Stress and Oral Health

InformalJohnJohn A. Patterson MD, MSPH, FAAFP
February 2014

Stress and poor oral health are interrelated.

The presence of oral disease and dental disorders can cause stress from low self-image, which can have a negative effect on well-being and personal happiness. Stress, chronic anxiety and depression can lead to self-neglect, including neglect of dental hygiene. For many people, dental self-care is not a high priority. It is especially common for stressful economic times to be associated with lapses in the proper oral hygiene habits of regular brushing and flossing of teeth and professional dental exams. Turning to sugar-laden comfort foods for stress relief can also lead to dental caries (tooth decay).

Emotional disorders and stress at home or work can lead to the excess production of dental plaque, which in turn can lead to periodontal (gum) disease, leading to gingivitis and bleeding gums. A highly emotional response to financial hardship, in particular, has been shown to increase gum disease. Periodontal disease is the leading cause of tooth loss and Kentucky ranks first or second among the national leaders in tooth loss.  A healthy diet, regular brushing, flossing, anti-bacterial mouth rinses and regular dental evaluations can save teeth.

Stress can increase the frequency of canker sores. Also known as aphthous ulcers, these painful lesions are not contagious and occur inside the mouth. Students often have canker sores during their school year but fewer sores during holidays and over summer vacation. Cold sores, also called fever blisters are contagious, painful blisters around the lips, nose or chin caused by the herpes virus. Stress is a common trigger for these herpes-virus blisters. Though canker sores and cold sores resolve with or without medication, their resolution and their prevention can be helped by stress reduction.

Stress, worry, anxiety and anger can also lead to bruxism- clenching and grinding of the teeth during sleep or while awake. This grinding of the teeth can eventually lead to problems with the TMJ (temporomandibular joint). TMJ problems can cause popping or clicking of the jaw when opening the mouth or chewing. It can also cause facial pain or tenderness in the face, jaw joint, neck, shoulders, and around the ear during chewing, speaking, or opening the mouth. A custom-made dental bite guard may be required to prevent damage to the teeth and the TMJ from frequent grinding. Individuals may be unaware of their teeth grinding and jaw clenching. Signs include flattening of the tips of the teeth and dental sensitivity from loss of dental enamel.

There are many ways to help prevent stress from having an adverse impact on your dental health. You can probably find something on this short list that fits your lifestyle and personal preferences. To begin, try to reduce your exposure to the circumstances, patterns of thinking, habits, people or other sources of your stress. Deal thoughtfully, methodically and rationally with external stressors like financial hardship. Seek financial, emotional or pastoral counseling rather than self-medicating with drugs, alcohol and overconsumption of unhealthy foods. To reduce mental and emotional stress, connect more with your body through your preferred physical activity- walking, jogging, swimming, yoga or sports. Practice daily skilled relaxation, meditation or prayer. Spend some time each evening reading inspirational material that uplifts your spirits. Get a massage. Hug a loved one. Play with children and animals. Get out in nature. Do something for others who are less fortunate. Participate in social and community activities that reduce feelings of isolation and loneliness. Count your blessings.

Listed below are several resources that offer self-directed approaches to stress management. They do not take the place of professional help should your burden of stress feel overwhelming or get worse over time. Speak with your dental or medical provider for a professional stress management referral if your self-care strategies are not helping.

You dental health and your overall health may depend on how effectively you manage your stress.

Resources-
Dr. James Gordon, founder of the Center for Mind Body Medicine guides a ‘soft belly meditation’
http://vimeo.com/37976492

Zen master Thich Nhat Hanh’s ‘single pointed meditation’ is led by Peg Baim of the Benson-Henry Institute for Mind Body Medicine
http://www.youtube.com/watch?v=gAIYm6wpzw4

Stressed out? Your Dentist Can Tell
http://www.deltadentalins.com/oral_health/stressed_out.html

How stress affects your oral health
http://www.webmd.com/oral-health/healthy-teeth-2/stress-teeth 

About the Author-
Dr Patterson is past president of the Kentucky Academy of Family Physicians and is board certified in family medicine and integrative holistic medicine. He is on the family practice faculty at the University of Kentucky College of Medicine and the University of Louisville School of Medicine, Saybrook University’s School of Mind Body Medicine (San Francisco) and the Center for Mind Body Medicine (Washington, DC). He operates the Mind Body Studio in Lexington, where he offers integrative medicine consultations. He can be reached through his website at www.mindbodystudio.org.