Stress and Oral Health

We often hear: “Stress ruins your health” or “Stress is a source of many diseases”. Being a health care professional for over 25 years I could not agree more.

What is stress exactly?

By definition stress is a feeling of emotional or physical tension. It is our body’s reaction to a challenge or demand. Common signs of stress are headaches, low energy, insomnia, tense muscles, upset stomach. Everybody experiences stress in their life. Short term stress is positive and helps us to get ready for a challenging situation keeping us alert, motivated, and ready to avoid danger. Stress becomes negative when a person faces continuous challenges without relief or relaxation between stressors. As a result, the person becomes overworked, and stress-related tension builds. This type of chronic stress without relief is called distress.

Distress can easily show it’s not-so-pretty self in our mouth as well. The oral cavity serves as a gateway to the rest of our body hence it makes sense why there is a strong connection between oral health and overall health. Many problems manifest themselves through our mouths. Studies have shown that the bacteria involved in oral diseases might play a role in various other diseases of the human body.

Stress can trigger bad habits such as smoking, drinking, or chewing tobacco. These coping methods result in serious consequences including bad breath, discolored fillings or teeth, dry mouth, and in severe cases precancerous lesions or squamous cell carcinoma (the most aggressive form of the cancer of the oral cavity.) When stressed many people consume ”comfort foods”: sticky, sugary, late at night snacks to help cope with distress. Unfortunately, these types of foods lead to a cavity, usually more than one. A cavity is a region of tooth decay that is caused by a combination of factors including bacteria, frequent snacking, sticky and sugary foods or beverages, and poor oral hygiene.

Cavities can go unrecognized for a long time mostly because they don’t cause any pain or discomfort at the beginning. Even quite a large cavity might just react slightly to sweet or cold foods. Many patients don’t seek professional help until they experience some extent of pain or discomfort and at that point, the damage might be quite severe.
Way too often that overlooked cavity turns to a tooth loss. Sometimes is due to losing so much tooth structure that the tooth becomes unrestorable. Sometimes is due to lack of funds or effort to continue treatment.

Very often stress is associated with depression which can cause a lack of interest in common tasks such as brushing your teeth. Poor oral hygiene leads to a number of oral health complications including not only cavities but also gingivitis. Gingivitis or inflammation of the gums is recognized by bleeding and inflamed gums that are typically caused by an accumulation of plaque on the teeth. Gingivitis is usually a result of improper brushing and flossing of the teeth. Untreated gingivitis is a straight road to periodontitis, a preventable but irreversible disease, which can cause severe bone loss and chewing problems. While gingivitis is a “visible” gum disease, periodontitis is not that easily recognized.

Patients are usually unaware of it until a health care professional performs an oral exam or a series of x-rays. Severe periodontitis, that might not give any symptoms results in teeth spreading apart, moving, and loss of teeth. In more advanced cases bone loss is so severe implants or other unremovable prosthetics to restore missing teeth might not have enough support. Missing teeth and chewing problems as a result of tooth loss is a serious disability especially if the large area remains unrestored in long periods of time. Preventive measures such as basic or deep cleaning can help resolve gingivitis and help improve periodontitis.

Stress can cause muscle tension, specifically on our facial muscles, and subconscious teeth clenching or grinding to relieve that tension. Long-term bruxing or grinding of the teeth can lead to loss of tooth structure. Grinding causes the teeth to become worn, chipped, damaged, and sensitive. Teeth can also be cracked, requiring more extensive treatment such as root canals and crowns. Grinding and clenching of the teeth is a parafunctional habit and might lead to a temporomandibular joint disorder also referred to as TMJ syndrome, characterized by pain in the jaw, face, or ear and an inability to completely close or open the jaw. Pain, headaches, and discomfort caused by jaw clenching and muscle parafunction can be easily resolved by muscle relaxing medication, a nightguard, or other oral appliances. A new technique to help alleviate muscle fatigue and nocturnal grinding are Botox injections into the muscles of mastication.

Stress can be a cause of indigestion and acid reflux syndrome. Acid reflux syndrome is a disorder that causes acidic stomach juices to come up from the stomach and into the esophagus and oral cavity. The highly acidic digestive juices are damaging to the enamel on the teeth causing erosion and sensitivity. Prolonged exposure to the acids might destroy enamel to the point that a root canal may be required to save the tooth. Teeth damaged from erosion or abrasion can be repaired through esthetic bonding, crowns, or veneers providing the patient with improved chewing function and a boost of self-confidence.

In general, people don’t associate their oral health with stress. Stress has detrimental effects on both our oral health and our overall health. Diagnosis and treatment can be difficult because in order to properly treat the patient the underlying cause of the stress must be resolved. Stress is a complex issue; therefore, it requires complex treatment. The best approach to finding a solution to stress is to resolve the root of the problem. Psychologists agree: “Problems are there not to dwell on them, but to solve them one by one.”

What can we do to improve our situation?

Effective stress management can help alleviate the hold stress has on your life and improve everyday functioning. There is a variety of different techniques that have been proven to help with stress like regular exercise, healthy and well-balanced meals, relaxation techniques such as deep breathing or meditation, a positive attitude, and accepting that there are events that are out of our control. Anyone experiencing any degree of stress should seek help from family or friends, and from health care professionals. It is important to attend regular dental check-ups to identify oral health complications at their onset to provide the best treatment and care to achieve a beautiful and healthy smile.