Dealing with the emotional turmoil of high school is hard enough, but when all that angst over exams, friends and dating comes with excruciating jaw pain and hefty dental bills, it's enough to make you gnash your teeth.
For some young people, nighttime tooth-grinding - or sleep bruxism - can go unnoticed for years. It wasn't until a teenaged Tara Nicholls found out she had temporomandibular joint disorder - a painful condition that can cause the jaw to lock up - that she realized she'd been unknowingly clenching her teeth in her sleep, exerting up to 600 pounds of pressure per square inch.
"I store stress in my jaw and shoulders, and I was a very studious, serious teen," says the 31-year-old librarian and competitive cyclist in Toronto.
There aren't hard statistics, but rising teen anxiety levels, combined with dietary factors and a greater desire for a perfect smile, have led some dentists to report that more of their young patients are wearing night guards - moulded plastic bite plates that fit over the top teeth.
"I'm prescribing more night guards today than in the eighties and nineties," says Clive Friedman, a London-based pediatric dentist who has been practising for 30 years. "A big concern is the amount of juice, pop and Gatorade that kids are drinking these days. Bruxism and acid wear together can be a double whammy."
Getting to the root of the cause -often, it's anxiety - is a more effective solution for bruxism, but a complicated one as Canadians' stress levels continue to rise. Doctor's visits for depression and anxiety doubled from 1994 to 2004, while 6.5 per cent of Canadian youths aged 15 to 24 reported experiencing depression in the past year, according to Statistics Canada's 2006 Community Health Survey on Mental Health and Well-Being.
"The trick would be to recognize the source of the stress, and deal with it," says Euan Swan, program manager for the Canadian Dental Association. "Whether it's through exercise, meditation, or something else, the biggest way to relieve bruxism is to reduce your stress level."
Bruxism is a common condition that 95 per cent of adults experience at one time or another. About 8 per cent of adults and 13 per cent of children are chronic sufferers, according to the Canadian Sleep Society.
Dental Services Group, which supplies dental appliances in the Toronto area, makes about 5,000 custom-moulded night guards a year for 300 dental practices. The materials vary, says manager Andre Dagenais, from thermoplastics to harder acrylics. Some patients use the same night guard for years, while others need frequent replacements. "For one patient, we make two new guards at a time every 10 months," Mr. Dagenais says. "Imagine two saws rubbing together - that's how badly their teeth grind." Telltale worn patches on the back molars caused by bruxism are usually first discovered by a dentist during a routine check-up, and morning headaches are a common tip-off. Lifelong grinders often start young.
Pediatric dentist Barry Rubinoff, whose two Toronto practices juggle about 5,000 patients from the age of 1 through university, says he's had night guards made for children as young as 6 or 7, though that's relatively rare. He typically charges about $400 per appliance. "You'll sometimes see bruxism in kids whose parents are going through a separation or divorce," Dr. Rubinoff says. "Some parents will tell me they're surprised that their child is grinding his or her teeth, even if mom and dad are both bruxers."
Scientists aren't sure how exactly stress leads to bruxism, though the powerful muscles in the jaw are linked to the nervous system's fight-or-flight response. During sleep, the body's normal inhibitions are switched off, and while bruxing, the jaw can exert as much as 10 times the normal force registered while chewing, which explains the harrowing, nails-on-chalkboard sound that can wake other family members.
"It's a stress-releasing mechanism, whether the cause is physical or psychological," Dr. Rubinoff says. Young kids who've had a rough day on the playground, digestive issues or growing pains will often grind their teeth at night, though most outgrow it without much ill effect once they lose their baby teeth.
But special-needs children, especially those with autistic spectrum disorders, Down syndrome and cerebral palsy, can be ferocious grinders. "Children with autism tend to create rituals to self-regulate," says Sylvia Sikakane, program director for the Geneva Centre for Autism. "They might grind because something isn't feeling right, but they can't express it."
For other kids, malocclusion, or misalignment of the upper and lower teeth, can also be a culprit, requiring orthodontic intervention. "Dentists will look at the way the teeth come together, and if the bite contacts one tooth more than the others, that can lead to grinding and pain," says Dr. Swan.
The few who carry the bruxing habit into adulthood are at risk for chronic jaw pain, increased sensitivity from worn-down enamel, and even cracked teeth. By middle age, some sufferers require full mouth restorations. Luckily, more conservative treatments are available if the problem is caught early, like glass ionomer cement applied to eroded teeth.
Ms. Nicholls got her first night guard custom-made by a dental lab, whose costs can run from about $350 into the thousands. For many, it's a sleepwear essential that can be a constant through changing schools, cities, jobs and marital status. "When I travel, I always make sure I have my night guard in my carry-on bag - it's pretty much irreplaceable," Ms. Nicholls says. "I can't really sleep well without it."
Special to The Globe and Mail