New York dentist says tooth fractures are on the rise during the pandemic

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Dr. Tammy Chen says she's seen more tooth fractures in the last six weeks than in the previous six years combined, and it's a problem that can't be brushed aside.

Chen is a prosthodontist, a dentist who focuses on the restoration and replacement of teeth, and the owner of Central Park Dental Aesthetics in New York City.

She wrote in the New York Times on Tuesday that she believes pandemic-related stress is damaging people's oral health. Here is part of her conversation with As It Happens host Carol Off. 

Dr. Chen, at what point during this pandemic did you notice that you were getting different types of calls, or more types of calls in certain ways, than you were getting from before?

So in New York City, we got shut down about middle of March. And I would say by the end of March, I was already getting a definitive increase of "My jaw is hurting," "My teeth are hurting," "I broke a tooth from the clenching and grinding."

And you've said in your piece that you've seen, in the last six weeks, more tooth fractures in the previous six years.

That is correct. Unfortunately, it's been a very stressful time. You know, New York is still under a lot of uncertainty and patients are just very stressed out. When I watch them, when they're speaking to me, they're just clenching and grinding while talking.

And I mention to them, "You're clenching right now."

And patients will tell me, "I just can't stop. I don't know where my kids are going to be for school. I don't know what's going to happen with my job."

It's the definite uptick of what we're seeing in that clenching and grinding leading to fractures. I, unfortunately, have not come to work one day and not seen a fracture.

So you're seeing the clenching, the grinding, that people have jaw pain. What else?

We're seeing an increase of the inflammation in the gums, because you're putting so much pressure on the teeth. It's in return bruising the bone and the gums. 

I'm definitely getting patients telling me that they're experiencing a lot more headaches, a lot more migraines.

I'm having more patients on some of the migraine meds and some of the anti-anxiety meds ... to help with, you know, some of their stress and anxiety, which in return can cause a dry mouth and can cause other problems in the mouth as well.

So it is, unfortunately, just an uncertain time and people are showing it in so many different ways.

[Canadian Dental Association spokesperson Aaron Burry told CTV] ... they haven't seen a relationship, a definitive relationship, between teeth grinding and stress. ... What would you say to that?

I would say that that's going to be a difficult thing for anybody to ever prove that there's a definitive relationship. But I think that from anecdotal [evidence] amongst my colleagues and from my patients, what we're seeing is people are stressed out and that they are grinding.

Dentists in Canada with whom we've spoken, they say they haven't seen an increase in fractured teeth. But Manhattan and New York has been particularly hard hit by this pandemic. Why do you think that, perhaps, you are seeing more fractures where you are?

That's hard for me to say. I will say I have received numerous e-mails from a couple Canadian dentists that are actually quoting the same things. I think it is just geographically which areas just got hit the [hardest].

I have some colleagues that maybe practice in a little more rural areas and in the middle of the country, and they are not seeing quite the same level of trauma that I'm seeing versus among my colleagues in New York.

And furthermore, in New York, we were not prepared to be a city that works at home. It almost was like overnight, Manhattan just vacated.

People just got told, "OK, you're working from home now." People cobbled together, the best they could, you know, a workstation here or a kitchen stool here to try and put together a workdesk. And ergonomics has a huge toll on our body. [When] we're hunched over kind of into that C shape, you're putting an extra strain because your head is tilted forward and the weight of that head is extra weight for those muscles to then pull. And at the end of the night, when you lay down or go to sleep, those muscles are tired and they will twitch and cause you to clench and grind.

Remember that our teeth should not touch unless you're actively chewing food.- Dr. Tammy Chen, Central Park Dental Aesthetics

You have one part of the anatomy that you're dealing with, but it sounds like you need a team to help people through this. ... The teeth fractures are a symptom, not a cause, right? So how can you help them?

There are some of the home remedies, such as just paying attention to your ergonomics when you are at home, such as your shoulders over your hips, your ears over your shoulders.

If you are working from home, you tend to be more sedentary than if you're in the office. So set an alarm on your phone every, say, 60 minutes, every 100 minutes. You're going to get up and walk around for five minutes, maybe do 20 jumping jacks and like 10 lunges, or whatever it is to kind of just release some of that stress that if you were in an office setting, you would have gone for a walk for a coffee with your colleague or walked down the aisle to another colleague and asked a question instead of sent an email.

On top of that, really trying to be conscious of, you know, your teeth touching during the day. Remember that our teeth should not touch unless you're actively chewing food.

Right. For all of us who are just consciously thinking about whether we're clenching right now as you speak, I'm sure lots of people are feeling that, "Oh yes, that's exactly what's going on in my mouth."

Absolutely. Patients tell me all the time when I tell them, "Your teeth should not touch, except for when you're actively chewing food," they look at me like I have 12 heads. They're like, "My teeth touch all day long."

Some dentists will recommend night guards, which, well, they are expensive. Do you find that people are doing that, or can they actually have that as an option?

I recommended that in the article as well. Anything that you can physically have to separate your teeth. I tell my patients all the time, I'd rather you crack a night guard than crack a tooth. It's much easier and much quicker and much cheaper for me to fix.

I understand that custom-made night guards do tend to be a little more costly, unfortunately.... I would rather something better than nothing. If you have retainers. I've had some people tell me, "I wear my old football guard."

If you can sleep with it, great. It's physical separation that we are looking for. Because while we are sleeping, we cannot consciously think about that tension and grinding.

Written by Sheena Goodyear. Interview produced by Katie Geleff. Q&A has been edited for length and clarity.