Nicolas Coomber, COLTENE’s National Account & Marketing Manager, explores dental issues created by stress, and tooth wear is one of them.
Tooth wear can cause big problems for patients, so prevention and early interception are needed, alongside ways to treat it without damaging more of the compromised enamel.
It is well understood that non-carious surface loss has a number of causes, some mechanical and others chemical. Cumulative wear and tear of the enamel is to be expected as we get older, but not every cause of wear is age-related other reasons can include stress, poor oral hygiene and diet. The type of tooth wear someone presents with often points to both causes and treatment options.
Treating tooth wear in patients with bruxism (tooth grinding and clenching) is not simple, as there many factors that can complicate the outcome, and they may require anything from a crown to a whole-mouth rehabilitation. Despite the challenges, quality materials, combined with the latest minimally invasive techniques, support predictable outcomes that can, with ongoing care and maintenance, endure.
COLTENE offers a range of products for strong, enduring and beautiful restorations, including BRILLIANT Crios, a reinforced composite bloc that can be used with CAD/CAM solutions and is particularly recommended for bruxist patients as it has exceptional shock absorbing qualities. COLTENE also offers materials for superior bonding and a range of options for single-tooth restorations as well as more complex cases.
But the patient might need more than restorative treatments.
Tooth wear issues
Tooth wear can lead to aesthetic issues, teeth can take on a dull and discoloured look, and this might be what your patients notice first. Teeth might also become shorter as they wear away. Other impacts include pain and/or sensitivity, plus problems with chewing food. Inefficient mastication, as well as being a functional issue, can mean social embarrassment, and excessive wear may cause cracks and fractures, particularly in cases of bruxism.
Bruxism often happens at night, and is a mechanical cause of tooth wear with an established link to stress. It is also linked with some of the medications used to manage stress and depression, such as selective serotonin reuptake inhibitors (SSRIs), it can also be linked sleep disorders (which often, although not always, go hand-in-hand with being in poor psycho-emotional health). So-called recreational drugs can also cause grinding.
Stress has become more widespread among the UK population and a letter to the BMJ earlier this year wrote about “pandemic bruxism”. Dentists, the letter claimed, are seeing an “increase in patients presenting with features of tooth wear attributed to grinding and jaw clenching,” primarily pain and chipped or cracked teeth.
Dental practices across the US have observed the same phenomena, also blaming the rise on coronavirus-induced stress. On top of oral health problems, bruxism can lead to headaches, exacerbating mental tension and stress.
Taking a dental patient’s detailed social history can help to establish if they are suffering from stress. Stress and anxiety can have grave impacts on oral health (and vice versa) because the sufferer is less motivated towards good oral hygiene. Mental issues raised by the pandemic have made the question of the dental practice’s role in supporting mental wellbeing more pertinent.
In years to come we might see practitioners from other disciplines located in the dental practice. Alternative therapies have proved useful, so perhaps dental hygienists and therapists might become trained in their use, helping build greater general knowledge about stress and anxiety, and its impact on oral health. Non-medical interventions will become important for dental teams who want to offer an elevated package of care.
Bruxism might require a mouth guard to be worn at night, to prevent and minimise further damage, alongside supporting the patient with regulating their stress levels. If restorative treatment is required, the patient must be guided to understand their personal role in keeping the outcome stable, especially in avoiding the behaviours that led to the tooth wear in the first place.
Stress-related issues can involve an element of the unknown. Someone who has learned to cope well with stress, and who has kept their grinding and clenching under control, may suddenly find themselves triggered by an unexpected event that sends them back to where they started. They need to be helped to understand that they are on an ongoing journey, with agreed contingency plans in place should the restoration fail.
A patient-focussed, holistic approach is likely to shape the future of dentistry and successfully treating habitual bruxists underlines how crucial it is for dental teams to understand the impact of stress on oral health.
See the original article here: Dental Industry Review