The recent COVID-19 pandemic has disrupted everyone's life and dentists are seeing the impact of this on their patients.
During the pandemic, there has been an increase in temporomandibular disorder (TMD) and bruxism. This is believed to be due to increased stress, and variously the result of:
Loss of jobs
Fear of contracting the virus
Working from home, leading to a blur in work-life boundaries and increasing work loads
Loss of socializing
Education of children from home and home schooling
Globally, an increasing number of people have been suffering from anxiety and depression as a result of COVID-19. As a result, more and more doctors are prescribing anti-anxiety medication and anti-depressants. Some populations have been affected more than others, with younger individuals and men being affected the most.
Dentists are now seeing the aftermath - which includes an increase in bruxism and TMD. Stress is a high risk factor for bruxism, with tooth grinding and jaw clenching causing muscle and jaw pain, as well as potentially damaging teeth. Bruxing can occur during the day or at night.
Diagnosing TMD can be challenging, particularly as many patients will attend complaining about their teeth. Indications that their pain is associated with TMD include:
Dental examination and radiographs do not result in findings of any pathology
Patients find it difficult to isolate the source of their pain
The pain is bilateral
Pain increases in the mornings
Pain increases when yawning or opening the mouth wide
Pain is present in the muscles of mastication (i.e., masseter, temporalis, medial and lateral pterygoids)
The patient experiences ear ache which often worsens on chewing
You notice multiple recently fractured teeth or old fillings
There are multiple methods for managing TMD, and multiple options are often needed. What is common among the strategies is that they require time to be effective. There is no quick fix for a patient's symptoms. Management may also require the involvement of multiple disciplines, including dentists, physiotherapists, radiologists, neurologists or even psychiatrists.
Management options for TMD include the following:
Oral appliances - splints. In general, a hard full coverage maxillary splint is recommended to be worn part-time (e.g., during the night for patients that brux at night)
Conservative measures, for example advising a soft diet, cessation of chewing gum, chewing nails or pens and for patients to support their jaw while yawning or opening wide
Physiotherapy to mobilize the joint
Medication - this could be muscle relaxants, anti-inflammatories or even botulinum toxin injections into the affected muscles
Meditation - and supportive measures to manage stress.
As dentists, we can make sure to ask our patients if they have any symptoms of TMD, being mindful that these might have developed over the course of the pandemic. We can then offer solutions to help manage this condition.
For more information on TMD and bruxism during the pandemic, please visit this link to a webinar on this topic.