The Daily Grind – for the nth time.

An article in the London Evening Standard about the character Carrie Mathison in Homeland made me think.

Firstly. About the incidence of pain in teeth, face and head that can be related to over active muscles of mastication and bruxism.

I learnt a huge amount about occlusion during the last recession in the late 80s / early 90s. Stress was widespread, its manifestations affecting thousands. It’s greater now. A significant proportion of the patients who attended my relatively new practice were suffering. A fresh graduate of the Stockport Dental Seminars programme and full of enthusiasm with my new qualification to join the British Society for Occlusal Studies, I was looking for the signs and symptoms. I have no idea of the number of Tanner and Michigan appliances I made during that period but probably well into the hundreds. The relief I provided was fantastic, the feedback wonderful and I can honestly say that occlusion along with perio and prevention were the rocks of my successful practice.

Secondly. I recall how many of my contemporaries reckoned that what I was doing was outside the scope of a GDP and that the “occlusionists” (their term not mine) were close to being charlatans. They were the ones whose patients were smashing their restorations, going to their GPs with headaches and musculo-skeletal pain.

Finally. How many dentists are still not routinely looking for the evidence of occlusal disease, still don’t ask the question in their medical / dental examination and are therefore missing a huge opportunity to do more to help their patients and subsequently do more for their bottom line.

Hey, but what do I know?

Answer: Loads – and thanks to the web so do the patients.

Here’s the piece in its entirety:

Homeland’s Carrie provides a bit of a reality check for the average Londoner who reckons they’re stressed. Where most of us get annoyed at the screwed-up Tube and Nigel Farage, in this week’s episode Carrie was running the CIA’s Kabul office, had just sanctioned a drone strike and was super-angsty about her newborn baby daughter being thousands of miles away in the US. But when tense Carrie went to bed she popped an Ambien, slurped a large glass of white wine then slipped on an anti-grinding mouthguard to keep her teeth in one piece.

And in her mouth kit at least, Carrie’s got something in common with a lot of modern working women. Both the British Dental Association and the advisers who run the phoneline at the British Dental Health Foundation report an increase in calls about “bruxism”, or what those not sporting scrubs call “teeth-grinding”, as the stresses of City life invade people’s jaws at night. Some dentists reckon it affects as many as one in 10 Britons, whose sleeping hours are spent clenching or grinding their teeth, triggering headaches and shooting pains in the morning as, long-term, their teeth start to wear down.

“When I first went to my dentist I was certain I had a massive abscess on my back molar as the pain was so bad,” admits one high-flying executive and mother. “But my dentist found there was no decay at all. It started taking over my whole head and giving me a shattering, stomach-churning pain that meant I could hardly talk sometimes. It was affecting me all day, for months on end. Soon it became obvious that the pain got worse when work was stressy, then went away when I was on holiday. So my dentist [David Cook at Wimpole Street’s London Holistic Dental Centre] fitted me with a night brace.”

The contraption cost £1,000 “and it’s seriously not sexy — it makes you feel like an old lady putting in her false teeth,” the grinding-sufferer adds. But it’s working. “In the past few months I’ve only had one headache — after I forgot to put it in.”

Teeth-grinding is an increasingly common problem — and not just among women. “In the past 12 months we’ve treated more men with anti-grinding mouthguards than women,” says James Goolnik, who runs the Bow Lane Dental Group, near Bank, whose patients include Jimmy Carr (who’s not a grinder). “Women are better at recognising the signs of stress and dealing with it than men, who just deal with the symptoms rather than the underlying cause.”While some sufferers use a mouthguard like those of rugby players, Katie, a PR from West Hampstead, opted for the scarier sounding mandibular advancement device (MAD): two plastic plates, held together by a screw, that stop the teeth from meeting. “It’s basically another form of contraception,” she says. “It makes me dribble, smells in the morning and looks ridiculous. But anything was better than how I used to feel after a night of teeth-grinding.”

It’s not just molars that are affected. “There is a direct correlation between having a good even bite and getting neck and shoulder pain,” adds Goolnik. “If your bite is uneven it can throw off your jaw muscles and then, in turn, your neck and shoulders.”

Still, it can take grinders a long time to actually visit the dentist about their problem. “I’ve been grinding my teeth for years but recently began waking with a very painful jaw,” a thirtysomething Londoner explains. “The solution was a delightful mouth guard. My husband banned me speaking with it in because he finds it so vile.”

For some, that bedtime look is just a step too far. “Some patients do not want to wear a night guard while they sleep so the latest treatment for grinding is to inject the grinding muscles with Botox,” adds Goolnik. “It reduces their strength and lessens the grinding.”

Hypnotherapy is another option. “One study reviewed the long-term effects of hypnosis and a positive outcome was still applicable even after 36 months,” says a spokesman for the Bruxism Association. Tackling the cause of the stress is another solution — but one that Homeland’s Carrie and a lot of Londoners might find impossible.

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