Editorial note: While many people in the UK make it a point of honor to say they never read The Mail, when it comes to its health and femail pages The Mail can be quite astonishing. For some of us who have followed the stories on RxISK linking SSRI use to alcoholism, the Mail’s pages feature an extraordinary parade of women crashing cars and killing others, or divorced by husbands or otherwise ruined because of alcoholism with their antidepressant usage tucked away in the corner of the story. Here the Mail tackles another issue but without mentioning antidepressants.
The single biggest cause the problems outlined here is likely to be antidepressant usage. See SSRIs & Tooth Grinding. There may be other drugs that can do this – let us know if you suspect something you have been on.
Women with bruxism tell of their ordeals
(The original article is here)
- Sue Downes’ upper gum started to swell
- It caused a dull throbbing pain that was impervious to paracetamol
- Her NHS dentist prescribed a protective silicone mouth guard
- Bruxism cost Sue her teeth, destroyed her self-esteem and a relationship
- One in four Britons suffer from bruxism
- Dentist Dr Stephen Pitt says more people are grinding their teeth than ever
- Cheryl Hills, 45, has had Botox
- She has just eight teeth left in her upper jaw
- Tanya Hindes, 36, from Lowestoft, Suffolk would wake up with migraines
By Antonia Hoyle for the Daily Mail
PUBLISHED: 22:57, 5 November 2014 | UPDATED: 06:39, 6 November 2014
Sue
One afternoon in October last year, Sue Downes’ upper gum started to swell, causing a dull throbbing pain that was impervious to paracetamol. The swelling eventually spread to the entire left side of her face until, as Sue says, she looked like the elephant man.
The agony was so great that at 2am the next morning Sue drove to A&E at the West Suffolk Hospital in Bury St Edmunds, where she was diagnosed with an abscess and prescribed antibiotics.
Worse was to come. When the infection in her gum finally cleared a month later, Sue, 57, was told the tooth at the seat of it had to be removed. It was the sixth she had lost, and the cause was the same — teeth grinding.
Sue’s story might sound extreme but she is not alone. One in four Britons suffer from bruxism — the medical term for the condition — and the majority are middle-aged women.
‘More of us are grinding our teeth than ever,’ says dentist Dr Stephen Pitt. ‘I treat more women than men and there seems to be an increase towards the age of menopause, because this is a stressful time for women and tooth grinding is a response to stress. It is an under-diagnosed and debilitating problem that can lead to infection, fractures, tooth loss and even hearing problems.’
For Sue, a learning disability support worker from Sudbury in Suffolk, bruxism has cost her not only her teeth, but destroyed her self-esteem and even a relationship. ‘It has caused me no end of physical and emotional pain. I have dreams of my teeth crumbling but am powerless to stop grinding them,’ she says.
According to research, sufferers grind their teeth while asleep, placing ten times more pressure on them than while eating.
Sue first realised she was doing it in 2004, when she was going through the menopause, but believes losing her mother to cancer, plus a demanding job, compounded the problem.
‘My sleep was fitful and I had night sweats,’ she says. ‘I would wake with headaches and jaw pain. Sometimes I’d even wake myself up by biting my cheek.’
That year, her NHS dentist prescribed a protective silicone mouth guard for her lower jaw, to wear overnight. Yet Sue found she was somehow taking it out in her sleep.
‘When I woke it would be at the bottom of the bed, and there was nothing I could do about it.’ Her teeth began to loosen under the pressure of constantly being compressed into her jaw, weakening the periodontal ligaments that held them into the bone.
By 2008, her back teeth had become too wobbly to save. ‘Each time one was taken out, I was devastated,’ she says. ‘It wasn’t the pain that upset me so much as the prospect of looking prematurely aged, toothless and unattractive.’
But still Sue didn’t stop. ‘I simply started grinding my front teeth. Every morning I noticed they had visibly shifted. I grew terrified of losing them, too.’
In 2009 Sue — who has never married — began seeing Kevin, a publican, now 52. But her grinding habit began to cause problems.
‘He said it sounded like a pneumatic drill, and he’d often leave our bedroom to sleep downstairs. We’d both be irritable through lack of sleep the next day and he’d be angry I’d kept him awake. The problem strained our relationship and we started to row.’
She’s convinced it contributed to their break-up in 2012.
One reason grinding is so damaging is that loosened teeth make it easier for bacteria to get into the gums and cause infections, and in Sue’s case, an abscess.
The tooth Sue subsequently had taken out left a visible gap. To disguise it she was advised to have a bridge fitted — a false tooth attached to its neighbours. But she was told it would cost £1,200. ‘That is money I don’t have,’ she says. ‘But if it gets to the point where I lose my front teeth I will re-mortgage my house to cover the cost of decent replacements.’
Cheryl
Because tooth grinding is often brought on by stress, counselling is recommended to address underlying psychological issues. But the most effective –—and surprising — treatment available is Botox.
Usually associated with eradicating wrinkles, Botox is a purified form of toxic bacterium Clostridium botulinum and works by blocking nerve activity in the muscles, temporarily reducing their activity.
Dentists began using Botox to treat tooth grinding around 2000. Injected into the lower jaw muscles, it relaxes them so that sufferers find it difficult to clench their teeth.
Cheryl Hills, 45, has had Botox. But a tooth grinding habit that she had from a child, but left untreated until eight years ago, means she has just eight teeth left in her upper jaw.
Married to upholsterer Paul, 51, Cheryl started suffering dental problems at the age of 30. ‘It hurt to eat. My gums were sore and grew infected. I developed abscesses and required endless doses of antibiotics,’ she says. ‘All day, every day, I was in constant pain.’
Her back six molars slowly started to fracture. ‘After root-canal treatment failed to save them they had to be taken out,’ says Cheryl, of Manningtree in Essex. ‘It might sound strange but my only emotion on losing them was relief — it meant I was no longer in pain.’
Astonishingly, Cheryl’s NHS dentist never suggested her problems came from tooth grinding.
Throughout her 30s, Cheryl felt huge pressure from her job as a secretary. ‘I’d go home every day worrying about my workload. Clenching my teeth seemed to be an almost automatic response to stress but I had no idea it was causing me harm,’ she says.
Unhappy with her dental treatment, in 2006 Cheryl went to Dr Pitt, who owns The Dental Studio in Colchester.
‘He said all my problems had been caused by tooth grinding,’ recalls Cheryl. ‘I was annoyed nobody had told me this before. Had I known in my 20s before my teeth started suffering the effects of grinding they could have been saved.’
Cheryl — whose missing top teeth were replaced by a partial denture — says a mouth guard she was prescribed did not prevent the grinding entirely, so in 2011 she started having £200 Botox injections every six months.
‘It has been brilliant at stopping me grinding my teeth,’ she says.
Tanya
Unfortunately, it is not just teeth that are at risk, as Tanya Hindes, 36, from Lowestoft, Suffolk, discovered. The joints in her jaw are now so damaged that if she opens her mouth more than an inch they make a cracking sound loud enough to make strangers stare.
A project manager for a market research company, she began grinding her teeth as a child but started suffering the consequences in her 20s.
‘I’d wake up with migraines at least once a month,’ she says. ‘They lasted a couple of hours and made my vision blurry, which meant I couldn’t drive, so I would be late for work. Once, when I was 24, the migraine was so severe I was hospitalised. My NHS dentist said she could see I ground my teeth as they had worn down but I had no idea it was the cause.’
At 30, her jaw started to ache. ‘It was a persistent pain and numbness and as the years passed it grew harder to open my mouth,’ says Tanya, who has three sons with husband Paul, 45, a store manager. ‘I knew I should see somebody about it but life as a working mother was so hectic my health became a low priority.’
Yet when she developed a persistent earache she saw an Ear, Nose and Throat specialist at James Paget University Hospital in Norfolk. He carried out a hearing test and examined Tanya’s jaw before telling her that the pain — along with the migraines — came from tooth grinding.
‘It is common to mistake pain from the jaw as earache as the jaw joints are close to the eardrums,’ says Tanya. ‘I was shocked.’
Dr Pitt explains: ‘The jaw is attached to the skull by a hinge joint. Over the joint where it joins the skull there is a capsule. When that is put under stress through tooth grinding it can cause the capsule to slip over the head of the joint, which is what causes the clicking sound, and, over time, stops people being able to open their jaw fully. In severe cases surgery may be needed.’
Tanya was prescribed anti-inflammatory cream and referred to an orthodontist, who told her to eat pureed food for eight weeks to allow her jaw muscles to relax.
She, too, was prescribed a mouth guard, but it caused her more pain. ‘The first night I wore it the edges rubbed the inside of my gum and ripped open my skin. Luckily, since then my mouth has grown more used to it, and it has helped, but if I’m concentrating at work I still grind,’ says Tanya.
She still suffers from migraines and enamel has started to flake off her damaged molars.
‘I’ve had to cancel the children’s play dates when my head hurts too much and I’d love to be able to eat steak,’ she says. ‘I’d also love to stop grinding my teeth but I don’t know how.’ Something that all too many women wonder, too.
Johanna says
I was under stress, under psych treatment and under the influence of various drugs for several years, but had no sign of tooth-grinding. Then I got put on Venlafaxine (Effexor).
Within a few months I was having my first molar pulled … it had cracked straight down the middle so no root-canal could save it. “You’ve been grinding your teeth at night,” said the dentist. “The wear marks are unmistakable.” I told him I’d been going to dentists since I was a kid, and none had ever told me I grind my teeth. “Well, now you do,” he said.
“Well, now you do” became a sort of theme song for the next two years. Soon I had “migraines” for the first time, with dizziness and vomiting, for which I was served Depakote. Then a new case of “restless legs syndrome”, although only when sleeping. Try Requip! I began clenching my teeth when awake; clenching my fists at times as well. Another molar cracked and had to be pulled. Then another. I began yawning prodigiously, but put that down to the lack of sleep.
Finally a cranky boss with a few issues of his own took me to task for the yawning, which he thought was a sign of disrespect. I mentioned this in passing to my shrink – as an example of all the stress that boss was causing me. He was surprisingly concerned. It turned out this was clearly an Effexor side effect and a sign of worsening “dystonias” along with the tooth-grinding. He showed me a case report about a guy on Effexor who yawned so hard he dislocated his jaw.
He took me off the Effexor. The yawning and tooth-grinding died down, and the so-called migraines disappeared entirely. The symptoms were absolutely drug-related … but without Cranky Boss, I might never have known.
Anne-Marie says
I used to yawn all the time on Paroxetine but not on Citalopram and I used to grind my teeth on both. I have just as it happens been to the dentist today to have two teeth refilled and the dentist commented on a loose tooth to keep an eye on. I know my teeth have weakened considerably since being on medication. The dentist also told me a tooth implant would cost probably around £2000.
Betsy says
It is interesting you mention the yawning, because I have had bouts of yawning on Effexor. I know I have clenched my teeth at night before Effexor because I had gum loss prior which was due to bone loss. Well, after Effexor, I am at 50% bone loss with severe gum recession. I have a mouth guard now, have for a few years, but no dentist prior to this last one recommended one, and I am peeved about that because there’s no getting that bone back! I have been tapering off the Effexor for the last three years, very slowly because I had a very bad protracted withdrawal from trying to come off of it too fast.
Mail Reader says
In my experience, citalopram is the one for bruxism, no doubt about it. Never caused me a problem as far as I know, but is definitely one of the effects. Another definite effect of citalopram is sweating, ridiculous amounts of sweating. Probably the body trying to rid itself, in anyway it can, of the poison which citalopram is. Once you start sweating, you just can’t stop, never known anything like it.
As far as alcohol goes, for me, citalopram was the one that made me drink like a fish. The drug makes you so very sociable, you like everyone and you think everyone likes you and if drinking is your social norm, then consumption and pub attendance goes through the roof, together with the amount of generous rounds you buy for all your new found best friends!
Worryingly, the carefree feeling the drug creates, can wipe out all your usual good sense and even, moral judgement. This for me, among other things, led to habitual drink driving. SSRIs in general, seem to remove one’s impulse control, or natural reserve. This can be a positive thing, but can also be very negative. If circumstances are such that you feel angered towards someone, or you feel tempted by doing something exciting, but immoral, before you know it you’ve just gone on and done it, without a care in the world. The drug is completely mind warping and character warping and getting back to who you were before, is a difficult and quite possibly endless, road.
Johanna says
Both these issues (tooth decay and grinding) are really well-recognized … for street drugs.
Back at the height of the 1990’s “rave” scene, users of Ecstasy were making pacifiers and lollipops a fashion statement. The pops helped with the dry mouth, the pacifiers when you started clenching your teeth. As for crystal meth, the media and law enforcement always talk about “meth mouth” — the rotted, discolored teeth addicts get after awhile.
The same goes for Adderall, the prescription amphetamine combo prescribed for ADHD. Funny how the doctor won’t know about that. But at http://www.quittingadderall.com, one of the first articles they posted was “How to get your teeth fixed in Mexico” (for those who couldn’t afford the work at US prices):
http://quittingadderall.com/by-request-how-to-get-your-teeth-fixed-in-mexico/
Dr. David Healy says
JonathanR1981 @JonathanR1981 19h19 hours ago
@DrDavidHealy I had 2 cracked molars after one year on Celexa. Took it for 10 years, never made the connection.
Professor Helen @MonsterYarn 5h5 hours ago
@Gurdur @DrDavidHealy I’m off to the dentist in an hour to discuss my nocturnal teeth grinding on 100mg Sertraline #SSRI
Bonnie says
1993 – Zoloft RX for FATIGUE, absolutely no depression. It was one of the best times of my life. Severe jaw, head, neck pain and muscle tightness across shoulders, front of neck, sometimes down back. Did not relate to bruxism until several months later.
No idea it was related to Zoloft.
Sought treatment for pain and TMJ. Was treated by several orofacial pain specialists, including Scripps and Cedars Sinai. An orthodontist had me wear both upper and lower splints 24/7 for months to a year. Made my (pHARMa) sales job extremely difficult. Became depressed due to pain.
1995 – Still thinking the pain started in neck and went up to jaw, conclusion drawn that it began with carrying new 12# laptop over shoulder all day for job. Doctor said it would be fraudulent to not file thru Work Comp insurance and the true ugliness began.
Constant appointments w chiros, PT, dentists, neurologists, psychologists, ATTORNEYS and their doctors. Depositions.
1995 – still not aware of SSRI involvement, doctor RX Klonopin qhs for bruxism, but now, 20 years later, I’m stuck on it.
Increasing pain meds over the years until on oxycodone and fentanyl.
Worked until 2001 when I was put on short term medical leave. Despite stellar performance, the company said they could not hold my position and was placed on Involuntary Medical Retirement at age 39. Felt like I was fired and could never work again. I did get significantly better in 2008-10 and almost secured a few positions back in Pharma (still drinking the Koolaid). Became extremely lost, purposeless. My life collapsed, lost many friends, support system (thru work). I never considered that I might not be able to work. No family.
Work comp lawsuit settled in 2004 for ~$70,000. (11 year process) Disability income of half my salary.
2006 – lost house in market collapse, husband lost job. Severe depression led me to seek out Intensive Outpatient Program to try to establish routine, get out of house. BAD choice. They put me on every possible drug combo for “treatment resistant depression” (cold switches) never addressing the psychosocial and career issues.
Continued to get worse with panic attacks upon wakening, uncontrollable crying and anxiety (never had anxiety previously. Situational/event stress only). Realize now it was classic withdrawal.
Hospital claimed that the psych drugs could not work due to interference at mu receptor by pain meds. Pain docs disagreed, have many people on both. Coerced me into detox. CTd oxycodone (1 pill per day), fentanyl, Klonopin upon admission. Could not use Suboxone due to university rule.
I left AMA at 3 days with warning from Medical Director that I’d be dead by 48. (I’m 53)
Went back to regular interventional pain doc who’d treated me for 10 years, never problems w addictive behaviors…had weaned on my own before detox horror. He gave me Suboxone and I was off all opiates in a few weeks. Used CHIRO and acupuncture for pain.
Returned to old psychiatrist (I had moved) who got me stabilized using Vyvanse while on Pristiq. Ss/NRIs never helped me, ever. He admitted they are depressogenic to some people and went the “dopamine ADD” route. It pulled me out of withdrawal/ depression completely. NOT suggesting to anyone!
2010- tapered off Pristiq over 10 months, thinking I didn’t need it w Vyvanse. Not severe immediate withdrawal (panic awakenings, no zaps, good energy and mood). After about 9 months, I lost doctor, was unable to find someone to prescribe Vyvanse and CTd. Crashed into hopelessness, apathy, SI. protracted SNRI withdrawal or Vyvanse..? Prob both?
2012 – got very desperate. Was DX w several AI, endocrine and neuro conditions that appeared upon withdrawal. Hospitalized for bradycardia, pacemaker suggested.
Was given Fetzima by psych. Didn’t take until late 2014. Pulled up heart rate and BP to normal. No change in mood.
About 3 months on 20mg, the bruxism and severe pain kicked it. Nothing is helping.
Consultation w movement disorder self proclaimed “guru” for problems w dopamine system. He suggested botox for TMJ. Mood still very bad (hopeless, akathisia, inability to focus/concentrate, apathy, no purpose) and now more pain and very difficult time tapering Fetzima. I knew better than to ever take another serotonin drug, yet desperation won.
Also, the university doc did genetic testing that showed SERT genetic polymorphism (“oh, youre right, you can’t process SS/NRIs” but still wants me to try). Also, ultrarapid metabolizer at CYP2D6.
Sorry so long. It’s been 22 continuous years on a cocktail.
Teri Zuckerman says
I’m sorry to hear all the problems you’ve had but I identified with a lot of it.. misdiagnosis repeatedly, over a dozen specialists never mind the regular pain, gp, chiros, etc., I’m also an ultrarapid metabolizer, which I thought before testing (most have no caffeine effect). I’ve been grinding since I’ve five, but it wasn’t diagnosed as part of the chronic pain condition (myofascial pain), last month I just had an epiphany when doctors told me it’s not normal to complain about having more pain when you wake I hate sleeping because it’s worse… especially since I take muscle relaxers for a sleep disorder so I’m knocked out instead of sleep walking.. it’s a long story but have you tried the botox for bruxism? I’m looking into it but it’s hard to find the right Dr. I started taking magnesium citrate as well as it has been known to help. best wishes, Teri, NJ
Katie B-T says
I have had to wear a nightguard for years because of intense teeth grinding. I’m also having a problem where 6 six months when I go to the dentist I have a bunch of cavities. I went today and I have 6! The dentist said today she thinks it’s all of the medicine I am on (that I can’t get off of despite tortured trying)–that it’s making my mouth dry and making me more prone to cavitities.
Katie B-T says
Clarification: I go to the dentist every 6 months for cleaning. Today when I went I had 6 cavities and this keeps happening.