Patient headaches on the rise

Photo: Getty Images/B2M Productions

Your patients have a lot on their minds.  

Some may have lost their jobs, while others who are still employed fear they’ll be standing in that unemployment line any day now. They’re stressed out about money and the struggling economy, and that could be hurting their dental health.

When people are stressed they’re more likely to grind their teeth and clench their jaw throughout the day and while they’re sleeping. And not only does it hurt their teeth, it can lead to jaw pain and headaches.

Your patients probably don’t even realize they’re grinding and clenching. We recently sat down with John Jansheski, Preventive Care Expert and CEO of DenTek Inc., who talks about how you can tell when you’re dealing with bruxing patients and the inexpensive over-the-counter mouthguards that can help them overcome this harmful, stress-induced habit.

DPR: Has there been an increase in bruxism cases in recent years? If so, why do you think that is?

Jansheski: There has been an increase in diagnosing bruxism over the last few years. We’re not aware of an actual study that proves the increase, however we’re in touch with thousands of dental professionals at all the dental shows every year and they have noticed a significant increase in diagnosing grinding in patients. The prevalent feeling is it’s because of the recession. Relationship changes, moving to a new home and job changes or losses can be primary causes of stress induced bruxism.

The one thing that is quantifiable is the increase in the market for dental guards. It’s gone up more than 50 percent in the last two years. And that’s not just our devices, but the segment as a whole. This is significant segment growth.

DPR:What are some of the problems associated with bruxism?

Jansheski: The mental stress associated with financial uncertainty can manifest in teeth grinding. About 80 percent of the population at one time or another has suffered from teeth grinding, and at any one time 18 percent of people are in the phase of grinding their teeth. It’s a significant source of pain and discomfort. Not only is it damaging to teeth and bone, it can cause bone and tooth loss. It also can cause jaw muscle tension, which can lead to headaches. Grinding teeth and malocclusion can exacerbate existing TMJ conditions and lead to TMJ on otherwise healthy patients.

DPR: What’s the best treatment for bruxism?

Jansheski: It's optimal to have bruxism diagnosed and treated by a dental professional. However, over-the-counter dental guards are an excellent alternative for reducing the symptoms associated with bruxism when the patient lacks the financial resources to purchase a professional guard. Dental guards are not appropriate for treating TMJ, however.

Fact

Most patients don’t know they’re grinding their teeth because it’s happening while they’re sleeping, so they have no idea why their jaw is sore or why their head hurts.

DPR:What are some of the symptoms clinicians should look for?

Jansheski: Uneven wear on the occlusal and upper lateral surfaces of the teeth where they would contact the opposing teeth. You see a lot of lower anterior occlusal wear, canine wear and the molars valleys are reduced in height because the ridges are wearing down. That’s the most prevalent. You also would see some gum recession because when patients grind their teeth, it causes the gums to recede, which exposes more dentin and cementum. When you expose the softer side of the tooth, it’s more sensitive to hot and cold. Just biting down can cause sensitivity.

Bruxism also causes more pressure to be exerted on the teeth. When chewing, patients put 70 to 80 pounds of pressure per square inch on the teeth. When clenching, patients are going to put up to 150 to 200 pounds of pressure on the teeth. What’s amazing is when patients are asleep, they can put up to 1,000 pounds of pressure per square inch on their teeth. That’s a lot of pressure. One night of bruxing is equivalent to about a month of normal wear and tear on the teeth.

Another symptom you’re going to notice is the jaw muscles will be overly developed. I can look at people and tell if they grind their teeth just by observing the size of their jaw muscles.

DPR:What’s the relationship between bruxism and headaches?Jansheski: I have seen studies indicating that 80 percent of headaches are caused by muscle tension. So it can emanate from the jaw up toward the temple and above the ear. Typically a TMJ or bruxism headache would be limited to the right or left side, not the front lobe or the top of the head. You can determine if the headache has to do with bruxism by having the patient get a dental guard and wear it for anywhere from a few days to a few weeks. If symptoms and pain subside the patient can say ‘Hey, I think that has to do with my grinding.’ They have to wear it for a long enough period to "retrain the brain and jaw muscles" and allow them to relax. 

When the teeth are kept apart by a dental guard it prevents the muscles from contracting to their full strength. It also prevents the jaw from finding it's comfortable "home" in full occlusion, which interrupts the neural feedback and reduces the overall strength of the clenching effect on the muscles.

DPR:What’s the biggest barrier to patients getting help for their grinding?

Jansheski: Dental professionals are acutely aware of grinding and all the problems associated with grinding. They’re doing a super job of making patients aware of bruxism. The problem is, solutions typically provided by dental offices cost $400 to $1,000. Patients hear the price and a lot of them will baulk. Again, over-the-counter solutions are an excellent alternative for patients who can’t afford custom guards.

Did you know...

Americans spend on average more than $4 billion annually on over-the-counter drugs and therapies for chronic headaches.
Source: Health and
Fitness Magazine, July 8, 2004.

We at DenTek have to do a better job of getting information about OTC guards in front of dental professionals. They’re so busy and have so many companies coming at them from so many different angles for so many different remedies, we have to break through the clutter. They’re usually relieved when they learn there’s something available for patients at the store level. You’re talking about $20 to $30 compared to $400 to $1,000 dollars. It’s a significant difference, especially today.

Renee Knight is a senior editor for DPR. Contact her at rknight@advanstar.com.

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