Teeth grinding habits related to stress

Teeth grinding and/or clenching habits are quite common and more often than not are associated with stress or sleep deprivation. More-over they may be subconscious, noticed only by a sleeping partner because grinding teeth can be quite noisy (kids do it a lot when they’re shedding their baby teeth), or its pointed out by a dental professional having caused excessive tooth wear.

That leads to the next important point; these habits are called "Parafunctional" (para-outside, function – normal), well outside the normal range. In parafunction, biting forces are increased in both magnitude and frequency to over ten times normal; this is when they can become damaging. These habits are commonly seen as clenching or grinding, generally "bruxing" (gritting) of the teeth for prolonged time periods, so called tooth to tooth habits. Parafunction can also manifest as tooth to soft tissue habits, such as thumb sucking or abnormal tongue posture habits; and tooth to foreign body habits such as biting on pencils or nails.

They can affect virtually any part of the oral system; the jaw joints or muscles resulting in pain and spasm; the teeth themselves resulting in wear, fractures or looseness; and the associated structures where these habits manifest as headaches, earaches, neck and even backaches.

Bruxing or gritting habits are commonly seen in individuals who are undergoing stressful periods or major changes in their lives, like getting married! The funny thing about stress is that it affects people differently, and sometimes manifests as back pain, stomach ulcers, skin breakouts and the like in other people.

Parafunction – tooth grinding habits are what we see in dentistry – a lot. The point is that this is just the way you are reacting and when you’re stressed again the same symptoms are likely to recur.

The question is what can be done to help. Treatment most often is aimed at relieving the symptoms and stopping damage. For pain and muscle spasm mild anti-inflammatory and muscle relaxant drugs are prescribed initially, and occasionally medication to assist in sleeping. Warm or cold compresses applied in the area of the jaw joints are also helpful. In some severe and unrelenting cases biofeedback, along with psychotherapy is helpful.

Your dentist will often recommend the provision of a night or occlusal (bite) guard. This is usually a hard "processed acrylic" (wear resistant plastic) guard that is quite unobtrusive. It is made to fit over the biting surfaces of the upper teeth only. It is adjusted by the dentist so that it is only a few millimeters in thickness (thinness is a better word), so that the lower teeth are free to glide or skate on the guard and this prevents them from biting into the upper teeth, thereby resting the muscles and stopping the pain. It may be that you will need to use the guard nightly or even during the day when the habit or symptoms are evident and if/when they recur.

A component of the problem may be related to abnormalities like malocclusion (a bad bite or jaw relationship) which can sometimes trigger these kinds of habit patterns. If your main problem is related to a malocclusion then orthodontic treatment (moving the teeth with braces) or bite adjustment by equilibration (minor reshaping of the teeth to even the bite), may be needed.

These and other factors involved cannot be discussed fully in this brief overview. It is therefore very important that you see your dentist to check out what’s really going on and that nothing more serious is being overlooked. You can then consider the above alternatives with your dentist.
Best wishes for a great future and don’t worry, this should be fixable.

Dr. Calvo is one of only 300 members in the world to achieve AACD Accreditation status.  Recently, she was honored by being selected as the featured dentist in an ad for Accreditation published in several dental journals.  Dr. Calvo is a well-respected Cosmetic Dentist in the Los Angeles and Beverly Hills areas.  Dr. Calvo is passionate about changing lives and increasing self-esteem in the patients she has helped serve through Smile Makeovers, Porcelain Veneers, Dental Implants and other artistic dental services. Click hereto view her blog for more information or become a Fan of her Facebook FanPage by Clicking Here.

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When is it the right time to use implants to replace missing teeth in a teenager?

This is an important question and the current wisdom is not to have implants placed until jaw and facial growth are complete. Although it varies from person to person, growth of the jaws in most cases is not complete until late teens. Of course, we are faced with the dilemma of waiting for the optimal time to place implants so that they will succeed on the one hand, and respecting the psychological needs of a teenager missing front teeth on the other.

Well, you may say, that still doesn’t answer the question. The rest of the answer has to do with the difference in the way in which teeth and implants attach to bone in which they are embedded.

Teeth are attached to the bone through a membrane called the periodontal ligament (peri-around, odont-tooth). The ligament is a living network which is composed of tiny fibrils made of a protein called collagen. The fibrils insert into the bone on one side and the tooth on the other. The most fascinating thing about this very special structure is that it is living and therefore capable of change. And it does, all the time. Specialized cells continually remove collagen and bone and make it anew; this does two things – it allows the teeth to react to stress, as when forces are applied such as in eating and allows movement of the teeth themselves through the magic of orthodontic treatment (braces). In addition, as the face changes throughout life and the teeth themselves wear, minute changes in the position of the teeth within the bone are compensated for by changes in the periodontal ligament. This "remodeling" process accommodates these changes.

An implant connection to the bone is quite different. Dental implants join biochemically to the bone by a process called osseo-integration (osseo – bone, integrate-to join or fuse with). This fusion, almost like pillars in concrete, allows no movement at all and stresses, even biting forces, are absorbed quite differently.

Consequently and most importantly, as the jaws continue to grow, the upper jaw may move in an outward and downward direction. The teeth will accommodate and move with jaw growth, but implants will not. As the upper jaw moves, the implants (and the crowns attached to them) remain stationary and so appear to intrude i.e. go back up into the jaw. This also affects the position of the gum tissues which also will not follow the growth of the jaws around the implants.
For these reasons, and since implants are a relatively permanent and best current solution to the problem of tooth replacement, it is better to wait until growth of the jaws and face is complete. Your orthodontist will be able to tell you when growth is complete by examination and specialized radiographs (x-rays) which will provide a good guideline. However, this is a very inexact science; it’s not really possible to determine exactly when a person has finished growing. Other factors can be indicative and helpful: Is your daughter still changing shoe and clothes sizes? Is she comparable in stature to her siblings and you, her parent(s)? These are good intuitive signs, but in the end, we add the science to our experience and make a judgment call.

There are many other good interim options for temporarily replacing the teeth for a few years, both aesthetically and comfortably until implants can be placed. For example, temporary "fixed-in" options like bonded bridges can be attached to the adjacent teeth with little if any irreversible change to them. You should consult your dentist about them.
Ultimately dentistry is an art form as well as science. This issue has been studied in the scientific literature and also proven in clinical practice. Sometimes, placing implants too early can be remedied by changing the crowns which attach to them. Other times it may mean removing and replacing the implants which may require bone regeneration – expensive and difficult options. Neither is as good an option as waiting for the correct time in the first place, even if it means waiting a little longer.

Dr. Calvo is one of only 300 members in the world to achieve AACD Accreditation status.  Recently, she was honored by being selected as the featured dentist in an ad for Accreditation published in several dental journals.  Dr. Calvo is a well-respected Cosmetic Dentist in the Los Angeles and Beverly Hills areas.  Dr. Calvo is passionate about changing lives and increasing self-esteem in the patients she has helped serve through Smile Makeovers, Porcelain Veneers, Dental Implants and other artistic dental services. Click hereto view her blog for more information or become a Fan of her Facebook FanPage by Clicking Here.

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