Dental Health in 2020 - A rough year for teeth?
The COVID-19 pandemic has impacted everyone, our work, our lifestyle, and our activities. But did you know that this has affected dental health too?
2020 has been a challenging year for everyone, for those looking for dental care as well as for dentists. With a lack of previous global scientific knowledge in handling the virus early on, the associated rumors on social media, irresponsible media scare, and the lockdowns, dental clinics shut down until early May 2020. Since the outbreak of COVID-19, there has been a sharp increase in gums and periodontal illness due to a lack of timely professional care. Stress-related dental problems such as grinding, clenching, and cracking of teeth have been reported worldwide due to health and financial problems, loss of work, salary cuts, loss of family members, etc.
While this does not appear to be a priority, the lack of dental intervention leads to the breakdown of weaker structures. This may include teeth, dental restorations, periodontal ligament, mandible joint (TMJ), and muscles. Periodontal and gum care specialist Dr. Anju Jeevan from Jeevan Dental Care, says “Unfortunately, elective procedures such as scaling and routine dental examinations were not carried out to reduce the patient load by the clinics. People also tried to stay away from dental visits out of fear; as a result, gingivitis and other periodontal problems have shown a sudden increase in a large population and have compromised dental health.”
We at Smile Station also observed a similar pattern with an increased number of patients requiring root canal treatments, given the lack of timely care or priority since the pandemic outbreak. Since the lockdown, there hasn’t been a single day when we haven’t started a few new root canal treatments. While cavities could have been easily restored earlier, they now require more advanced treatments such as root canals, tooth build-up, and crowns, which has resulted in an increase in clinic visits and an increase in dental expenses.
Stress-related teeth clenching and grinding also have their own consequences. Chipping, loose teeth, broken tooth restorations, increased sensitivity of the teeth, tooth form and size changes, development of cracks in the teeth, or in unfortunate situations, even a complete breakage of a few teeth are a familiar sight. Emergency visits with sore muscles, pain in the jaw joints, and sometimes even excruciating pain with jaw locks are encountered.
The good news is that oral health professionals can easily identify these situations and that your path to recovery and management begins with your family dentist.
Why do people gnash their teeth?
Oral Medicine specialist, Dr. Srinivas K, who has a particular interest in Neurosensory dysfunction of the face, from Manipal Hospitals, Bangalore, says, “Anyone who feels stressed is likely to clench or grind their teeth during the day or more at night involuntarily, totally unaware during sleep as a parafunctional habit (oral habits not associated with chewing, swallowing and speech). Night Bruxing is a sleep disorder, the duration, and intensity of which depends on emotional stress and activities before sleep. Sleep studies have shown that bruxism occurs when you experience vivid dreams and go from a deeper sleep state to a lighter sleep state. People who clench or grind their teeth (Brux) while they sleep are more likely to have other sleep problems, such as snoring and breathing breaks (sleep apnea).”
Certified Sleep Medicine Specialist, Dr. T. Arun Kumar of Shre Vinayakaa Dental who practices, airway-focused dentistry, says, “The management of bruxism is mainly dependent on a good diagnosis of the causal factors of this complex para-functional activity. The management includes fine-tuning the bite to reduce muscle activity, stabilizing splints at night to protect teeth, and preventing wear and tear and stress reduction. Changes in lifestyle, active de-stress, breathing exercises, and short-term medication play an important role in management.”
TMJ Dysfunction (TMD) is characterized by pain in the jaw, the jaw joint, the chewing muscles, difficulty opening the mouth, pain when yawning or chewing, and sometimes the rattling noise within the joint. Some may have headaches and neck pain as well. TMD can be caused by jaw injury, clenching or grinding of teeth, abnormal chewing patterns, and postural imbalance.
Conventional management of TMD:
Conventional management includes medication for pain management, dental splints, bite adjustments, oral rehabilitation, and massages. A gentle diet, high-protein meal replacements, avoiding large mouthfuls and chewable foods, heat-cold applications, posture training, and physiotherapy are largely beneficial for dental health. But unfortunately, these therapies have been effective only for some over the long run. In the case of TMD, blood flow to affected areas is often compromised. These conventional therapies rely heavily on existing blood pathways to provide relief and, as a result, challenges.
New Effective TMD Management Approaches:
A) Low-level Deep Tissue Lasers:
The orthopedic and sports rehabilitation therapist, Dr. Sitaraman Sunderasan from 33 Intact, shares his experience using lasers to manage TMD. He says, “By using lasers, you can heal the nerves around the disc and generate new ways for the blood to get to the affected areas. Low-level cold lasers are limited in dosage and cannot reach the damaged tissue efficiently beyond a certain depth of the skin. Class 4 lasers bypass the circulatory system and transfer laser energy directly to affected cells and the muscles around them. Its efficacy is also on surrounding tissue areas, so proliferation occurs quickly for outcomes. You may have already received laser treatment, but you have not achieved the desired results because low-penetration lasers may have been used. Deep tissue laser therapy helps reduce pain and inflammation and increases the range of mouth opening when performed three times a week for three weeks.”
B) TMJ Injections
Dr. Arun Kumar says, “TMJ injections have been largely successful in the management of TMD. Injection of local anesthetic for the immediate management of pain, Botox can relax the joints. Steroids reduce the inflammation and I-PRF to regenerate the capsular tissues have provided both immediate and long-term benefits to the patients in terms of dental health.”
While light TMD typically resolves over time, established situations require intervention. As dental professionals, we can intercept and provide remedial solutions, and with early diagnosis, we might also prevent further damage from occurring. If you think 2020 has been a challenging year for your teeth, a visit to your family dentist might just start to make a difference for you.
Hopefully, 2021 is going to be better.
Valuable inputs from Dr. Anju Jeevan, Dr. Srinivas K, Dr. T Arun Kumar, and Dr. Sitaraman Sunderesan were taken while putting this article together.