While most dental practices are now open and treating patients with consistently growing patient volumes, COVID-19 continues to inflict its own brand of destruction on patients’ mouths.
Stress as a side effect of COVID-19 is impacting dentistry, perhaps more than other types of healthcare. Some patients experiencing high levels of stress have taken it out on their teeth by cancelling or delaying appointments due to fear of the pandemic or through the onset of bruxism.
According to a poll conducted by the American Dental Association Health Policy Institute (ADA HPI), many practitioners are seeing a rise in oral health problems such as caries and periodontal diseases, as many patients have delayed or cancelled their routine preventive care.1 These numbers are reflective of a preliminary report by the Centers for Medicaid & Medicare Services that shows dental services for children ages 18 and younger dropped by 69% between March and May compared to 2019 data for the same period.2
Stress also directly affects the dentition, as more patients grind or clench their teeth. Bruxism can damage the dentition, soft tissues, and temporomandibular joints, while also causing facial pain and headaches, and negatively impacting sleep and quality of life. The ADA HPI poll indicates a 59.4% jump in bruxism as well as increases in the prevalence of chipped and cracked teeth (53.4%) and symptoms of temporomandibular disorders (53.4%) in patients.1
Give Teeth a Break
Oral health professionals do have options for patients experiencing stress-related bruxism. Nightguards, or occlusal splints, worn by patients when they sleep, have long been the standard for keeping upper and lower teeth apart and otherwise protecting tooth surfaces from grinding forces. Other strategies include relaxation techniques, biofeedback, and Botox treatments. New technologies are being developed to go even further, including a wireless sensor that attaches comfortably to a patient’s temple. When the sensor detects the start of bruxism, it triggers a signal to relax the jaw via mild electrical impulses.
Increased stress levels may also raise the risk for painful aphthous ulcers and mouth sores caused by cheek biting. Recommending pain-relieving mouthrinses, such as those containing aloe vera, can help soothe oral tissue discomfort and speed healing.
Because bruxism can result in dentinal hypersensitivity, a number of products are available to ease this discomfort, such as toothbrushes with soft bristles and toothpastes and mouthrinses containing potassium nitrate, which can block dentinal tubules to reduce dentin permeability, preventing nerve stimulation. Application of fluoride varnish may also be helpful in some cases. But the most important factor in maintaining and improving patients’ oral health is to receive professional oral health care. As dental practices have reopened safely, hopefully more patients will return for routine care.