Dentists are uniquely qualified to diagnose, treat, and refer patients for stress-related oral health issues. Anecdotally, during March and April 2020, when dental offices were shut down, my patients started reporting cracked teeth and bruxism.
For example, a patient of mine fractured a second molar shortly after her twin grandchildren began second grade home schooling in April. Even my former college roommate, an accountant, cracked a first molar that had previously received root canal therapy. During Thanksgiving, my adult son reported pain and inflammation on his second molar.
What is happening? As parents and grandparents juggled work, school, and home without boundaries, and learned to Zoom, the rapid changes caused stress. With no outings, no restaurants, and few vacations, stress-related oral conditions increased.
Negative news cycles have added to the stress. I’ve had a big increase in treatment planning for bruxism and parafunction, but that is the tip of the iceberg for coping with pandemic stress. It has an official name, pandemic-related anxiety, which often leads to clenching and grinding teeth and a wide variety of physical issues affecting overall health and wellness.
By the Numbers
Early in 2020, dentists were seeing an increase in cracked teeth, which was reported in The New York Times as early as June 2020 as “an epidemic of cracked teeth.” This increase also was confirmed by the ADA’s Health Policy Institute (HPI).
By September 21, 2020, bruxism, chipped teeth, cracked teeth, and TMJ symptoms had increased more than 50%, according to the HPI’s poll of 3,491 dentists who compared pre-COVID-19 to current patient conditions. Even caries and periodontal disease had increased 26% and 30% respectively, compared to pre-COVID-19 levels.
While a bite guard is often recommended to reduce stress forces on teeth, more can be done to alleviate stress by referring a patient to an appropriate provider.
In our office, we are also seeing increases in some sleep disorders, including sleep disordered breathing, muscle and TMJ pain, facial dermatitis, and other issues, such as the effects of delayed treatment for caries and periodontal disease during the pandemic, especially for high-risk patients.
However, dental professionals can be first responders for these stress-related disorders. They can open up a dialogue with patients about stress-related issues during this unique time. We can probe beyond the cracked tooth to ask if patients are sleeping well, eating well, and exercising routinely.
Teamwork As a Solution
In addition to delayed dentist visits, patients may not be seeing their family physicians, therapists, or social workers during the pandemic. In the event that patients return to their dentists, they can only screen for oral manifestations of pandemic-related anxiety. However, dentists may be in a perfect position to reconnect their patients with their other healthcare providers as well.
By using a dentist-directed, patient-friendly teledentistry solution such as MouthWatch’s TeleDent, dentists can schedule an interdisciplinary consultation. In this virtual session, intraoral camera images and relevant patient records can show a patient’s primary care and mental health provider exactly how their anxiety is manifesting itself in a mutual patient’s mouth.
What’s more, the patient’s extended care team can discuss the stress-related symptoms that the dentist has diagnosed and is treating within his or her scope of practice. During the consultation, providers can develop a stepwise multi-disciplinary treatment plan that potentially includes medical care, any pharmaceutical needs, and/or counseling.
It should be noted that the patient can also be engaged in this consultation to ensure compliance and prevent additional anxiety-related symptoms. In short, teledentistry enables providers to work toward better outcomes as a team effort in health care, with the dentist and other appropriate healthcare providers ensuring a trifecta of better oral, systemic, and mental health outcomes.
Dr. Scarlett is an infectious and chronic disease prevention specialist, practicing dentist, and author. For 30 years, she has provided expert guidance on infectious diseases and infection control as a consultant to the CDC, the World Health Organization, the Pan American Health Organization, the United States Agency for International Development, the American Red Cross, and many consumer health companies. Retired from the US Public Health Service as a CAPTAIN (0-6) after more than 20 years of service, including two years in the US Army Dental Corps, she proudly served as a disease detective/epidemiologist at the CDC. During the Ebola outbreak of 2014-2015, she provided expert infection control guidance and training for the CDC to health workers and Public Health Service officers deployed to West Africa. Since 2005, she has been providing expertise and leadership to the CDC on pandemic preparedness and response, working with the CDC’s emergency operations center, various CDC centers and institutes, and various private and public sector partners to mitigate epidemic impact on daily life and workplaces. She can be reached at mscarlett@scarlettconsulting.com and (404) 808-9980.
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