Getting Mouthy, Pt 1: Teeth Grinding and Your Voice
Some of you may not know this, but since 2009, I have dealt with a variety of health issues related to stress. For the next month, I will be re-sharing several published articles about my journey.
The first installment is from an article dated October 2011, when my teeth grinding reached an all-time distress level…..
“Why do you have a lisp?” “What is wrong with your teeth?” “How come the shape of your face looks different?” These are all questions I have come to expect when I bump into a friend, colleague or acquaintance that I have not seen for several years. Because of a device prescribed to me by a dentist to mitigate my nocturnal teeth grinding, I have developed a lisp and the shape of my face has changed. If you grind your teeth at night, then this cautionary tale is for you.
In 2009, my dentist suggested that I start wearing an NTI (Nociceptive Trigeminal Inhibition Tension Suppression System) to help alleviate my severe teeth grinding, also known as bruxism. The NTI cost $170 and was covered by insurance. My dentist was concerned that I could potentially have long-term nerve damage, and my teeth grinding could also be a contributing factor to my frequent migraines. Habitual teeth grinding can lead to a host of additional health problems including daily jaw pain, tooth loss, gum recession, neck pain, and insomnia. If left untreated, chronic clenching can also cause dental decay, tooth fracture, arthritis of the temporomandibular joints and TMD. For a singer, these are all frightening possibilities. Obviously, I did not hesitate to wear an NTI as my migraines and jaw pain were already negatively affecting my teaching and singing. Little did I know that this was just the beginning of my dental nightmare.
I diligently wore my NTI for two years, making sure that I regularly visited my dentist for check-ups. Initially, I noticed slight changes to my bite, but nothing overly concerning. Then, without warning, I began to observe rapid changes. My teeth were shifting dramatically (I had worn braces in junior high and had perfectly straight teeth), and now my bottom front teeth were crooked.
The next symptom was that when I clenched my teeth, there was a noticeable gap between my upper and lower teeth in the front. From there, my symptoms rapidly deteriorated. All of this occurred within a five-to-six month period and had major implications for my dental health, my speaking voice, and my singing. What the heck? What was going on here? I had never had serious health issues. In fact, I had never even had a cavity.
My next plan of attack was to visit my dentist to find out what was going on with my mouth. His recommendation? Surgery that would entail breaking my jaw in several places, wiring my mouth shut, and a long and painful road to recovery. Now I was REALLY freaking out. How would this impact my voice? How could I continue teaching voice at the university level with my jaw wired shut? I then decided to seek a second opinion. I had no idea that this would lead to nearly ten ‘second opinions.’
Within a month, I consulted ten dentists, orthodontists, and oral surgeons. Each doctor would pass me on to another specialist, as no one had an answer. I often felt like a lab rat as dentists would call their colleagues into the examination room to peer into my mouth in wonderment, exclaiming, “Wow! I have never seen anything like this!” Meanwhile, my concern was mounting into sheer panic as each doctor gave me a new set of recommendations (often conflicting). Proposed solutions? Undergoing major surgery, long-term use of muscle relaxers and anti-inflammatory drugs, wearing braces for eighteen months, extracting my posterior molars, bonding my teeth, and/or installing TADS (Temporary Anchorage Device System). I was subjected to every evaluation method possible- in-depth exams, detailed measurements of my malocclusion, molds, x-rays, and even a CT scan.
What they did all agree upon was that my problem was serious, that something had to be done to restore occlusion and to re-establish a comfortable jaw position, and that most NTI users do not experience such drastic side effects. Lucky me, I was the exception. They also concurred that my teeth in the back of my mouth had erupted, meaning that my upper teeth had actually extended down in order to meet my lower teeth when I was still wearing the NTI device. This meant that while wearing the NTI at night, my teeth were still grinding away. I now had a visible gap between my upper and lower teeth in the front when I clenched my teeth in the back, also referred to as an anterior open-bite. My malocclusion was so severe that when I clenched my teeth in the back, there was enough open space in the front so that I could actually stick out my tongue through the open gap.
Meanwhile, I was experiencing a wide array of side effects. The immediate issues included a pronounced lisp, tongue thrusting, and difficulty eating. Taking a bite of pizza was impossible. Cosmetic problems were that I now had crooked teeth and the shape of my face had changed. My jaw was so misaligned that my face went from being round and symmetrical to being oblong and asymmetrical. I even noticed that on the left side of my face, my upper jaw-bone was protruding. I made this disturbing discovery while demonstrating a concept to a student during a voice lesson.
The experts I consulted discovered even more startling issues, including possible degenerate joint disease, unstable jaw joints, and my breathing airway was open to only 15% capacity. Long-term implications were that I could experience tooth loss, gum disease and arthritis.
And what about the effects on singing? I began to experience severe pain after teaching and singing. My lisp was embarrassing, especially when standing in front of a room of twenty-five students while teaching undergraduate vocal pedagogy. My lisp even affected my diction while singing until I stood in front of the mirror for hours on end, observing my tongue movements during vocalizes. Eventually I was able to train my tongue back to a more natural position.
Many dentists I consulted were extremely accommodating, meeting me during the holiday season when their offices were closed, and some did not even charge me for their consultation. It was an emotional roller coaster. I had never even had a cavity in my entire life and had already had braces as a kid. Before this debacle, my teeth were perfectly straight. The most disturbing part was seeing each new doctor and coming away without any concrete answers or solutions. Was I going to have to live with this pain forever? How could I continue on as a professional voice user?
Eventually I was fitted with a $600 flat-plane-splint, which is an unwieldy, unattractive and uncomfortable device that covers all of my upper teeth. It is even difficult to speak once it is lodged in my mouth. Although it is a much more expensive device than the NTI and was only partially covered by insurance, it covers the entire region of my mouth, so teeth grinding becomes impossible. It helps mitigate pain, but it will not solve the gap between my upper and lower teeth or my misaligned jaw. I will have to wear this device every single night for the rest of my life.
The lesson to be learned from my horrible experience? Several!
ALWAYS get a second opinion. As singers, we implicitly trust our voice teachers to help grow and nurture our voices, as they are experts in their perspective field. Similarly, I trusted my dentist whole-heartedly as an expert. I will not be so naïve next time.
Conduct your own research. Although a flat-plane-splint was the best short-term option, there were numerous remedies available such as biofeedback, hypnosis, stress management, and relaxation therapy, none of which any of the experts I consulted suggested.
The most important lesson? Do not cut corners with costs when it comes to your dental health. The short-term savings can equal long-term vocal problems. Although you can purchase an inexpensive night guard at the grocery store, the possible side effects do not outweigh the financial savings.
Chronic pain when you sing is not worth any amount of money saved.