When Stress Takes a Toll on Your Teeth

With economic pressures affecting millions of Americans, dentists may have noticed a drop in patients opting for a brighter smile, but they are seeing another phenomenon: a rise in the number of teeth grinders.

"I'm seeing a lot more people that are anxious, stressed out and very concerned about their financial futures and they're taking it out on their teeth," said Dr. Steven Butensky, a dentist with a specialty in prosthodontics (aesthetic, implant and reconstructive dentistry) in Manhattan.

One of his patients lost hundreds of thousands of dollars invested with Bernard L. Madoff. Another reported that he had lost a job with a seven-figure salary. A third, a single mother with a floral design business on Long Island, said she was working twice as hard for half as much.

"All three are grinders, directly affected by what's going on out there," Dr. Butensky said, gesturing outside his Midtown office window.

Dr. Robert Rawdin, another Manhattan dentist with a specialty in prosthodontics, said he had seen 20 to 25 percent more patients with teeth grinding symptoms in the last year. And in San Diego, Dr. Gerald McCracken said that over the last 18 months his number of cases had more than doubled. They, along with other dentists interviewed for this article, chalk it up to the economy.

"We're finding in a lot of double-income families, we have the people who have lost jobs and are worried, and then we have the spouse, who still has the job, with the added pressure and uncertainty," Dr. McCracken said. "This can cause some real grinding at night."

With or without economic hardship, 10 to 15 percent of adult Americans moderately to severely grind their teeth, according to Dr. Matthew Messina, a dentist in Cleveland and a consumer adviser for the American Dental Association.

Because it is a subconscious muscle activity, most grinders grind without realizing it, until a symptom such as a fragmented tooth or facial soreness occurs.

While many experts believe that genetics may play a role in bruxism (or teeth grinding), stress has long been known to set off clenching and grinding in some people, Dr. Messina said. "Recession breeds stress and our body responds to stressful events so in times like these, the incidence of bruxism goes up," he said, adding that over the last year or so he had heard from dentists around the country who had seen an uptick in patients with bruxism while also complaining about financial stress. In his own practice, he said he had treated twice as many cases in the last year than in the year before.

"Stress, whether it's real or perceived, causes flight-or-fight hormones to release in the body," he said. "Those released stress hormones mobilize energy, causing isometric activity, which is muscle movement, because that built-up energy has to be released in some way."

The most expensive option for rebuilding teeth damaged by grinding is with veneers, but this year, dentists say that many of their bruxism patients are requesting one of the least costly treatments: a night guard, also known as an occlusal splint. Manufacturers said sales of these devices had gone up. "Our night guard sales have increased 15 percent over the prior year," said Greg Pelissier, a manager at Glidewell Laboratories, a maker of custom restorative, reconstructive and cosmetic dental products based in Newport Beach, Calif.

New drugstore products have also come to market, including a disposable night guard, Grind-No-More (about $30 for 14 guards). Its makers hope it will appeal to on-again-off-again grinders.

Stan Goff, executive editor of Dental Products Report, a monthly publication, wrote in an e-mail message that all this teeth grinding "may be playing a role in the introduction of several new products designed to not only prevent bruxism, but to help fight against tooth sensitivity" and other conditions that are aggravated by grinding.

While experts believe bruxism is not a dental disorder per se, but rather originates in the central nervous system, the condition can greatly affect the teeth and the entire craniofacial structure.

"Normally, we exert about 20 to 30 pounds per square inch on our back molars when we chew," Dr. Rawdin said. "But teeth grinders, especially at night without restraint, can exert up to as much as 200 pounds per square inch on their teeth."

Some nocturnal grinders will grind up to 40 minutes of every hour of sleep. The relentless wear and tear can quickly erode enamel (10 times faster than that of nongrinders), fracture teeth, affect bite and damage the temporomandibular joint at the hinge of the jaw, and the masseter muscle, which controls the jaws. Jaw and face pain, as well as earaches and headaches, may also occur.

"I kind of thought I was going crazy," said Adrienne Lee Kornstein, 48, a patient of Dr. Butensky, whose floral design business in Jericho, N.Y., has suffered because of the economy. "A tooth broke for what seemed like no reason, and by the time I got to Dr. Butensky, I'd been to my physician, other dentists, even a dermatologist to try to get relief from migraines and facial pain I was taking painkillers for. I had no idea I was grinding or that grinding your teeth could even lead to all that."

The most common treatment for the disorder is to wear a night guard, which may not only alleviate grinding but, in some cases, train someone to stop grinding altogether.

Fitted in the dentist's office, a custom guard is usually a clear, hard plastic device that runs over the top or lower teeth from front to back and prevents the top and bottom molars from making contact. Although not cheap (the price can range from $350 to $1,000), most dentists prefer a custom guard to over-the-counter guards, which are usually made of softer material and can encourage chewing and exacerbate masseter muscle activity.

There are also smaller prefabricated splints that a dentist can customize. These are generally cheaper than the fitted full arch guards and require fewer adjustments. But some dentists argue they are not as effective as the full arch guards.

Many teeth grinders interviewed said they would not go to bed without their night guards.

"Sometimes I wake up in the middle of the night and having my guard in makes me more aware if I'm tensing my body or gripping my jaw, and I can just take a moment to relax," said Alisa Fastenberg, 50, a graphic designer in Manhattan.

Other treatments for teeth grinding include acupuncture, medical massage, hypnosis and Botox injections into the masseter muscle to relax the muscle enough to stop it from going into spasms without changing one's chewing function.

"Grinding is like body building," said Dr. Alexander Rivkin, a head and neck surgeon at Westside Aesthetics in Los Angeles, who has also seen an increase in grinding-related cases this past year. "The constant workout of the masseter muscle, the largest in the head, builds up that muscle and that can cause a lot of pain, not to mention make the face appear more square."

He added, "For, I'd say, 85 percent of the people who come to me complaining about headaches, jaw soreness and pain, Botox injections into the masseter muscle on both sides of the face is the answer."

But even something as simple as taking time before bed to de-stress has been known to help.

"Good sleep hygiene goes a long way to keeping the mind relaxed and the jaws from starting to smack together," said Dr. McCracken, who has studied the relation of sleep to teeth grinding. "We know that the stress center of the brain is directly next to the part of the brain that controls teeth grinding. We're not sure how it relates to the disorder, but it's intriguing. Lately, I even tell my patients, before they go to bed, not to watch the news."

By: CAMILLE SWEENEY

Why It's So Hard to Tell Which Tooth Has the Ache

When it comes to a toothache, the brain doesn't discriminate. A new imaging study shows that to the brain, a painful upper tooth feels a lot like a painful lower tooth. The results, which will be published in the journal Pain, help explain why patients are notoriously bad at pinpointing a toothache.

For the most part, humans are exquisitely tuned to pain. The brain can immediately distinguish between a splinter in the index finger and a paper cut on the thumb, even though the digits are next-door neighbors. But in the mouth this can be more difficult, depending where and how intense the ache is.

"We don't know much about tooth pain," comments dentist and neuroscientist Alexandre DaSilva of the University of Michigan in Ann Arbor, who was not part of the new research. The new study is one of the first to address the puzzle of toothache localization, he says.

In the study, researchers led by Clemens Forster of the University of Erlangen-Nuremberg in Germany analyzed brain activity in healthy - and brave - volunteers as they experienced tooth pain. The researchers delivered short electrical pulses to either the upper left canine tooth (the pointy one) or the lower left canine tooth in the subjects. These bursts of electrical stimulation produced a painful sensation similar to that felt when biting into an ice cube, Forster says, and were tuned such that the subject always rated the pain to be about 60 percent, with 100 percent being the worst pain imaginable.

To see how the brain responds to pain emanating from different teeth, the researchers used fMRI to monitor changes in activity when the upper tooth or the lower tooth was zapped. "At the beginning, we expected a good difference, but that was not the case," Forster says.

Many brain regions responded to top and bottom tooth pain - carried by signals from two distinct branches of a fiber called the trigeminal nerve - in the same way. The V2 branch carries pain signals from the upper jaw, and the V3 branch carries pain signals from the lower jaw.

In particular, the researchers found that regions in the cerebral cortex, including the somatosensory cortex, the insular cortex and the cingulate cortex, all behaved similarly for both toothaches. These brain regions are known to play important roles in the pain projection system, yet none showed major differences between the two toothaches. "The activation was more or less the same," Forster says, although he adds that their experiments might have missed subtle differences that could account for why some tooth pain can be localized.

Because the same regions were active in both toothaches, the brain - and the person - couldn't tell where the pain was coming from. "Dentists should be aware that patients aren't always able to locate the pain," Forster says. "There are physiological and anatomical reasons for that."

DaSilva agrees that the brain's inability to tell top-tooth pain from bottom-tooth pain "pairs really well with what we see in the clinic."

Understanding the pathway from tooth to brain may help researchers devise better treatments for acute tooth pain, such as cavities or infections, and more-chronic conditions, DaSilva says. One such condition is phantom pain that persists in the mouth after a tooth has been removed.

By, Laura Sanders, Science News

Tongue Piercings Associated With Gap Between Teeth

'Playing' with a pierced tongue stud could lead to a gap between the front teeth - according to a new study. The Research, which was carried out at the University at Buffalo in New York, suggested that tongue piercings could be a major cause of unnecessary orthodontic issues. 

The report claimed that those with tongue piercings were likely to push the metal stud up against their teeth and consequently cause gaps and other problems to arise. 

Chief Executive of the British Dental Health Foundation, Dr Nigel Carter, said the study highlighted the risks that tongue piercings have on oral health. 

Dr Carter said: "It's certainly something to think about before going out to get a tongue piercing. The temptation of playing with the stud in the mouth would be very high and in time this could lead to hundreds of dollars worth of corrective treatment. 

"The results of this study stress the risks that are associated with tongue piercings. As well as causing an apparent gap, oral piercings can also lead to chipped teeth and infection. 

"In order to avoid such health problems in the future, along with the spiralling costs of any related treatment, I would advise people to stay clear of tongue piercings." 

Lead author of the study, Sawsan Tabbaa, said that 'force, over time, moves teeth' and that the results are caused by people playing with their studs crop up in a 'very high percent of the cases'. 

A professor of orthodontics at the University at Buffalo School Of Dental Medicine, Tabbaa, explained that tooth damage was common in both past and current case studies. 

The current study featured a 26 year-old female patient and showed that a space between the upper front teeth had appeared during a period of seven years, as the metal bar was pushed against and between the teeth. 

The patient provided researchers with photographs to show that she had no diastema before having her tongue pierced. It was strongly thought that positioning of the tongue stud between the maxillary central incisors caused the midline space between the front teeth. 

The only solution was for the patient to wear braces for an extensive period of time. 

The author concluded that tongue piercings could result in serious injuries, not just to teeth but said they have also been associated with hemorrhages, infections, trauma to the gums and, in the worst cases, brain abscesses. 

The results of the study were published in the Journal of Clinical Orthodontics. 

Source: British Dental Health Foundation 

Can Green Tea Strengthen Teeth?

Researchers suspect antimicrobial molecules contained within green tea helps preserve teeth (as long as you don't add sugar).

• People aged 40-64 who drank one cup of green tea a day were less likely to lose teeth.
• Drinking unsweetened coffee had no effect on keeping teeth.
• Antimicrobial molecules called catechins may account for green tea's benefits.

A cup of green tea a day may keep the dentist away.

That's the finding of new research published in Preventive Medicine. The findings show that drinking at least one cup of green tea a day increases the odds of keeping your teeth as you age.

The researchers suspect that antimicrobial molecules called catechins present in green tea and in lesser amounts in oolong tea provide the benefit. But be careful if you like your tea with sugar: sweetener may negate the effect, the team found.

"Green tea may have bacteriocidal effects, which would affect teeth, but only if you drink it without sugar," said Alfredo Morabia, of Columbia University in New York and editor of Preventive Medicine, who wrote an editorial accompanying the new research.

"They also reported that drinking sweet coffee was actually deleterious," he added. "Coffee alone had no problem, but sweet coffee would actually make you lose your teeth."

Yasushi Koyama of the Tohoku University Graduate School of Medicine and colleagues looked at more than 25,000 Japanese men and women between age 40 and 64 in making the determination.

They found that men who drank at least one cup of tea a day were 19 percent less likely to have fewer than 20 teeth (a full set including wisdom teeth is 32) than those who did not drink green tea. Tea-drinking women had 13 percent lower odds.

One possible explanation for the benefits of tea drinking is that warm drinks wash out your mouth. But coffee, which also provides a mouth rinse, had no benefit, suggesting something else is going on.

Catechins have been shown to kill mouth bacteria associated with tooth decay and gum disease, so the researchers suspect this is what gives green tea its dental benefits.

"Previous research has indicated that regular consumption of green tea may lead to a lower instance of periodontal disease, a leading cause of tooth loss in adults," said Samuel Low of the University of Florida College of Dentistry and President of the American Academy of Periodontology in a statement to Discovery News.

Maintaining healthy teeth and gums is part of maintaining a healthy body, Low said. "That is why it is so important to find simple ways to boost periodontal health, such as regularly drinking green tea -- something already known to possess certain health-related benefits."

Toothaches- causes, home remedies, and treatment

“Tooth ache” can be generally regarded as pain around a particular tooth, teeth or jaws. Tooth pain can range from mild discomfort or sensitivity to being excruciatingly painful. Some women have even compared toothpain to being as painful as child birth. Of course, these might be exaggerated claims from some desperate women, but it does reflect the intensity of the pain arising from a toothache.

The actual pain we feel is due to the irritation of the nerves which are associated with the tooth/teeth. If you didn’t know, nerves are responsible for carrying sensations like heat, cold, touch and PAIN to the brain. In this case when the nerves inside the tooth are irritated, these carry the pain impulse to the brain.

Causes of toothpain

Most of the causes of tooth pain are limited to oral/dental causes.

The oral causes of toothpain are

• Tooth Decay or Cavity (being the most common cause of tooth pain)

The most common cause of tooth pain is Tooth Decay. Tooth decay is the degradation of the tooth due to harmful acids secreted by bacteria in the oral cavity.

• Gum Disease

The next important causing agent of tooth pain is gum disease. Poor oral hygiene leads to bacterial plaque accumulation and the toxins release from these bacteria damage the gums. The gums become swollen, red and painful (Gingivitis). If gum disease is not controlled early, you are at a risk of losing your tooth.

• Root Sensitivity

Root sensitivity (commonly termed as tooth sensitivity) is when the roots of the teeth become exposed due to recession of the gums. The roots are very sensitive and respond with pain to reasonably hot or cold foods.

• Cracked teeth

A painful accidental blow or extreme biting force can cause the tooth fracture which can become a source of intense pain whenever the fractured tooth is even touched.

• Temporomandibular joint(TMJ) Disorder

TMJ disorder is an inflammatory reaction at the sight of the lodgment of the lower jaw at the skull. Various factors such as Bruxism (Night grinding or teeth grinding), arthritis can cause TMJ disorders.

• Wisdom tooth eruption or impaction

The eruption of a wisdom tooth often causes pain due to its misalignement. It can become impacted (does not erupt) and require surgical extraction.

• Fillings:

People who have undergone fillings can get severe toothache suddenly. This might be because of the spread of the decay to the pulp and you will need to undergo root canal treatment for that. It can also occur due to accumulation of fluid with organic debris and bacteria between the filling and your teeth often termed as microleakage in dental jargon.

The non-oral causes include Ear and Sinus infections .

Prevention of toothpain

There is no magic trick to prevent tooth pain from occurring. All you need to do is maintain a good oral hygiene.

Home remedies for toothpain

There isn’t a fixed time for toothpain to occur. You can’t drive to your dentist at 3 am at night. However, you can surf the net looking for home remedies. Although, these should not be substituted for a visit to the dentist, they can provide temporary relief from the agonizing pain.

I have not tried any of them and do not suggest their use either. They are listed here for informational purposes only

1. Sensodyne Therapy: Works for tooth cavities

1. Rinse your mouth with warm water.
2. Put max strength sensodyne toothpaste on the cavity.
3. You can feel the pain relief after few minutes.

The effect will decrease when you drink water or other liquids after putting the sensodyne.

2. The Whiskey BC Mix: Works for nearly all tooth pains and is quite effective. Note that this can be nasty when you try it.

1. Add teaspoon of baking soda in a shot of Whiskey.
2. Dissolve a packet of BC pain relief powder in the above mix.
3. Swish around the affected tooth for two minutes.

Try this if you have unmanageable tooth pain and you cant get health care right away.

3. Nyquil therapy: Lots of people swear by this fast and effective trick. It works very well indeed and I have quite a few people thanking me for this one.

Take half a teaspoon of Nyquil or Kroger Nitetime (cold/flu syrups) and swish around the affected area.

Other

Try sucking at a clove or put clove oil on the affected tooth.

Place a raw piece of onion on the affected tooth.

Treatment for Tooth Pain

The treatments for toothpain vary greatly. They treat the actual cause of your tooth pain. For example

If you have tooth decay, you will have to undergo a filling procedure.

If the tooth decay has reached your pulp, you would have to undergo a root canal procedure.

If you have impacted wisdom teeth, they need to be extracted.

Your dentist will determine the best treatment option for you after examining you.