Damaged teeth and sore jaws speak clearly:
Life is a grind
By Sharon Kirkey
Citizen health writer

The teeth on the slide in Dr. Tom Harle's office look as if they connected with a baseball bat. Some are split and chipped, others pounded flat. Two have been sheared off completely.

Life is getting this Ottawa patient, and thousands like him, right in the teeth.

There's no hard evidence to prove it, but dentists say the number of teeth clenchers and grinders is rising fast, yet another symptom of the stressed-out, downsized 1990s.

With unemployment in the double digits, personal debt at an all-time high and job angst through the roof, little wonder we've become a nation of gnashers.

Not all cases are serious, but some people are gritting and grinding their way to serious tooth damage and painful jaw disorders.

An article in the Journal of the American Dental Association last year estimated that U.S. dentists are constructing splints or night guards for some 1.5 million grinders a year. While there's no comparable Canadian data, several local dentists say they're making more nightguards than ever.

"I used to make two a week. Now I'm making as many as two a day," says Dr. Gerald Wexler, an Ottawa dentist and expert in temporomandibular dysfunction and oral facial pain.

Some people are such aggressive grinders they're taking Valium or other anti-anxiety medications to save their teeth. Others have been known to even grind their mouth-guards to dust within months.

Harle, a prosthodontist, says bruxism -- the medical term for occasional or habitual teeth grinding and clenching is common. Almost everyone does it to some degree, but studies suggest that about 20 per cent of the adult population are chronic bruxers. (Many dentists believe the numbers are really much higher.)

Sometimes the problem is a bad bite or occlusion, where the teeth don't match up properly Some researchers believe that clenching and grinding is actually a form of sleep disorder: a recent Canadian study found that about 17 per cent of people whose legs twitch in their sleep (so-called restless leg syndrome) also grind their teeth.

But many experts point their fingers squarely at the stresses of daily life.

"I see this day in and day out," says Wexler.
"I see anywhere from two to four new patients a day with jaw problems, and I'd have to say that most common problem among them is the fact that they're clenching or grinding."

Wexler says tooth clenching and gnashing is a natural release mechanism for stress, anxiety, anger, and tension. "In some spheres it's considered physiological as opposed to pathological normal as opposed to abnormal because it's so common a stress outlet."

Animals grit and bare their teeth when provoked or attacked, and humans aren't immune to these "baser instincts," he says.

"We react as soon as things happen. It can be something as little as our boss putting something on our desk. Our blood pressure goes up, our muscles tense. There's a tightening of the jaw muscles and very often clenching and grinding."

Wexler, who's practiced in Ottawa for 27 years, says he's seen a significant increase in bruxers, something he attributes in part to the 1991 recession and federal government downsizing. "Everyone is sitting on edge, worried about their jobs."

All walks of life
He counts federal public servant, teachers, sales people, journalists, and technical workers among his patients. Of those who seek treatment, women outrank men four to one, he says.

Why the gender imbalance? The actual incidence is believed to be equal among men and women. But men tend to suffer less jaw, muscle stiffness and soreness than women, and tend to seek treatment less. It may be because men have a greater capacity to handle the extra load due to stronger muscles.

Children grind their teeth, too, and while bruxism in children is often due to growing teeth, stress can play a role.

"We know that stressed children, hyperactive children, clench and grind their teeth more," Wexler says. Even the stress of a new situation, like changing schools or teachers, can trigger childhood bruxism.

But while children often outgrow grinding as their teeth and jaw structures change, adults tend to be more habitual gnashers. And the price can be serious tooth damage, Harle says. Long-term bruxing breaks down the tooth structure, causing fillings to chip and crack. Some teeth can be ground down to the gumline.

"Sometimes you get this almost wizened up look." Harle says. "You actually lose what’s called vertical dimension the dimension between your nose and the tip of your chin because you've lost so much height from your teeth."

People can actually kill the nerve in a tooth with too much clenching and grinding and end up with a root canal, Wexler says.

Bruxism is also a major cause of disorders of the temporomandibular joint the hinges on either side of the face that connect the lower jaw to the skull and the muscle system surrounding it. Symptoms can include sore, tired jaws, a clicking noise in the jaw, earaches, headaches or problems opening the mouth. Sometimes the jaw muscles go into such spasm that they lock up like a charley horse.

One of the primary treatments for nighttime grinding is a night guard a rigid, clear plastic shell that usually fits over the top teeth. Night guards create better balance in the mouth and prevent teeth from grinding together.

Patient education is also key. Most people have no idea just how much their teeth touch during the day. In fact, teeth are never supposed to touch. Ligaments in the jaw muscles hold the teeth apart, so that when the jaw’s in neutral, there should be a slight space between them.

Some grinders and clenchers put colored stickers in strategic places on their computer screen at work, the fridge and stove at home to remind them to unclench their teeth.

So called "auto suggestion" can help too. Many dentists coach their patients in the bruxism mantra: "Lips together, teeth apart. Lips together, teeth apart."

Wexler recommends never going to bed worried about a problem.

"Because if you try to work out the problem while you're sleeping, you're just keeping the computer active," says Wexler, "and all that clenching and grinding continues."

Bruxism can't be cured completely, but it can be managed. Wexler's advice? See your dentist if you're experiencing any tooth sensitivity, muscle soreness or strain.

And try not to let life's stresses gnaw you down.