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Cracked Teeth. What’s Going On?

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Dentists Are Seeing an Epidemic of Cracked Teeth. What’s Going On?

When I reopened my dental practice in early June, the tooth fractures
started coming in: at least one a day, every single day that I’ve been
in the office.
[well-teeth-articleLarge.jpg?quality=75&auto=webp&disable=upsca
le]
Credit...Getty Imges

By Tammy Chen, D.D.S.
* Sept. 8, 2020, 5:00 a.m. ET
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“How’s your dental practice?” a friend of mine asked, brow furrowed,
concern evident on her face.

I’ve seen this look a lot recently. Since the onset of the pandemic,
with a citywide shutdown and social distancing measures firmly
entrenched, more than a handful of friends and family members have
presumed I must be on the brink of closing. But I let her know that I
am busier than ever.

“Really?” she asked. “How’s that possible?”

“I’ve seen more tooth fractures in the last six weeks than in the
previous six years,” I explained.

Unfortunately, that’s no exaggeration.

I closed my midtown Manhattan practice to all but dental emergencies in
mid-March, in line with American Dental Association guidelines and
state government mandate. Almost immediately, I noticed an uptick in
phone calls: jaw pain, tooth sensitivity, achiness in the cheeks,
migraines. Most of these patients I effectively treated via
telemedicine.

But when I reopened my practice in early June, the fractures started
coming in: at least one a day, every single day that I’ve been in the
office. On average, I’m seeing three to four; the bad days are six-plus
fractures.

What’s going on?

One obvious answer is stress. From [17]Covid-induced nightmares to
“[18]doomsurfing” to “[19]coronaphobia,” it’s no secret that
pandemic-related anxiety is affecting our collective mental health.
That stress, in turn, leads to clenching and grinding, which can damage
the teeth.

[20]Latest Updates: The Coronavirus Outbreak

Updated 2020-09-08T19:53:41.959Z
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But more specifically, the surge I’m seeing in tooth trauma may be a
result of two additional factors.

First, an unprecedented number of Americans are suddenly working from
home, often wherever they can cobble together a makeshift workstation:
on the sofa, perched on a barstool, tucked into a corner of the kitchen
counter. The awkward body positions that ensue can cause us to
[26]hunch our shoulders forward, curving the spine into something
resembling a C-shape.

If you’re wondering why a dentist cares about ergonomics, the simple
truth is that nerves in your neck and shoulder muscles lead into the
temporomandibular joint, or TMJ, which connects the jawbone to the
skull. Poor posture during the day can translate into a grinding
problem at night.

Second, most of us aren’t getting the restorative sleep we need. Since
the onset of the pandemic, I’ve listened to patient after patient
describe sudden restlessness and insomnia. These are hallmarks of an
overactive or dominant sympathetic nervous system, which drives the
body’s “fight or flight” response. Think of a gladiator preparing for
battle: balling his fists, clenching his jaw. Because of the stress of
coronavirus, the body stays in a battle-ready state of arousal, instead
of resting and recharging. All that tension goes straight to the teeth.

So what can we do?

You’d be surprised how many people are unaware that they’re clenching
and grinding. Even patients who come into the office complaining of
pain and sensitivity are often incredulous when I point it out. “Oh,
no. I don’t grind my teeth,” is a refrain I hear over and over again,
despite the fact that I’m often watching them do it.

Awareness is key. Are your teeth currently touching? Even as you read
this article? If so, that’s a sure sign that you’re doing some damage —
your teeth shouldn’t actually touch throughout the day at all unless
you’re actively eating and chewing your food. Instead, your jaw should
be relaxed, with a bit of space between the teeth when the lips are
closed. Be mindful, and try to stop yourself from grinding when you
catch yourself doing it.

If you have a night guard or retainer, devices that keep the teeth in
proper alignment and prevent grinding, try popping them in during the
day. These appliances provide a physical barrier, absorbing and
dispersing pressure. As I often tell my patients, I’d much rather you
crack a night guard than crack a tooth. Your dentist can custom make a
night guard to assure proper fit.

And since many of us will be continuing to work from home for months,
it is imperative to set up a proper work station. Ideally, when seated,
your shoulders should be over your hips, and your ears should be over
your shoulders. Computer screens should be at eye level; prop up your
monitor or laptop on a box or a stack of books if you don’t have an
adjustable chair or desk.

[27]

The Coronavirus Outbreak ›

Frequently Asked Questions

Updated September 4, 2020
* What are the symptoms of coronavirus?
+ In the beginning, the coronavirus [28]seemed like it was
primarily a respiratory illness — many patients had fever and
chills, were weak and tired, and coughed a lot, though some
people don’t show many symptoms at all. Those who seemed
sickest had pneumonia or acute respiratory distress syndrome
and received supplemental oxygen. By now, doctors have
identified many more symptoms and syndromes. In April, [29]the
C.D.C. added to the list of early signs sore throat, fever,
chills and muscle aches. Gastrointestinal upset, such as
diarrhea and nausea, has also been observed. Another telltale
sign of infection may be a sudden, profound diminution of
one’s [30]sense of smell and taste. Teenagers and young adults
in some cases have developed painful red and purple lesions on
their fingers and toes — nicknamed “Covid toe” — but few other
serious symptoms.
* Why is it safer to spend time together outside?
+ [31]Outdoor gatherings lower risk because wind disperses viral
droplets, and sunlight can kill some of the virus. Open spaces
prevent the virus from building up in concentrated amounts and
being inhaled, which can happen when infected people exhale in
a confined space for long stretches of time, said Dr. Julian
W. Tang, a virologist at the University of Leicester.
* Why does standing six feet away from others help?
+ The coronavirus spreads primarily through droplets from your
mouth and nose, especially when you cough or sneeze. The
C.D.C., one of the organizations using that measure, [32]bases
its recommendation of six feet on the idea that most large
droplets that people expel when they cough or sneeze will fall
to the ground within six feet. But six feet has never been a
magic number that guarantees complete protection. Sneezes, for
instance, can launch droplets a lot farther than six feet,
[33]according to a recent study. It's a rule of thumb: You
should be safest standing six feet apart outside, especially
when it's windy. But keep a mask on at all times, even when
you think you’re far enough apart.
* I have antibodies. Am I now immune?
+ As of right now,[34] that seems likely, for at least several
months. There have been frightening accounts of people
suffering what seems to be a second bout of Covid-19. But
experts say these patients may have a drawn-out course of
infection, with the virus taking a slow toll weeks to months
after initial exposure. People infected with the coronavirus
typically [35]produce immune molecules called antibodies,
which are [36]protective proteins made in response to an
infection[37]. These antibodies may last in the body [38]only
two to three months, which may seem worrisome, but
that’s perfectly normal after an acute infection subsides,
said Dr. Michael Mina, an immunologist at Harvard University.
It may be possible to get the coronavirus again, but it’s
highly unlikely that it would be possible in a short window of
time from initial infection or make people sicker the second
time.
* What are my rights if I am worried about going back to work?
+ Employers have to provide [39]a safe workplace with policies
that protect everyone equally. [40]And if one of your
co-workers tests positive for the coronavirus, the C.D.C. has
said that [41]employers should tell their employees -- without
giving you the sick employee’s name -- that they may have been
exposed to the virus.

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Consider, too, that in our new home offices, it’s not uncommon to roll
out of bed, find a couch, then sit for nine hours a day. Try to mix it
up with some standing, whenever possible, and incorporate more
movement. Use each and every bathroom break, or phone call, as an
opportunity to take more steps, no matter how small your home or
apartment might be.

At the end of the workday, I advise my patients to — excuse the very
technical, medical term here — “wiggle like a fish.” Lie down on the
floor on your back, with your arms extended straight above your head,
and gently wiggle your arms, shoulders, hips and feet from side to
side. The goal is to decompress and elongate the spine, as well as
release and relieve some of that tension and pressure.

If you’ve got a bathtub, consider taking a 20-minute Epsom salt soak in
the evening. Focus on breathing through your nose and relaxing, rather
than thinking about work, scrolling through emails, or contemplating
your kids’ back-to-school schedule (easier said than done, I know).

Then, right before bed, take five minutes to quiet your mind. Close
your eyes, suction your tongue to the roof of your mouth, and breathe
in and out through your nose, in and out through your nose. It’s a
decidedly low-tech solution, but deep breathing is one of the most
effective ways to stimulate the vagus nerve, which controls the body’s
parasympathetic nervous system. A counterpart to the fight or flight
response, the parasympathetic nervous system triggers the body’s “rest
and digest” mechanism, slowing the heart rate, lowering blood pressure,
allowing for more restful, restorative sleep. The more relaxed your
body, the more likely you are to wake up with less tension in the jaw.
That means less grinding at night.

Teeth are naturally brittle, and everyone has tiny fissures in their
teeth from chewing, grinding and everyday use. They can take only so
much trauma before they eventually break. Think of a wall that has a
tiny spider crack that, with weathering, can become bigger and bigger
until it becomes a gaping hole. We want to prevent any added stress
from grinding that could cause these microscopic cracks to propagate
into larger cracks and, ultimately, a catastrophic failure requiring
root canal, a crown or other major dental treatment.

If you haven’t already done so, make an appointment with your dentist.
Stay up on your six-month screening and cleaning schedule.

And if you do nothing else, get a night guard.

Tammy Chen is a prosthodontist and the owner of [42]Central Park Dental
Aesthetics in Midtown Manhattan.

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