With heightened concerns about job security, the cost-of-living crisis, international conflict and climate change, it is unsurprising that anxiety is gripping the UK. 60% of individuals experience at least mild symptoms of anxiety, and 76% experience moderate to high levels of stress.[i]
For dental practitioners, awareness and understanding of the growing prevalence of anxiety and stress is essential because of the oral health impacts it can have: 70% of bruxism occurs because of anxiety or stress.[ii] A major concern is that patients may overlook bruxism as a significant problem because they could be unaware that they are doing it – global sleep bruxism prevalence is 21%.[iii] As bruxism can damage the teeth and any restorations, dental practitioners should identify and help affected patients to reduce their anxiety or stress-induced bruxism.
Anxiety and stress
Anxiety and stress are similar but different. Anxiety is a feeling of apprehension, even dread, for situations that may have no actual threat and is disproportionate to the situation faced.[iv] Stress is a condition or feeling that is experienced when a person believes that they do not have the available resources to meet the demands. Unlike stress, anxiety persists even after the event or situation has passed.iv
It has also been observed that men have higher job stressii whilst anxiety is more common in women.iv Both anxiety and stress can be detrimental to sleep; with medications disrupting how well a patient falls asleep and then stays asleep.[v] An unrelaxed body is also likely to lead to sleep bruxism.[vi]
Winter warning
With the winter months comes a shift in mood, with seasonal depression and the worry of costs leading to anxiety and stress. These expenses include the very high costs of heating the home, purchasing Christmas gifts and, for parents, spending to entertain their children over the holidays. This is why 40% of UK residents believe that financial security would help prevent anxiety.v As such, tooth grinding is more common in the winter months.[vii] Dental practitioners may be able to identify at-risk patients by both an inspection of the teeth and an understanding of the current circumstances, for instance if they have a stressful job.
Anxious angst
Anxious angst Whilst adults are prone to teeth grinding, prevalence of sleep bruxism is at its highest in adolescents, with 15% found to grind their teeth at night.[viii] This number declines with age. Adolescents, the period from 10-19 years old, have many reasons to be anxious or stressed. These could be concerns about their academic performance, how people perceive their image at a new school, college or university, being bullied, or concern about pubescent changes in their body.[ix] Along with other risk factors, such as irregular sleeping patterns, drinking alcohol and substance abuse, these anxieties can cause sleep bruxism.vi
For practitioners, identifying, educating and treating adolescent patients with anxiety and bruxism can be a challenge. It seems unreasonable to expect anxious teenagers to be honest about their worries to a dentist, and it may seem unreasonable to a teenager that a dentist is asking. Moreover, informing anxious patients of tooth wear can give them something more to worry over, potentially worsening the problem. A friendly, warming dental practice with posters or brochures about anxiety can help affected patients feel more comfortable and confident when dealing with it.[x]
Patients with notable signs of bruxism – wear and early cracks on the outer layer of the tooth – should be asked if they are aware of grinding their teeth in the day. If they are not, a follow-up question could ask about any stress around work, school or other life events that could explain sleep bruxism. For patients who admit anxiety and stress, recommend that they find ways to relax before going to sleep, such as breathing exercises or listening to music.vi Keeping a regular bedtime and unwinding beforehand can improve sleep quality and reduce teeth grinding.
Repairing the damage
For some patients, bruxism may have already damaged their teeth, requiring restorative work and a reliable composite bloc. BRILLIANT Crios from COLTENE is an ideal solution for single-tooth restorations in both the anterior and posterior regions. Available in three translucencies and 15 shades, the reinforced composite bloc has superb mechanical properties for a natural bite Its high flexural strength gives restorations a sturdy resistance, helping minimise the damage of any future teeth grinding.
Anxiety and stress are often experienced together, even though they are different. As the leading cause for bruxism, highlighting the impact anxiety and stress can have on the oral health of at-risk patients is crucial. Together, practitioners and patients can loosen the chokehold that anxiety and stress may have over their health.
For more on COLTENE, visit www.coltene.com,
email info.uk@coltene.com or call 0800 254 5115.
[i] Pindar, J. (2022). Anxiety Statistics UK | 2022 Data. [online] Champion Health. Available at: https://championhealth.co.uk/insights/anxiety-statistics/.
[ii] Bruxism.org.uk. (2022). Causes Of Bruxism. [online] Available at: https://www.bruxism.org.uk/causes-of-bruxism.php.
[iii] Zieliński, G., Pająk, A. and Wójcicki, M. (2024). Global Prevalence of Sleep Bruxism and Awake Bruxism in Pediatric and Adult Populations: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine, [online] 13(14), p.4259. doi:https://doi.org/10.3390/jcm13144259.
[iv] Anxiety Uk (2024). About Anxiety. [online] Anxiety UK. Available at: https://www.anxietyuk.org.uk/get-help/about-anxiety-and-anxiety-disorders/.
[v] Mental Health Foundation (2023). Our new research reveals anxiety is gripping the UK as many people suffer in silence and struggle to cope. [online] www.mentalhealth.org.uk. Available at: https://www.mentalhealth.org.uk/about-us/news/new-research-reveals-anxiety-gripping-uk-many-people-struggle-cope.
[vi] NHS (2017). Teeth grinding (bruxism). [online] nhs.uk. Available at: https://www.nhs.uk/conditions/teeth-grinding/.
[vii] Kardeş, S. and Kardeş, E. (2019). Seasonality of bruxism: evidence from Google Trends. Sleep and Breathing, 23(2), pp.695–701. doi:https://doi.org/10.1007/s11325-019-01787-6.
[viii] Sleep Foundation. (n.d.). Bruxism & Sleep – Sleep Disorders. [online] Available at: https://www.sleepfoundation.org/bruxism.
[ix] Miller, C. (2022). How anxiety affects teenagers. [online] Child Mind Institute. Available at: https://childmind.org/article/signs-of-anxiety-in-teenagers/.
[x] Appukuttan, D. (2016). Strategies to manage patients with dental anxiety and dental phobia: literature review. Clinical, Cosmetic and Investigational Dentistry, [online] 8(1), pp.35–50. doi:https://doi.org/10.2147/ccide.s63626.
