Last week I discussed clenching, which is vertical force put on teeth. Grinding or bruxism is lateral (excursive) forces put on teeth that cause teeth to rub together and wear. Both of these are very destructive to teeth, joints, and muscles.

Some people present with symptoms relating to these two issues, but more often than not, people do not have symptoms. We dentists know that patients who present with signs of tooth wear are riskier to treat. Riskier because the “issues” are often times, and maybe even most often, not treated. This is a significant reason for tooth structure breakdown and shorter life-span dental work.

There are many reasons people grind or clench their teeth. Sometimes these problems are preventable with simple lifestyle changes, and other times they need more aggressive treatment because they are coming from the central nervous system. They can also be caused by certain medications.

In today’s world, everyone is being pushed to their limits in just about every aspect that you can imagine. More is demanded with fewer resources and less time. All this becomes a source of stress, anxiety, and even depression for the population as a whole.

This “epidemic” of depression and anxiety spurred the development of newer medications with fewer side effects to help manage these conditions and hence, the SSRIs (selective serotonin reuptake inhibitors) were born in 1988. Since then, recent reports show that the use of the SSRIs (i.e. Paxil, Zoloft, Prozac, Celexa, Effexor, etc.)  has increased more than 400 percent!

Dentists see the signs of clenching and/or grinding of the teeth on a regular basis, and some of it is the result of stress and anxiety. But another factor to keep in mind is that patients are now taking more anti-anxiety and antidepressants than ever before in history. It is often overlooked, but the SSRIs and even some of the SSNRIs (Selective Serotonin Norepinephrine Reuptake Inhibitors) often increase bruxism or clenching and grinding effects at night.

This can lead to an increased frequency of headaches, jaw pain and other symptoms of clenching/grinding. In my own practice, I have seen many patients who have presented with increased frequency and intensity of symptoms shortly after starting on these medications. I have found that sometimes a change in medication or reduction in the dosage with the help of the prescribing medical doctor can help, but sometimes there seems to be little to no effect.

In recent studies, there is support for a theory of how these medications cause an imbalance in the brain, leading to a drug-induced bruxism that sometimes does not go away with a decrease or cessation of the medication and may even require other medications to help alleviate the bruxism.

So, if you are on any of these medications, the next time you see your dentist you should ask if you have any signs of tooth wear. And, by all means, if you are having any symptoms that you do not feel are normal, you should bring those up too.  If your dentist can show you pathological tooth destruction, you might want to keep in mind that not treating the underlying cause may contribute to unwanted future dental issues.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com. You can view all previously written columns at www.jpeterstclairdentistry.com/blog.

Visiting your dentist every six months for cleanings and examinations is one of the main ways to protect your mouth, teeth and gums from bacteria growth and the many problems that come along with it. However, your local dentist says you stand to gain even more from preventive dentistry – it’s an educational opportunity for you as well. As you read on, you’ll discover what questions you should be asking at your next visit so you can maximize your time.

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There are many reasons people get headaches, and many medications and suggestions on how to prevent them. You may have heard that reducing stress in your life can help reduce headaches. Although methods of relaxation are important to get through the stresses of life, it may not be enough to prevent headaches, especially in the subconscious (i.e. sleeping).

Studies have shown a link between tooth grinding, clenching and headaches. For people who grind or clench, the muscles that open and close the jaw can become painful from overuse, causing a range of symptoms from tension to migraine headaches to jaw joint (TMJ) problems to tooth pain.

Bruxing (grinding) and clenching teeth is defined as abnormal tooth contact (parafunction). Ordinarily, teeth are in contact while eating and swallowing, only about 10 to 15 minutes on a daily basis. People who grind or clench their teeth during the day, or while sleeping, can have their teeth in contact for as much as six hours a day or more. Researchers say that one night of grinding is equivalent to 80 days of normal wear.

Clenching can be just as bad, and in some cases worse than grinding. The average person puts about 200 lbs. of force on back molars during function but a person who clenches can put up to 1000 lbs. on the molars. This is a lot of force for the teeth to withstand. Fractured teeth are seen on a regular basis in dental offices due to clenching.

The American Dental Association estimates that 95 % of the American population suffers from a grinding or clenching problem at some point in their lives. Some people do so much damage over time that to restore their teeth back to normal function takes a significant amount of dentistry. The key is early diagnosis and treatment.

Many patients do not realize or refuse to accept the fact that there is a problem. The reason for this is because many, if not most, do not have symptoms. The masticatory system is a very adaptive and forgiving system. This does not automatically mean, however, that there are no signs of problems. With intervention, help can prevent problems in the future.

Therefore, successful therapy starts with acceptance of the pathology present. In addition to behavior modification, nighttime bite splints can be very effective. They should be worn every night, not just when it “seems” like you have been grinding or clenching. There are many types of nightguards for different problems. Over-the-counter appliances are not recommended and can be dangerous to use. Some types of nighttime appliances can be extremely effective in treating people who suffer from headaches due to clenching.

Headaches are only one of the symptoms associated with clenching. Everything from sore muscles, sensitive teeth, worn teeth, broken teeth, and sore joints can be caused by clenching. Ask your dentist whether you have any of the signs associated with grinding or clenching. Treatment can be easy, relatively inexpensive, and save you from potential future problems.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com. You can view all previously written columns at www.jpeterstclairdentistry.com/blog.

In a recent poll I read, people were asked if they would choose a cosmetic makeover, liposuction, facelift, or teeth whitening if money was no object. 52% of those surveyed said they would choose teeth whitening. While there are many ways to whiten teeth, including professionally in the dental office, consumers are spending over $1 billion per year on over-the-counter (OTC) whitening products. People want whiter teeth because it makes them look better.

Almost all whitening products will lighten teeth to a certain extent because they all contain hydrogen peroxide or a derivative. The controlled environment of the dental office and the quality of the materials used usually provides the most predictable and most effective results. If you choose to use OTC products you will just want to be aware of the potential risks, the most common being overuse.

All forms of tooth whitening can have side effects, including gum irritation and sensitive teeth. These side effects are normal and usually subside once the treatment has stopped or shortly thereafter. When your teeth are whitened under a dentist’s supervision, he or she will be able to detect any adverse side effects the bleaching may have and give suggestions to correct. If you choose to whiten on your own, it is best to make your dental team aware of the use of those products to help guide you.

The issue with overusing whitening products is the continuous assault of the pulp or nerve of the tooth through any exposed dentinal or root surface by the bleaching gel. If the whitening is causing tooth sensitivity it means the gel is affecting the pulp of the tooth in some way. In the short-term that’s usually not an issue and the pulp recovers.

In my experience it is very rare to see permanent damage done to teeth if the whitening products are used properly. It is important to note that different kinds of teeth require different strengths of bleaching to get the desired result. These different “types” of teeth also have varying levels of sensitivity to the bleaching products.

Teeth belonging to patients 30 and under and teeth that are yellow in appearance, typically take less time to achieve the desired result. These teeth are also the most susceptible to the side effects of bleaching. People with recession are also more susceptible to sensitivity. This group will usually see great results with professional at-home tray whitening in about 2 weeks.

The older and darker teeth are, the more time it takes to lighten them and the less susceptible they are to side effects. For example, I treated a patient with severe staining due to tetracycline medication as a child who was told his teeth would not lighten all that much. He did at-home professionally monitored bleaching every night (or almost) for 9 consecutive months and got amazing results.

There is nothing quite like a bright beautiful smile. The simple process of teeth bleaching can completely change a smile. There are some OTC products that are perfect for some patients as long as the included directions are followed. For those who have more bleach challenged teeth or want more predictable results, professional whitening is advised.

Teeth Whitening makes a great present too!

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com. You can view all previously written columns at www.jpeterstclairdentistry.com/blog.

Despite the generalized notion that people should visit a dentist bi-annually, I am more a proponent of individualized frequency recommendations based on a few factors. We are not all the same; therefore, each of us has our own specific needs.

Results from a recent Gallup-Healthways poll of 355,334 Americans indicate that more than one-third of the population, 34% to be exact, did not visit a dentist last year at all. Over 50% of the population said they visited the dentist one time or less last year.

In a study reported in The New York Times and other major media, a report by the Journal of Dental Research indicates “little evidence supports biannual preventive care for all adults.” Similarly, the headline from HealthDay News read, “Annual Dental Cleaning May be Enough for Some.”

The researchers explored the association between long-term tooth loss and the frequency of preventive dental visits in adults with and without three risk factors for periodontal disease: smoking, diabetes and interleukin-1 genetic variations (regulates immune and inflammatory responses). Subjects were deemed low risk if they had none of these factors.

The data showed that as a group the high-risk patients who had two preventive dental visits lost significantly fewer teeth compared to the high-risk group that had only one preventive dental visit per year. By contrast, there was no difference in tooth loss for the groups at low-risk based on one versus two preventive visits per year. The researchers concluded that individual risk factors should dictate the frequency of cleanings.

The American Dental Association recommends regular dental visits at an interval determined by the patient’s dentist. The patient’s dentist makes an individualized recommendation based on the patient’s health history and current oral health status.

Here are some points that may help you understand the study and the importance of personalized care:

• The key takeaway from this study is that personalized oral care—taking into account your oral and overall health history—is necessary for good dental health.

• The study only looked at tooth extraction and its association with risk factors for gum disease; however, other health conditions can contribute to poor oral health. That’s why personalized dental care is critical to good patient care.

• Personalized treatment plans should be the priority. Recommendations for future dental appointments should be based on what is seen during your examination, your health history, and any concerns you may have about your oral health.

• The American Dental Association’s website at www.mouthhealthy.org has a lot of information on how to take care of your oral health between dental visits.

While there is clearly a segment of the population who can “get away” with visiting a dentist once a year to maintain a healthy mouth, this group is relatively small. 75% of the population has some form of gum disease. Within that group, there are those who should see a dentist/hygienist twice per year, some three times and others four times or more to maintain proper health.

It is up to you and your dentist to have an open conversation about how often you should go. If it has been a while, getting there the first time is step number one.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com. You can view all previously written columns at www.jpeterstclairdentistry.com/blog.

Do your gums bleed when you brush or floss? This isn’t a toothbrush or flossing problem, it’s the first sign of periodontitis. Around 50% of American adults suffer from mild, moderate, or severe periodontal (gum) disease. The first stage of this disease is called gingivitis. Keep reading to learn the differences between gingivitis and periodontitis as well as how a mild health issue like bleeding gums can progress into something much worse.

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