2020 has certainly proven to be a stressful year for everyone due to the pandemic. For some, their business will not survive. Others are still able to work, but have been faced with a huge shift in the dynamic of the previous work environment. Similar to the economic collapse that we faced during the recession in 2008-2009, financial strain is playing a huge role in the physical and mental health of people everywhere. As we know, stress can cause excessive clenching or grinding of the dentition (bruxism) and tightening of the cervical masticatory muscles, both of which can lead to Cephalgia.
Numerous studies have shown that there is a definitive association between anxiety/depression and bruxism. In addition to self-reported clenching and grinding, there is also dentist-assessed physical evidence of damage found during routine cleanings and procedures. Occlusal wear, gum recession and tongue indentations are common indicators associated with bruxism.
When patients are clenching/grinding their teeth, they may not even be aware of it. Some have nocturnal bruxism, but many are daytime clenchers.
Masticatory muscles can also tighten as a result of bruxism. Hypertrophy can present, and the masseter and temporalis muscles become tense. A physician will become aware of this during a head and neck exam, as the patient will express pain as a result of the facial muscles being palpated. Areas of pain can include the head, neck, back, shoulders, temples, masseters and pterygoids. In medicine there often are multiple causalities of a diagnosis.
In 2020 I have seen two categories of patients with TMD. 1) Clergy, they love helping their parishioners but those in their flock are stressed, anxious and frustrated causing the Bishop, Minister, Rabbi or Pastor to now also clench or grind more than usual and 2) People who had clenched or ground their teeth for years without pain are now clenching or grinding more causing pain to occur & TMD symptoms.
All of the above-described symptoms can lead to none other than a headache. Approximately 50% of the general population has headaches. Migraine and Tension headaches are the most common types.
The effects of repeated stress may lead to alteration in brain networks both functionally and structurally. As a result the brain responds abnormally to environmental conditions (psychological or physiological). High levels of stress are reported in migraine patients, particularly in those suffering from chronic daily migraine.
Stress-related headaches are also known as Tension headaches. They typically involve both sides of the head, and tightness in the forehead can present itself. Tension headaches are not usually debilitating, and those who experience them will most likely have a few per month at most. Again, during the course of this pandemic, it is very probable that the frequency is much higher.
Chronic stress is one of the most destructive factors for human organisms. There are many ways that we can manage stress. Common recommendations include getting adequate sleep, make sure you are exercising, maintain a healthy diet, eliminate bad habits like smoking, reduce alcohol intake, practice deep breathing and meditation, and if you feel that you are unable to control your stress levels, make sure to talk to your doctor for help.
For any questions on managing stress, and to learn more about stress/tension headaches or bruxism, please visit our website.
References:
Sutin AR, Terracciano A, Ferrucci L, Costa PT Jr. Teeth Grinding: Is Emotional Stability related to Bruxism?. J Res Pers. 2010;44(3):402-405. doi:10.1016/j.jrp.2010.03.006
Gungormus Z, Erciyas K. Evaluation of the relationship between anxiety and depression and bruxism. Journal of International Medical Research. 2009;37:547–550.
Maleki N, Becerra L, Borsook D. Migraine: maladaptive brain responses to stress. Headache. 2012;52 Suppl 2(Suppl 2):102-106. doi:10.1111/j.1526-4610.2012.02241
Shetty S, Pitti V, Satish Babu CL, Surendra Kumar GP, Deepthi BC. Bruxism: a literature review. J Indian Prosthodont Soc. 2010;10(3):141-148. doi:10.1007/s13191-011-0041-5
Sauro KM, Becker WJ. The stress and migraine interaction. Headache. 2009;49(9):1378-1386. doi:10.1111/j.1526-4610.2009.01486
Aguilera SB, Brown L, Perico VA. Aesthetic Treatment of Bruxism. J Clin Aesthet Dermatol. 2017;10(5):49-55.
Ahlberg J, Lobbezoo F, Ahlberg K,et al. Self-reported bruxism mirrors anxiety and stress in adults. Med Oral Patol Oral Cir Bucal. 2013;18(1):e7-e11. Published 2013 Jan 1. doi:10.4317/medoral.18232
