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STRESS and It’s Effect on Oral Health! by Charles Wilson D.D.S.T he experts tell us that a certain amount of stress is good. It is only when w exceed our "limit" that it becomes harmful to us. But how do you know that you have reached your limit?Here are two oral health problems that can indicate that you have exceeded your stress "limit". 1. ANUG or Acute Necrotizing Ulcerative Gingivitis is believed to be primarily caused by stress. It was discovered during World War I and was initially called "Trench Mouth" because it occurred among the soldiers in the trenches in the front lines. The tremendous stress on the soldiers combined with poor oral hygiene resulted in this painful gum condition. How do you know if you have it? ANUG is characterized by severe pain in the gums combined with severe bad breath. The classic indicator that it is ANUG is a white membrane on the interdental papilla (the pointed gum area between the teeth). I commonly see this condition in young people during final exams but I have also seen it in older individuals who are going through severe stress. What do you do about it? You should see your dentist immediately for treatment. ANUG that goes unchecked can cause permanent gum damage! Some things you can do in the mean time: 1. reduce your stress however you can (a tall order!) 2. use a cotton swab dipped in hydrogen peroxide to gently swab your gums 3. don’t worry, your dentist can help you make a quick recovery. 2. "TMJ" Syndrome or Temperomandibular Joint Syndrome has been renamed "TMD" or Temperomandibular Dysfunction Syndrome because it commonly does not involve just the joint but also the muscles and tendons around the joint. TMD is most commonly caused by night time clenching and grinding of the teeth during sleep. Many of my patients have a hard time believing that they do this but it’s true! During times of high stress, this night time clenching and grinding becomes very intense and can result in muscle pain and tendonitis around the jaw joint. (Physical trauma can also cause TMD - for example, a severe blow to the chin during a car accident or perhaps extreme jaw opening during wisdom tooth removal). How do you know you have it? TMD can be hard to diagnose but it usually is characterized by headaches or facial pain especially in the morning, difficulty opening your mouth wide, and perhaps pain during chewing. What do you do about it? To be honest with you, there is much controversy about the treatment of TMD. I would compare TMD to lower back pain - and there are many varied treatments for lower back pain; many of which are very controversial. My "conservative" approach is as follows: 1. reduce your stress! (easier said than done...) and try to get more rest, 2. limit your diet to soft foods, 3. do not open wide (even yawning can make it worse), and 4. see a dentist who treats TMD for evaluation. What might the dentist do? I usually start the 3 steps above and see how you do. If your case is severe, sometimes medication is indicated to relax the muscles and/or a device called an Occlusal Splint. This device holds your jaw slightly open in a comfortable position to prevent stress on your joint tissues during sleep and sometimes you might need to wear it during the day. A newly designed occlusal splint called an "NTI Appliance" has been developed. There are two qualities about the NTI Appliance that make it unique: 1) it is very small and easy to wear during sleep and 2) it triggers a natural reflex that tends to limit grinding and clenching during sleep. Is surgery ever indicated as a treatment for TMD? In my opinion, only in the most rare cases is surgery indicated for pain in the jaw joint area. In rare cases, there can be physical damage to the jaw joint similar to what happens to knee joints and arthroscopic surgery is indicated. I do not agree with the use of orthognathic surgery that attempts to change the bite of the patient to solve the problem. Changing the bite to treat TMD is very controversial and I believe should only be done using "non-invasive" or "reversible" procedures. Is orthodontics ever indicated as treatment for TMD? Again, we have entered an area that is very controversial. I see patients every day with terrible bites that have no problem with TMD. And I also see patients who have severe TMD with no significant bite problems. Are orthodontics really going to stop a patient from clenching and grinding their teeth? I know of no reliable scientific studies to support this. My advice to patients is that your motivation in getting braces should be to correct your bite and/or improve your appearance. That way, if your TMD is not cured, you have not wasted your time and money because you still have achieved your goal.
Well I hope this has helped you understand ANUG and TMD. The big key with both of these conditions is to reduce stress because they are our bodies way of telling us that we have exceeded our limit! |
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