Beth Mason was having routine repairs on a crown when her dentist noticed that she had nerve damage on another tooth.
Unbeknown to her, it turned out Ms Mason had been grinding her teeth in her sleep — a behaviour known as "bruxing" by dentists.
It was the first time a dentist had picked up on it — but the damage had already been done.
She had a gold crown put on the damaged tooth and was sent home with a splint to wear at night to prevent further problems.
"They said it's really normal for people that grind their teeth because gold is more malleable than a ceramic crown," Ms Mason said.
She said the splint had been "brilliant" but was not without its challenges.
"I feel like it's not something that people talk about openly," Ms Mason said.
"It's quite bulky and it makes me feel like a teenager wearing my retainer."
Ms Mason, a teacher, said it was difficult to treat the issue because she was oblivious to grinding her teeth.
"I have a stressful job and it's a weird thing — you can't cure it and you subconsciously do it," she said.
"Even if I go to have an hour nap in the afternoon, I've got to put it in or else I'm going to wake up and my teeth will be sore."
The cost of the splint was not covered by Ms Mason's private health insurance.
"That probably puts off a lot of people too who need one [because] it's just not included in basic dental cover," she said.
Not always about stress
Patients with teeth-grinding-related issues increased at Christine Farrelly's Sunshine Coast dental practice ahead of the festive period.
A rise in the condition has been noted internationally, according to Scott Davis, the vice president of the Australian Dental Association.
"We believe it may very well be associated with increased stress and anxiety because of the pandemic, financial situations, job security and all of those factors," he said.
The condition could also be exacerbated by alcohol, caffeine and smoking, Dr Davis said.
Dr Farrelly says teeth grinding has many contributing factors.
"It has a neurological aspect and obviously a mental health aspect — a stress aspect — and also an anatomical and genetic aspect," Dr Farrelly said.
"It's often the people who have the most sunny disposition that are happy.
"They're like: 'I'm not stressed, I'm not overworked' but you can see it in their mouths."
While common, grinding or clenching is a problematic, multifaceted issue that requires individualised solutions, Dr Farrelly said.
"It's tricky and sometimes you don't even know there's a problem until you break a tooth off or get a toothache from grinding the enamel off your teeth," she said.
"Sometimes we can say, 'Yes, we can fix this for you' and sometimes it needs a neurologist or a chiropractor, or physiotherapist."
Can botox help?
While a night guard or splint could help prevent damage from grinding teeth, Dr Farrelly said it might not address the root of the problem.
"The analogy that an ENT (Ear, Nose and Throat specialist) once told me is it's like someone is smashing their head against the wall, and your treatment is to give them a helmet," she said,
"You're limiting the damage, but you're not working out why they're doing that."
Some of Dr Farrelly's patients turned to botox injections in their jaw muscles.
"Botox is a big thing that a lot of people have been sort of developing as a new treatment for bruxing or grinding your teeth, but it definitely doesn't work for everyone," she said.
"The dosage required for grinding your teeth is quite a lot and you can get recruitment of other muscles — your jaw is very smart."
Knowing the best way to treat the condition has been a work in progress for dentists over the decades, Dr Davis said.
"Even from the early 1960s, there have been endless attempts to determine what types of treatment can reduce or treat, sleep and daytime bruxing or bruxism," he said.
"Unfortunately, there is no definitive evidence as to what strategies work.
"Population-wise, we find some things work for some people and not for others."
Managing stress an important step
The first line of defence is typically to get patients to manage stress and anxiety, says Dr Davis, and provide a splint, which he says is the only consistently useful option to prevent wear and tear of teeth.
"It prevents your teeth from coming into contact while you're grinding or clenching in your sleep, and you wear the device out, not your teeth," he said.
Grinding and clenching could be described as "a canary in the coal mine", Dr Davis said, and should be taken seriously.
"It's telling us that something's going on and you really need to deal with the primary drivers of these conditions," he said.
Taking time out to unwind is a good place to start, Dr Davis said.
"We don't have enough downtime. So turn the computer off, shut the screen, go for a walk, chill out," he said.
"We live in the best country in the world — it's going to get better."
Dr Davis says that people who notice tightness in their jaw or face, teeth wearing or chipping, or people who are informed by a partner or parent that they are grinding their teeth should visit a dentist.
