Two Main Line Dentists Explain the Rise in Chipped, Cracked Teeth

What’s behind the increase in damaged teeth? We asked Dr. Rohini Bhatia and Dr. David Stall about the bruxism pandemic.

How do we handle our stress? Apparently, we grind our teeth. It’s such a serious condition that there’s a medical term for it: bruxism. Diurnal bruxism is grinding while we’re awake; nocturnal bruxism happens while we’re asleep.

Though the Sleep Foundation notes that diurnal bruxism is more common, nocturnal bruxism can be more damaging, putting up to 250 pounds of force on our teeth. “Those jaw muscles are very, very strong,” says Dr. Rohini Bhatia of Chester County Prosthodontics. “We’re built that way to chew. But if you don’t have food in your mouth, then you’re just chewing your own teeth.”

“We’re seeing people with chipped, fractured teeth. We’re seeing a lot of teeth that are totally shot—beyond repair.” —Dr. Rohini Bhatia

No one grinds their teeth on purpose. “It’s one of those strange human things,” says Dr. David Stall, who practices general dentistry in West Chester. “Maybe our bodies are trying to work things out while we sleep.”

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Even so, bruxism isn’t connected to dreaming. In fact, a 2020 report from the Sleep Foundation showed that most nocturnal sleep bruxism takes place early in the sleep cycle, during the first two stages of non-REM sleep. That said, nocturnal bruxism is difficult to study because it’s a self-reported condition—and because we’re asleep when we do it.

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Teeth grinding may start when we’re young. A Sleep Foundation study showed that sleep bruxism is most common in children, adolescents and young adults. Exact numbers are hard to confirm, but anywhere between 6 and 50 percent of kids grind their teeth while asleep.

Nocturnal bruxism is very common among the pediatric patients that Dr. Benjamin McKee treats at his practice in Wayne. Pre-orthodontics, kids’ teeth don’t always align. “They go through many developmental changes as teeth are coming in and falling out,” says McKee. “Mouths try to self-adjust. That creates grinding.”

Special-needs kids can suffer from severe bruxism; its typical among people with Down syndrome, autism and anxiety. Even allergies can cause grinding. But in most cases, pediatric bruxism doesn’t do a lot of damage, mostly because the teeth aren’t permanent. “If you grind on a baby tooth, it falls out anyway,” McKee says. “I haven’t seen one worn down so far that it abscesses.”

The frequency of bruxism declines as we age. The Sleep Foundation reported that only 8 percent of middle-aged adults and 3 percent of seniors grind their teeth at night. That’s been the case since “la bruxomanie” was identified as a dental term in 1907 by Marie Pietkiewicz. The COVID-19 pandemic changed that.

“Teeth grinding is one of those strange human things. Maybe our bodies are trying to work things out while we sleep.”
—Dr. David Stall

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For the past 15 months, local dentists have seen an epidemic of bruxism in adults of all ages. To be specific, they see the side effects of bruxism. Chipped teeth, broken teeth, jaw pain and neck pain are a few of the results of bruxism. The rise in symptoms corresponds directly to the pandemic. Local dentists report that they started getting emergency phone calls in March 2020.

At the time, dental practices were closed for COVID mitigation. Stall was one of the few dentists treating emergencies. “I got patients from this region and as far away as Delaware and Scranton,” he says.

Patients needed emergency tooth extractions and root canals. “People were breaking their teeth because they were stressed out,” Stall says. “The volume was much, much higher than we normally see on a month-to-month basis.”

Courtesy of Dr. Stall
Courtesy of Dr. Stall

By June, when the state allowed dental practices to reopen, the situation was critical. Since then, it’s improved, but only slightly. “We’re seeing people with chipped, fractured teeth,” Bhatia says. “We’re seeing a lot of teeth that are totally shot—beyond repair. We have to repair or remove them and replace them with implants.”

Some teeth are more susceptible to breaking. Teeth with unrepaired small chips can suffer further damage. Large silver fillings can weaken teeth, as can large cavities. Gum disease opens the door to other dental problems. Stall notes that many of his patients’ conditions worsened during the pandemic. “Those who we normally see every two to three months to maintain the health of their gums were falling apart,” he says.

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Some breaks can be bonded and repaired, while others need crowns or must be removed completely. Because a lot of dental damage is permanent, prevention is the best medicine. Nightguards are an easy, effective treatment method. Many dentists use molds to take impressions in their offices and send them to specialty dental appliance makers.

Kids’ teeth aren’t permanent, so they typically don’t need nightguards. But they can experience jaw discomfort from grinding. Applying warm washcloths or heating pads to cheeks can relax a jaw’s powerful masseter muscles, and oral anti-inflammatories are sometimes deployed. McKee’s most common suggestion: Reduce screen time before bed. “That helps sleep in general for kids and adults,” says McKee.

In adults, some cases of bruxism are so severe that dentists refer patients to physical therapists to improve daytime posture problems that lead to clenched jaws. Cell phones and other devices can make it worse. “It’s about how you hold your head when you hold your phone,” Bhatia says. “Your back is curved and your head is down. If your shoulders are back and your head is erect, there’s not as much pressure on teeth.”

Chiropractors and osteopathic physicians can also help. Stall may even suggest psychological counseling to patients dealing with an avalanche of stress. “The situation has gotten much better,” he says. “People are accepting that we have to live this way for now, and we’re trying to adapt so we can live our lives in healthy ways.”

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