Dr. Marissa Ryan, a dentist in South Portland, says she is seeing more patients reporting cracked teeth and other dental problems resulting from an increase in stress during the pandemic. Ben McCanna/Staff Photographer
That cracked tooth? Turns out the pandemic could be the cause of that, too.
Dentists nationally and in Maine have seen an increase in oral health problems caused by stress during the COVID-19 pandemic. More than half of those who participated in an American Dental Association survey this fall reported an increase in grinding, chipped or broken teeth, and jaw pain in their patients.
“We all carry stress differently,” said Dr. Brad Rand, who practices in Brewer. “One of the ways people carry stress is certainly in the mouth and in the jaw.”
Maine shut down dental offices except for emergencies for two months at the start of the pandemic. The state was one of the last to allow routine care to resume in May, and dentists said that gap would cause oral health to decline, turning minor fillings into more involved root canals or worse. Some providers said they were not surprised to see more signs of bruxism, or teeth grinding, when patients returned.
Dr. Marissa Ryan, who has an office in South Portland, said patients don’t always realize there is a problem because they are grinding subconsciously or even in their sleep.
“A patient will come in, and they’ll have a broken tooth,” Ryan said. “They’ll say, ‘I wasn’t eating anything hard, but all of a sudden, it broke.’ It wasn’t the scrambled eggs that caused it to break. It was most likely grinding at night.”
Patients also complain of an increase in headaches, soreness in their jaw joints or even sensitivity to cold in their teeth. Dentists worry that the pandemic might prevent people with those warning signs or even more severe pain from scheduling an appointment. But such problems are more likely to get worse than better, they said.
The American Dental Association has also surveyed dentists weekly on their patient volume, and more than 65 percent of those who responded said they were seeing fewer people than usual at the end of November, a dip from the traffic they had over the summer. Local providers detailed safety precautions – COVID-19 screening, changes to their usual procedures to reduce droplets from patients’ mouths, upgrades to air filtration systems – that they said should make people feel comfortable coming into the office.
“Avoiding dental care, basic preventative dental care, is not something I could recommend for someone to do,” said Dr. Jonathan Shenkin, who practices in Augusta. “It’s more important now than ever to make sure you’re taking care of your oral health.”
For some patients, just being aware of the source of their discomfort can help. Others need a mouth guard or similar appliance to prevent night grinding. And people who have tooth damage could need fillings or root canals – or they could lose a tooth entirely.
“If you have a cracked tooth, the crack is never going to get smaller,” Rand said.
Dr. Todd Ray, who practices at Love Dental Arts in South Portland and serves on the Maine Board of Dental Practice, said he’s been seeing a lot more fractured and chipped teeth, crowns and bridges. He believes the stress of the pandemic, along with political and social issues in the country this year, have contributed to that increase.
“Everyone’s lives are affected and there’s a lot of unknowns,” he said. “People are reporting they are a lot more stressed out.”
Patients say they find themselves clenching their jaws more, and some say their jaws clench even harder when they wear masks, Ray said.
During the eight-week shutdown, Ray could only see patients who were experiencing an urgent or emergency dental issue and he had to turn away five out of six patients who called. All but 10 to 15 percent of his patients have resumed dental visits since spring, but some are still delaying appointments until COVID-19 case numbers go down.
Ray said he encourages people to maintain good oral health as part of an overall strategy to maintain a healthy immune system that can fight off viruses. And people shouldn’t worry about going to dental offices, which have been dealing with viruses and handling aerosols for decades, he said.
“Patients should feel safe if their office is following protocols,” he said. “It should be very safe to go to your dentist.”
Dentists who work primarily with children aren’t seeing the same trends. But they did report an increase in untreated decay in their younger patients, a consequence of missed checkups and fluoride treatments. Some parents are afraid to bring their children into the office, while others can’t afford to miss work or pay for dental care right now.
“Dental decay, especially in a small child’s mouth, can get very big very fast,” said Dr. Norma Desjardins, the executive director of St. Apollonia Dental Clinic in Presque Isle. “We would want to reinforce our message of prevention and the importance of having checkups.”
Desjardins also recommended that parents examine their children’s teeth and keep an eye out for signs of pain when they eat. And dentists for both adults and children recommended calling with any questions, even if a patient isn’t sure they feel comfortable with an office appointment.
“It’s hard to tell patients to reduce their stress,” Ryan said. “That’s difficult right now.”
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