The recession is a grind on people's teeth as well as their pocketbooks.
Cracked and worn-down teeth, jaw pain and headaches are getting the attention of dentists across the central San Joaquin Valley - and stress is at the root of the problem, they say.
There's no official data, no tooth-based economic indicator. But dentists are hard-pressed to explain what else besides stress from things like layoffs and home foreclosures would be the driving force behind the booming demand for tooth-repair services.
"We know that everybody's under a lot of stress lately," said Matthew Messina, a Cleveland dentist and consumer adviser for the American Dental Association.
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The body reacts to stress - whether real or perceived - with a spurt of energy that enables a person to run or fight, Messina said. People who are under stress burn that excess energy off somewhere, he said. Some do it at night by clenching or grinding their teeth.
Jennifer Brockman, 34, of Fresno thought her tooth pain was from cavities until she saw Henry Cisneros, chief dental officer for Family Healthcare Network in Visalia.
She found out the truth. "It's just stress on my teeth," she said.
Brockman began clenching and grinding her teeth in September when she was laid off from her job as a Web site designer for an Internet-based gift card business. Dental X-rays from a year prior showed no tooth damage, she said. "But the ones I just had a month ago do show it," she said.
It got so bad that one of her teeth broke in the past month.
"No doubt it's stress related," she said.
Pounds of pressure
Clenching and grinding, also called "bruxism," puts hundreds of pounds of pressure on tooth surfaces. Typically, chewing exerts 20 to 40 pounds on the teeth, but the pressure from grinding can be 250 pounds or more.
Broken and chipped teeth are some of the results. And grinding can wear off enamel until the softer, dentin layer of the teeth is exposed. Teeth also can be rubbed flat.
Wear-and-tear on teeth isn't the only result.
"When you clench your teeth, you can get pain behind the eyes, ringing in the ears, sinus pain, neck pain, headaches - it can even trigger migraines," said David Wright, a Fresno dentist who has training for the treatment of facial and joint pain.
Overworked muscles in the jaw, neck and face cause the pain, Wright said.
Breaking a clench-and-grind habit isn't easy. Stress management techniques can help some patients. But there's more to solving the problem than just telling a patient to relax and expecting everything to be all right, dentists say.
Not a cheap fix
Many patients try over-the-counter night guards that prevent teeth from snapping together and allow muscles to relax. But while the one-size-fits-all devices can be relatively cheap (from $25 to about $150), they often don't work well, dentists say.
What works better are custom-made appliances that fit the patient's mouth. The special guards can be pricey - as much as $900 or more.
Preventing clenching and grinding might be worth the cost of a custom-made night guard. A tooth fractured from clenching and grinding may need to pulled, or it could require a root canal or crown, both costly dental procedures, the dentists say.
Insurance sometimes pays for guards that are prescribed for medical reasons, such as to prevent muscle pain, jaw pain, headaches and migraines, Wright said.
Heidi Fisher, 47, of Fresno turned to Wright for a device to keep her from grinding her teeth after she began waking up with a headache and jaw pain.
Fisher didn't have insurance to pay for a $1,000 made-to-fit tooth guard. She had tried an over-the-counter product and found it to be uncomfortable. Wright fashioned a device for her about a month ago. She's been wearing it every night.
Now, Fisher said, her headaches are gone.
She'd never clenched or ground her teeth in her sleep before, she said. But she's recently been anxious and stressed: Her husband, Gilbert Fisher, opened a family law and bankruptcy practice six months ago. "With any business, it's just really hard, especially to open now," she said.