Managing TMD and Bruxism and the COVID-19 pandemic

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

• Uncertainty

• Isolation

• Working from home, leading to a blur in work-life boundaries and increasing work loads

• Financial pressures

• 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.

Signs and symptoms of TMD

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

Managing TMD

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:

1. 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)

2. 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

3. Physiotherapy to mobilize the joint

4. Medication - this could be muscle relaxants, anti-inflammatories or even botulinum toxin injections into the affected muscles

5. 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.