#1: Anxiety, Oral Health and the Impact of Social Media on Dental Care

July 1, 2024
Dr. Townsend and Dr. Josh Muir discuss the direct and indirect effects of anxiety on oral health, including muscle fatigue, pain, and dental issues. They provided practical tips for alleviating these pains, such as using heat compresses, massage, and reminding oneself of proper teeth alignment. They also touched on the impact of social media on self-esteem and the importance of identifying sources of stress in dental care. Finally, Dr. Josh Muir emphasized the benefits of enhancing smiles through various dental treatments and the significance of collaboration among dentists to provide comprehensive treatment.


Dr. Tanner Townsend 0:00
Well, Dr Muir, we’re back. Thanks for coming back on with us again. So today, let’s talk a little bit about how anxiety kind of affects our oral health as a whole. And I think there’s a couple different routes that we can take with this. We can talk about how our insecurities about our teeth can cause some anxiety, whether we have gaps or spaces or sheep, our teeth aren’t shaped the way we want them to be, but also how just generalized anxiety can deteriorate our oral health with time. So let’s kind of start there, because that’s the more generalized one towards our whole audience. How can anxiety affect our oral health long term?

Dr. Josh Muir 0:39
Yeah, so you know, what a great topic, anxiety is one of those things that affects the majority of people nowadays, at least in the United States, and it starts at a young age. So the more anxiety we have in our lives, it does start to affect our oral health. So for example, clenching, grinding, those sorts of things will break our teeth down, once they start breaking down, then that leads to pain, it leads to dental bills and dental appointments, which increase anxiety. And so it’s just a cycle that continues and continues. What are some of the things you’ve run into?

Dr. Tanner Townsend 1:15
Along with that, I think the clenching and grinding is huge. I think that’s become a way bigger problem in recent years, and we see more cracked teeth because of it. I think in addition to that, we often see more temporomandibular joint issues like jaw issues. When people open and close, they either get locked up or something like that. That is an often a common side effect, or just muscle fatigue. Just up through here, they often get headaches and stuff like that, and they don’t realize that it’s because they’re closing their teeth all the time that they’re getting these muscle spasms and muscle pain. And so that’s, I think, of one of the bigger ones that I’ve even noticed in myself, is when I’m stressed out, I’m constantly closing my mouth and clenching my teeth, and I get all this muscle pain throughout my jaw.

Dr. Josh Muir 1:58
And that’s, that’s probably one of the biggest things. I mean, as we’re, you know, with friends, I rarely hear someone say, Hey, I’m clenching and grinding. But I do hear people say, and friends and family, hey, I’ve got this headache. Oh man, you know, it’s all up here. Well, when we think about those muscles that control our clenches, we’ve got the big one, the temporalis muscle, here, and we’ve got the masseter muscle here, and those work together to squeeze everything like that. And so when you multiply that with the two sides of our head, it pulls across the top. Everything tightens. And that’s what that tension comes from. When we hear about tension headaches, and you know, as far as quality of life, as far as anxiety and stress goes, it’s just again, it’s that snowball. You know, you go to work, you get stressed out, you end up getting a headache. Now that headaches causing more stress, it makes work harder. You go home to family, and you can’t function as a father, as a mother, as a sibling. It’s a struggle.

Dr. Tanner Townsend 3:00
Yeah. So in cases that you’ve seen, when you have patients come in and they you can see the clenching and grinding effects, their teeth are a little bit more worn down, but they also complain to that muscle pain, and they may not even realize the muscle pain because they’ve been living with it for so long. What do you recommend for patients as a treatment? Let’s give our listeners some actionable things that they can do to help alleviate those pains?

Dr. Josh Muir 3:20
Yeah. I mean, the easy answer is really hard to actually do

Dr. Tanner Townsend 3:24

Dr. Josh Muir 3:24
you’ve got to decrease the stress in your life. Okay. Well, how do we do that? You know that that’s on so many different levels, but if you can’t really decrease the stress, then let’s focus on decreasing the tension in the muscles. So number one is it’s a combination of heat, compresses and massage. And so what I like to tell patients is, fill your your bathroom sink up with super hot water, put a wash cloth in it. You’ll dip the washcloth in there. You’re gonna put it across these muscles and hold it there, and then dip it again and hold it. Do that a couple of times, and then you’re just gonna start doing some massage through here. And you can clench down, feel where your muscles bulge, and those are the places you want to massage when you get down to this muscle, I call it milking the muscle, but you’re going to pull that down and stretch out those tightened fibers of the muscle. And if you’ll do that, it’s amazing how much stress it can relieve even, you know, case in point, I had a teacher that came over and she said, Hey, I was out on the playground. I had playground duty, and this kid did something, and I turned and I just kind of barked something back at the kid. And right then, ah, ah, what just happened to my jaw? The muscles cramped up. She said, What can you guys do for that? I said, Well, this is what I want you to do. I want you to do this water thing. I want you to do these massages. And she later said, I just thought that was a wasted appointment. I can’t believe I came to the dental office and this is what they’re telling me to do. But she called us the next day, and she said, guys, I just wanted to tell you how well that worked. I was so mad when I left your office, but it really did work. And so there’s a really good treatment. It doesn’t cost anything to do, and it works really well. Another thing though, a lot of patients, or some patients, don’t get the relief as much as they need to from that massage. And so the next thing is, we can consider Botox. Botox, when used for esthetics, it paralyzes or weakens muscles so that we don’t get these lines across here. Our eyebrows don’t raise as much and they don’t furrow as much on our brow, but when we’re talking about muscle pain, we can weaken these muscles, and weaken these muscles if you can’t stop clenching and grinding, well, let’s weaken the muscles. It’ll decrease the forces. It’ll decrease that tension across here. And that can really help. And then, you know, there are some patients that they’re going to continue their grinding, but what happens is their teeth come together, and they’re catching on the bumps of the teeth, and that, in and of itself, harms the teeth, but it also works these muscles a lot more. And so in those cases, this doesn’t prevent the grinding from taking place, but wear a night guard of some kind, an oral appliance that just allows their teeth on the top to slide across the teeth on the bottom, rather than catch all of the little bumps on the teeth. And by doing that, that can cause some relief as well. So those are a handful of things. What do you want to add to that?

Dr. Tanner Townsend 6:41
I love that. I think all the things that you said are 100% true. And I love the warm compresses. The warm compresses works great for me when I’m having issues. I once had oral facial pain. Expert tell me he reminded me he’s like when we use our teeth, our teeth only touch are only supposed to touch when we eat. It’s the only time our teeth are ever supposed to touch together, but our teeth are constantly touching because we’re stressed. And so sometimes the first thing I’ll tell patients is, hey, check yourself mentally during the day. And if you can catch yourself when you’re not eating food and your teeth are touching, just open up your jaw slightly. That’s the first step, I usually say, and then from there, in addition to the warm compresses, I’ll usually say, hey, let’s do some muscular exercises, like we’re working out your jaw. So I’ll have patients hold wide open, as big as they can for 10 seconds. And I’ll do sets of that, about three to five sets of that great idea, along with opening and closing, opening and closing, as big as they can a set of 10 and or and they’ll do that three to five sets as well, and usually just the exercises along with the massaging and warm compresses, that’ll usually get it to a manageable point. But I know for me and myself, for some reason, that reminding myself that, hey, my teeth aren’t supposed to be touching right now made a really big difference, and that may just be me, but reminding myself, hey, they only are supposed to touch when you chewing food, and that’s like 1% of the time. So…

Dr. Josh Muir 8:11
One, one thing that reminds me of that I see a lot, and this is with myself, but also with patients. People that tend to grind and clench a lot tends to rest their tongue on the roof of their mouth. So if, if you’re watching for that as well, like for me, anytime I feel my tongue gets stuck to the roof of my mouth, you go, okay, hold on. I must be a little bit more stressed right now. I need to try to keep it off of there. May not reduce the stress, but it’ll help with that grinding.

Dr. Tanner Townsend 8:42
So ultimately, what we’re trying to help patients with this is to relieve the stress, the tension they have, and also prevent future dental problems. But another issue we have that’s related to anxiety, that can cause some anxiety is when you have gaps in your teeth, missing teeth, or teeth that are spaced out funny. How have you noticed that in your career be an issue amongst patients?

Dr. Josh Muir 9:07
Yeah, so that’s interesting, because you’re right. We have stress that can cause dental issues, but we also have dental issues that causes stress, yeah. And so again, going back to a young age with a lot of patience. You know, we compare ourselves to social media posts and all of these images of what we see and view as the perfect smile, the perfect face, the perfect nose, ears, haircut and all of that. But then we look in the mirror and we find ourselves with all of these inadequacies, and we judge ourselves very harshly, and it might even be something that we hear when we speak. So we might have a little whistle. We might have some spaces between our teeth. We might have teeth that aren’t shaped perfectly. And so all of those things lead to more stress. Right? And the number one thing is just being aware of where our stress is coming from. If we can figure out where our stress is coming from, then we can decide, is this a stress that I can control? Is it a stress that I can’t control fully, but I can influence one way or the other, or is this a stress that I have no control over at all. Well, the ones we don’t have any control over at all. You know what? Start massaging stuff. Start, you know, do the best you can. The ones we can control though. Let’s talk about that, and if it’s an esthetic concern. Well, I’m not saying that everyone should have every procedure done, but if there’s something that can be done to help improve your quality of life, yeah, let’s at least talk about that. And that’s one of the things that I really value about in our office, doing free consults. You know, if, if someone is just curious about, hey, what are the options for something like this? You know what? Let’s talk it might be veneers. It might be orthodontics, it might be Invisalign, it might be braces, it might be crowns, it might be teeth that are broken down, and it might be a combination of all of those things, including missing teeth. And so let’s talk about it, and with a free console, we can at least go over that, give you your options and at least make a plan. It might be a 10 year plan. You know what? You’re pretty young. Let’s, let’s see how it plays out over the next couple years. You know what? One thing you can do is whiten your teeth, and most of that will come from brushing better. So you actually don’t need treatment from us. You just need to brush better. Or, you know, what don’t drink quite so much coffee. Or when you do drink coffee, switch some water in your mouth and get those dark colors off of your teeth. So there’s a number of things like that that can come up. Another thing is, you know, during a regular hygiene visit, just talk to your hygienist, talk to your dentist. You know, sometimes we’re intimidated to talk to the dentist, talk to the hygienist, they’ll give you their honest opinion about your smile. And they see so many smiles, and so it’s, you know, what a credible source. And you can’t always just talk to your mom or your grandma, because they love you either way, but talk to the hygienist, get that opinion.

Dr. Tanner Townsend 12:20
I love that. I think sometimes we’re a little hypercritical about, Oh, this one tooth is slightly turned this way, or slightly flared this way. My wife did it, like two weeks ago. She came in, she came into our office, she said she needed some new retainers for just to sleep in because she had worn through her old ones. She’s like, this tooth is really flared. But when you look at her tooth compared to other people, it’s beautiful, like her smile is great. And honestly, I wouldn’t go through the process of necessarily changing it. And I love that you said, Hey, talk to the people that are educated in it and see it every day. Because I think sometimes we’re our own worst critics in terms of that. Now back to your point of, hey, come in and let’s get a consult to talk about what our options are. Because a lot of times we don’t really know what the options are. It could just be as simple as brushing better, or it needs to be more extreme, like a full mouth of implants, or let’s do a bunch of veneers. But how have you seen as you change the smile, as you enhance the smile esthetically, it also improves function, or being able to chew and eat better, and the muscles work even better.

Dr. Josh Muir 13:31
Well, when people are finally able to let go of that one big thing that’s concerning them that they’ve carried for 20 or 40 years, or even one year, they relax and at least about their mouth suddenly chewing and function just function better, because they’re not as worried about their teeth. If you’re always worried about your teeth, every time your teeth come together, you’re thinking about the things you don’t like about it. It’s a constant reminder of something bad. Instead of once you get your teeth in a an esthetic position that you like, then when your teeth come together, you’re constantly reminded of everything you went through and this final outcome that has brought you some peace. That’s the cool thing about it. I’ll share a little story. So years ago, my dad decided he wanted Invisalign. And I said, Really, Dad, you want Invisalign? You think you need to move your teeth? And he said, Yeah, I’d like my teeth straightened. I had never noticed here I am a dentist. I’ve looked at my dad’s teeth many times, and I didn’t think anything of it. But it turns out, as I looked back through he was not someone that smiled in Photos Ever, unless he was caught off guard laughing or something. Yeah, and I looked back through this whole wall of family photos over the years, over the decades, and rarely does he smile into his teeth. Well, as it turns out. When he was a young man, he got his side front tooth knocked, and it sat back more than the teeth around it. I never noticed it, probably because he never really smiled. We did Invisalign. We straightened his teeth suddenly, without anything else, he just started smiling. Yeah, he came in and he said, this is, this is pretty neat. People have been asking me, did you whiten your teeth? No, what did you do? Did you have some veneers done? No, all it was, was we straightened a little tooth, and that gave him the confidence and security to start smiling on his own. No one told him to start smiling. He just was able to release those 40 years of stress about those concerns, about that tooth. I mean, you know, personal story with him, but it just shows how much we are, our worst critics. And again, I thought my dad’s smile was fine. He hated it, and he didn’t smile as a result, and now he does. So pretty amazing that way.

Dr. Tanner Townsend 16:06
Yeah, and I don’t think that’s necessarily an uncommon story, though, either

Dr. Josh Muir 16:09

Dr. Tanner Townsend 16:09
in the fact that people have that one little tooth that bugs him, and they’ll hold back, and then that stress of that can be alleviated, whether it’s through ortho, with braces or with veneers or crowns or implants, whatever the case may be, being able to adapt that smile to make it something they’re proud of is a great way to alleviate that stress that could be pent up for multiple years.

Dr. Josh Muir 16:35
We have that patient that we worked on recently who we did one implant on this side where a tooth had been missing for years and years, she had a little mini denture that a partial denture that she wore, but it didn’t quite match, and it was uncomfortable because it covered the roof of her mouth. And then on this side, though, her tooth was really small, and so in that case, no veneers, no orthodontics, no crowns. We just added a little white filling to close the space and make her teeth more symmetrical. And it was she loved. Was awesome. She loved it. And I think it goes back to the best treatment is no treatment. And if no treatment isn’t the option, if that doesn’t solve the problem, then the best treatment is whatever is the least amount of treatment that is going to get the job done in a predictable way, at a predictable price as well. And so that was one of those cases. So my dad’s was a little bit more that was moving the teeth Invisalign. This one was just doing one little filling. And, yeah, pretty amazing. She loved it.

Dr. Tanner Townsend 17:45
Yeah. I think that that is really powerful. The sometimes the best change is just something very simple, and it gets them the smile they want. It fixes it. Well, anything else you’d like to add before we kind of wrap up this section on stress and how stress can affect our oral health?

Dr. Josh Muir 18:02
Yeah, you know, we’re talking about, so far cases where people are still doing well with their teeth. Their teeth may cause stress. Their stress may cause damage to their teeth. But we’re talking about these types of treatments that they just keep their same teeth. But there are a lot of cases where this goes on for many, many years, decades. They start breaking teeth, they lose teeth, and next thing you know, they don’t have teeth to fix and restore. And so that’s when we also see a lot of patients where, all right, we’ve got to somehow start over for you, and that’s where you know, ideally, it’s that hybrid or fixed denture that that screws into the implants. It looks natural, it feels natural. Those are what we call the full mouth makeovers. And this particular patient was excited about that one filling we did, a filling or a crown on a back tooth, or even an implant on a back tooth. Okay, it fills a space. They can chew better. They feel a little bit better by themselves, maybe. But in the end, it’s just it’s on a back tooth. No one really cares, but these big makeover smiles that we do, I mean, those are the incredible ones where we talk about changing quality of life, yeah, and going from not smiling to smiling. I mean, these are people that don’t show their teeth whatsoever. They don’t move their mouth when they talk. And then, you know that amazing thing is, when they hold that mirror, they go, Oh, my word. And we say, do you recognize that guy? Have you had you forgotten who that was? That’s you. You know, that’s your smile. From my side, those are the most rewarding ones. But from the patient’s side, those are the ones that make the biggest life changes.

Dr. Tanner Townsend 19:55

Dr. Josh Muir 19:55
You know, as we talk about stress, as we talk about all of those things. No matter what stage of that progression a person is at, there are answers, and it’s just a matter of taking the time to talk about it and identify is this something that can be controlled or not controlled? If it can be controlled, what are the steps we can take to help it out?

Dr. Tanner Townsend 20:20
Yeah, I love that. I think just reminding us of all of that, of like this is what steps can we control? And then let’s get to the outcome that you want and help you recognize that, hey, that’s a new person, or that’s a new smile, and that’s part of you, so that is it. Thank you guys so much for joining us today.

Dr. Josh Muir 20:42
So Dr Townsend, I was going to tell you too, you know, a lot of times patients, or at least sometimes patients, will need treatment that involves more than just us.

Dr. Tanner Townsend 20:52

Dr. Josh Muir 20:52
I mean, we pride ourselves on doing most cases fully in house, but there are those times where we reach out to the orthodontist and we say, hey, we need your help on this. Yeah, we reach out to the oral surgeon, to the periodontist, to the restorative dentist, to this whole team of dentists to work together to get a particular result.

Dr. Tanner Townsend 21:14

Dr. Josh Muir 21:14
when you do that, how are those cases received?

Dr. Tanner Townsend 21:18
Are you talking by the restoring dentist or the periodontist, or whoever?

Dr. Josh Muir 21:21
maybe both

Dr. Tanner Townsend 21:22
or by the patient?

Dr. Josh Muir 21:22
or by the patient.

Dr. Tanner Townsend 21:23
I think it varies patient to patient, but it depends on how you frame it, I think of if you’re framing it, of, hey, this is takes a team effort, and we’re gonna have to get you across the finish line, but it’s gonna take all of us working together, if we if it’s phrased appropriately, I think it goes comes across really well, both from the patient and from the doctor. Approaching the doctor be like, hey, I need your help with this. I can’t do this portion to the way that the patient deserves. Let’s see how you do and get them to where their portion, where you need to get them. And then I’ll take over from there. So I think making sure it’s as collaborative as possible helps the patient get the best, most comprehensive treatment possible. I don’t know. Have you seen the same thing?

Dr. Josh Muir 22:11
Well, I think it really is a trust factor. I personally, I think patients really appreciate when we tell them, hey, look, I want to do all of treatment, but in this particular circumstance, because of this that I’m going to show you, you need to go see the endodontist. I can do everything else, very predictably, but this procedure, I don’t do often enough, and so I’m going to send you out to have that done. I think it shows that even though patients know, yeah, we do want to do treatment. That’s what we do, and that’s what our livelihood and our families and employees and so on depend on. But just that honesty of, hey, we need to work with the team here, and we’re fortunate to live in an area where we do have a lot of good resources around us. So I think it’s a trust builder, it’s an inconvenience, but it’s a trust builder, and those outcomes can be better in those cases.

Dr. Tanner Townsend 23:07
Heck, you can even share that story of your case today, that you started months ago, that you decided, hey, it needed to go back to the orthodontist to get a little bit more space for the teeth.

Dr. Josh Muir 23:17
Yeah, absolutely.

Dr. Tanner Townsend 23:18
If you would like to share that, feel free.

Dr. Josh Muir 23:20
So, so this patient came in, I had forgotten about that, but he finished his orthodontic treatment. He had his braces taken off. He came in for his implant, but the way the teeth were moved, there really wasn’t enough space for a predictable, long term implant success. And so I said, Look, we can put an implant in, and if, if you want us to, we’re happy to do it. But the best option would be, let’s send you back to the orthodontist. Let’s get braces put back on. We need to space those teeth in a better position so that long term, you’re going to have a better result. And so they did that several months ago. They came in today, and we were able to put the implant in, in a better position and with a better plan than it would have been so…

Dr. Tanner Townsend 24:12
Man, and that’s just a testament to what we just talked about, of like working as a team and that’ll get the best outcome.