth in probably the past six months," said Dr. Paul Koshgerian, an oral surgeon with The Oral Surgery & Dental Implant Specialists of San Diego.

For Koshgerian's office, before the pandemic, treating one cracked tooth per day or every other day was normal. These days, two visits per day for fractured teeth have been the norm; on the worst days, he might see five cases.

Derek Peek — leader of Eastern Iowa Endodontics and diplomate of the American Board of Endodontics — found that in August and September, his office had already treated twice as many cracked teeth in comparison to those respective months last year, even with fewer patients this year.

Covid-19 doesn't make teeth more fragile, but the "anxiety that surrounds everything that's going on — Covid, the rioting, the protesting, the looting (and) the general state of the country — has gotten everybody's thermostat dialed up a couple notches," Koshgerian said.

"In the oral surgery or dental realm, often that translates to people bruxing their teeth," he added, describing the condition in which people involuntarily gnash, grind or clench their teeth. Bruxing can damage fillings or crowns, or crack teeth.

When to call your dentist

Symptoms of bruxism include pain when teeth are together and/or brushed, swelling indicative of infection, lingering pain and/or cold or broken pieces of teeth, Peek said. If the sides of your face feel sore when you awaken, you might be grinding your teeth at night, Koshgerian said.

"Also, if people have partners," he added, "oftentimes the partners are the ones that tell the patient themselves that clenching is happening because it's audible to the person that may be sleeping or cohabitating with the person."

If you're experiencing symptoms, calling your dentist early on — before the problem worsens — is best. There are ways to safely attend an appointment, since offices have implemented safety precautions like social distancing and screening during the pandemic.

If a tooth "is considered non-salvageable by the dentist, oftentimes it's referred to an oral surgeon for treatment," Koshgerian said.

Treating cracked teeth

When you visit an oral surgeon's office, Koshgerian said, she'll take X-rays to visualize your mouth, but will also take your oral history to pinpoint any underlying issues.

Previous dental work can make teeth become more prone to fracture or breaking. Car accidents, chewing popcorn seeds or some other event may crack teeth — but in the absence of that knowledge, bruxism might have caused the injury.

The treatment hinges mostly on how the tooth structurally broke, made clear by understanding a little odontology 101:

The crown of a tooth is the visible part. The root anchors each tooth into the bone of the jaw. Enamel covers the crown.Underneath enamel is dentin, which makes up the body of the tooth, both the crown and the root. At the core is a hollow chamber called the pulp, where the nerve and blood vessel are.

If the crack travels through the enamel and into the dentin without entering the pulp, it can be fixed with a root canal. "However," Koshgerian said, "if the crack goes through that hollow chamber and it communicates through the root of the tooth, there's no way for the root canal to be able to save it because you can't seal off that crack underneath the gum because you can't see it."

Dental implants could replace broken teeth, but a dentist won't start with implants if less intrusive measures might work: Wearing a customized mouth guard during the evening is one common way to protect teeth from bruxism, Koshgerian said. "Instead of teeth grinding together and wearing the teeth down, there's a soft or hard splint" that acts as a barrier.

'Stress comes out at night'

Stress has been the driver of the increase in cracked teeth, Peek said, and stress usually "comes out at night when people clench or brux their teeth."

During the daytime when you're fully conscious, you can likely feel yourself tensing up and decide to relax, Koshgerian said.

"But in the absence of that control in the evening when you're sleeping, you don't have that mechanism," he added.

"So that parasympathetic activity, which causes relaxation in the muscles, oftentimes is absent." The sympathetic response, which makes the muscles contract, "kind of takes over and they go unchecked, which causes quite a bit of strain in the muscles, and the teeth pay the price for that," Koshgerian said.

Other stressful circumstances — divorce, moving, deployment — have also been known to increase bruxism, Koshgerian said.

How to stop grinding your teeth

Regularly engaging in activities such as exercise, yoga, meditation, massage and acupuncture can separate your mind from your troubles and help to reduce stress responses, Koshgerian said.

Bruxism is sometimes related to other head and neck muscular pains.

"Proper posture with an aligned spine and a jaw that is relaxed are keys to avoid clenching and the subsequent stresses that places on your jaws, your jaw joints, and your teeth," said Alan Gluskin, a doctor of dental surgery and president of the American Association of Endodontists.

If you habitually clench your teeth during the day, try to develop awareness of how you're holding your jaw. Your teeth should only touch when you chew, speak and swallow, Koshgerian said.

Build an arsenal of tricks to use when you feel your teeth clenching. Putting your sensitive tongue between your teeth while they're resting is one way to send yourself feedback that ensures you're not grinding.

Customized pillows and neck positioners can also relieve pressure and stress on the jaws and neck while sleeping, said Gluskin, who is also professor and chair of the department of endodontics at the University of the Pacific in San Francisco. Cutting back on refined sugars and ice-chewing and improving oral hygiene can prevent unnecessary stress on teeth.

Additionally, "as we age, our teeth that seem so strong and absolute change over time ... and become more brittle and ultimately more susceptible to cracks and fractures," Gluskin added.

"This is an important factor in why we need to take thoughtful care of our dentition when we are young and healthy because as we age, the health of our teeth and our ability to chew our food for good digestion and ultimately good health is so important to our overall health in our later years."

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