Bruxism - in which people unconsciously grind their teeth and clench their jaw - is a stress-related condition affecting more and more New Zealanders.
Dentists are now taking a more holistic approach to the problem, which can leave sufferers with fractured teeth, headaches and painful lockjaw.
The grinding of teeth usually happens when people are asleep and can lead to teeth being ground down and nerves exposed.
It is a treatable condition but complex, New Zealand Dental Association chief executive Dr Mo Amso tells Nine to Noon.
A person with bruxism may unconsciously clench their teeth while awake (awake bruxism) or clench and/or grind them during sleep (sleep bruxism).
Mild cases may not require treatment, however, in some people, bruxism can be frequent and severe enough to lead to jaw disorders, headaches, damaged teeth and other problems, Dr Amso says.
“In New Zealand, we are hearing anecdotal reports from dentists that they are seeing more bruxism in their patients ... But bruxism has always been reasonably prevalent in the community, with the onset of Covid-19 and the ensuing pandemic. There has been an impact, albeit anecdotal.”
International studies suggest the condition affects females more than males and predominantly 35-to-50-year-olds and professionals, he says, but anyone who suffers stress is prone to experiencing it.
“In my personal practice over the past 10 years, I have encountered it in people who have a tendency towards either stress because of their personality or their work or who work out at the gym. So, it’s quite diverse.”
Stress is the predominant factor in bruxism, Dr Amso says.
One child he treated started grinding her teeth when she moved in with her unloving father and stopped as soon as she moved back in with her mother.
Awake bruxism is predominantly attributed to stress, anxiety and negative emotion, Dr Amso says, while night bruxism is more complex and multifactorial.
Stress plays a role but underlying health conditions such as respiratory failure, cardiac conditions and genetic factors can all come into play, he adds.
People who have nighttime bruxism may not be aware of grinding their teeth yet wake up with a sore head or jaw - a common sign of the condition - or be alerted to it by their partner.
“Some people may go decades without recognising it until it’s brought up to them by their dentists."
Over time, the damage from teeth-grinding in your sleep can be significant, Dr Amso says.
“Often if teeth are compromised with heavy fillings or they’re weakened by other factors there could be more damage to the physical structure of the teeth by way of chipping the tooth or breaking the tooth, the actual tooth structure could sometimes be worn significantly.
“People’s teeth look shorter, and in extreme cases where bruxism is quite complex and also pathological, people may grind their teeth all the way down to the gums or just about. So, it can have quite noticeable symptoms or quite mild ones.
Wellington woman Olivia Hope-Simcock has experienced bruxism for the last few years.
She first noticed symptoms that seemed similar to a toothache when a filling is needed, but a dentist advised that her teeth were fine.
“It was one of those situations where I didn’t notice I was so stressed and it was coming out in other forms, such as this teeth ache," she says.
Hope-Simcock has been clenching and grinding her teeth since 2017, and the severity of it over this period has varied depending on her stress levels.
Years of bruxism had led to Hope-Simcock having cracked teeth and needing a root canal before interventions by her dentist and medical practitioners were successful.
Now the TMJ muscle in her jaw is injected with Botox every five-to-six months to stop it from clenching and a mouth guard protects her teeth from grinding.
Hope-Simcock also began seeing a psychologist to address the causes of stress.
Faced with a case of bruxism, dental specialists try to ascertain the underlying causes of the condition as they attempt to mitigate the damage it causes, Dr Amso says.
Dentists now focus on the patient as a whole, he says, as general issues of health and wellbeing often influence what’s happening in their mouths.
“For a lot of people causative factors could be high caffeine or alcohol intake, or if they’re taking meth or cocaine. Sometimes it's psychiatric disorders. As soon as we’ve elucidated ... what are the overlying causes and if we can try to eliminate them, we can decide the best approach.
“Often we work quite closely in a multidisciplinary approach alongside other health professionals and allied health professionals to wrap around a patient and make sure their condition does get the treatment required.”