Who can forget January 1st, 2021 when the entire world exclaimed in one unified voice, “Hallelujah! 2020 is over!” OK, maybe not, but most of us were thinking it. Agreeably 2020 was pretty awful, with the COVID pandemic, social unrest, and economic worries making all the headlines. And while it’s good to have 2020 in the rear-view mirror, I have some bad news for you: 2021 wasn’t much better and 2022 isn’t exactly off to a great start.
Recently I wrote an article about bruxism, or clenching and grinding, and how to manage it, from home care techniques to professionally-made custom appliances. I wrote that article because of the increase in bruxism we’re seeing as a profession due to stress. Worn teeth, broken teeth, and noises in the jaw joint are some of the signs and symptoms, but unfortunately these are the end effects. Damage such as this only appears after the bruxism has been going on for a while, and the damage can be expensive to treat and often irreversible.
Fortunately, there are some early signs that can be surprisingly reliable. Just like any early warning sign, they need to be taken in context and are not a guarantee of an underlying dysfunction, nor is their absence a guarantee of health. Here are some simple things you can do right now to see if you might be having an issue.
Any Scouts out there?
With either hand, hold your pinkie down with your thumb and keep the other three fingers lined up against each other (this is the ‘scout sign’ that scout leaders display to get the troop to quiet down, which never works so is followed with a shout of “QUIET!”). Now, with your fingers aligned vertically, open as wide as you can and try to fit your fingers between your front teeth. This technique is a rule of thumb for how wide the jaw should be able to open. Any tension in the joint or muscles will lead to restricted opening and not allow enough room for all three fingers.
This maneuver assumes no prior jaw injury or issues that limit jaw movement. Keep in mind, you should never get to the point of eliciting pain or risking further jaw injury when performing this test. Every jaw movement, whether a measurement test, stretching exercise, or regular function, should remain within the envelope of comfort.
Stick your tongue out
Standing in front of a mirror, stick your tongue out and look at the sides. If you see indentations that run from the back, around the tip, and over to the other side, you are seeing a common sign of bruxism. Clenching and grinding often involves thrusting of the tongue forcefully into the teeth. This thrusting will lead to indentations, called scalloping, that will persist for hours, even days.
Any extra jawbone?
While you’re in front of the mirror, pull your cheeks out and look at the sides of your upper teeth and the gum tissue above. The teeth and gums should form a relatively straight line all the way up; repeat this observation for the lower jaw. However for some people the bone will display a bulged-out appearance.
The bone in your system is not static. Your body will build bone where it is needed, and take it away where it is not. Clenching and grinding creates extra forces on the teeth, which is transferred to the surrounding bone, and the body responds by strengthening the bone to compensate. This extra bony growth in the jaw is called an exostosis and is a fairly common, benign condition. Many people will have these bony growths for no discernible reason, so the important factor here is if the growths are new or getting bigger.
Any of the findings listed here warrant a discussion with your dentist. Growths of any kind in your mouth should be professionally evaluated, and while they are often benign, only your dentist can rule out a more serious condition.
When is your next cleaning appointment?
Think about your upcoming cleaning appointment. (Assuming you have one scheduled. If you don’t, you know what to do. Yes, now.) Think about staying open so the hygienist can get things sparkly and fresh again. How do you feel right now? Is your jaw already starting to ache? Are you thinking of excuses for rescheduling? If your jaw gets sore from being open for a routine cleaning, there is a significant likelihood that clenching or grinding is the culprit.
Believe it or not, many people actually enjoy going to the dentist for a cleaning. If dental visits often lead to jaw soreness, request a ‘mouth prop’ next time you’re in. This simple device keeps your jaw open, allowing you to relax and take the pressure off the muscles and joint.
In my experience, about half of people who clench and grind their teeth are aware of it. I tell my patients that simply recognizing it is 50% of the battle. Just like any health condition, early diagnosis and treatment are critical to a successful outcome. Most people are rightly concerned about the damaging effects of tooth decay, but through clenching and grinding, we can actually cause just as much damage to our dentition as the bacteria in our mouth.
– Dr. McGann