Oral Health and Wellbeing

When you think of oral health, you think of teeth and gums in isolation with no connection to the rest of the body. But new research is starting to show a big connection between oral and mental health.

Conditions like anxiety, depression and stress can affect our daily lives and our oral hygiene. And poor oral health can contribute to a decline in mental wellbeing, creating a vicious cycle that’s hard to get out of.

The World Health Organization describes oral health as, ‘the state of the mouth, teeth and orofacial structures that enables an individual to perform essential functions such as eating, breathing and speaking and encompasses psychosocial dimensions such as self confidence, wellbeing and the ability to socialise and work without pain, discomfort and embarrassment.’ This proves that oral health and mental health are well connected and need to be considered when dealing with either of these.

This article will look at oral and mental health from a 360 degree perspective, exploring the science behind the connection and what you can do to improve your oral health and mental health.

The Science Behind the Oral-Mental Health Connection

The Two Way Street

Oral health and mental health are connected in a two way street, meaning that compromised mental health can affect your ability to look after your oral hygiene and this will in turn lead to poor oral health. And poor oral health can exacerbate mental health issues.

Mental illnesses like anxiety, stress and depression can have physical manifestations that are often reflected in self neglect, for example neglecting self care routines which may include oral hygiene. Research shows that people with mental illness, particularly severe mental illness are more likely to develop oral health problems due to poor nutrition and oral hygiene, excessive consumption of sugary drinks, comorbid substance misuse including tobacco, alcohol or psychostimulants and financial or other barriers to accessing dental care.

On the other hand oral health problems like gum disease or tooth loss can cause distress, embarrassment and social anxiety which feeds into a cycle that affects mental health and can be a contributing factor to mental illness.

Stress and Anxiety

Stress affects every part of our body and oral health is no exception. Conditions like bruxism (teeth grinding), temporomandibular joint disorders (TMJ) and dry mouth can all be stress related.

Bruxism in particular can lead to severe tooth wear, headaches and jaw pain. The pain and discomfort from these can increase mental health problems like frustration and anxiety and create a vicious cycle.

Stress also weakens the immune system making it harder for the body to fight off oral infections like periodontal disease and worsen oral health.

Nutritional Deficiencies and Poor Oral Health

Dry mouth (xerostomia) is a major risk factor for oral health problems. It’s often exacerbated by gum disease which can result from nutritional deficiencies associated with psychosis or anorexia nervosa.

Eating Disorders

An eating disorder is a mental illness that encourages people to use food control to cope with feelings and situations. According to the American Dietetic Association people tend to eat too much or too little when stressed or feeling low.

The link between eating disorders and oral health problems has been known for a long time and typically presents as tooth erosion from acidic fruit and drinks, gastric reflux or frequent vomiting most commonly on the inner surfaces of the upper teeth.

Mental Health Medications and Their Impact on Oral Health

Many medications used to treat mental health disorders like antidepressants, antipsychotics and mood stabilisers can have side effects that affect oral health. One of the common side effects is xerostomia or dry mouth which can lead to tooth decay, bad breath and periodontal disease.

Commonly used medications for mental illnesses are paroxetine, sertraline, escitalopram, citalopram and fluoxetine. Fluoxetine has side effects that include nausea, diarrhea, headache, jitteriness, insomnia, fatigue and sexual dysfunction. Fatigue can cause mood swings and make patients not want to go to the dentist.

Nausea can sometimes lead to frequent vomiting which can cause chemical erosion of the tooth enamel one of the common oral symptoms found in patients with poor mental health.

Diarrhea can reduce the body’s electrolytes and cause dry mouth making patients prone to tooth decay. Dry mouth is when saliva production is reduced and saliva plays a big role in oral health by neutralising acids and washing away food particles.

Oral Health Conditions That Affects Mental Wellbeing

Gum Disease and Systemic Health

Research shows a link between mental health conditions and dental problems like tooth decay, periodontal disease and tooth loss.

Gum disease also known as periodontal disease is linked to various systemic health problems like cardiovascular disease and diabetes. Recent studies suggest that gum disease may also be associated with cognitive decline especially in conditions like Alzheimer’s disease.

The chronic inflammation from periodontal disease can potentially affect brain health and contribute to mental health disorders or worsen existing mental illnesses.

The Psychological Effect of Tooth Loss

Tooth loss whether from decay, trauma or gum disease can have a huge psychological impact. It can lead to low self confidence and self esteem and a reluctance to socialise.

People with missing teeth may feel embarrassed to smile or speak and find comfort in isolation which can trigger or worsen mental illnesses like depression and anxiety. This proves that the aesthetic aspect of oral health plays a big role in mental health.

How Mental Health Disorders Affects Oral Health

Research shows that those with poor mental health are more likely to have poor oral health than those who are not and are more vulnerable to more risk factors for oral and dental disease than the general population. This can be attributed to the side effects of the medications they take, lack of self care, difficulty in accessing health services, negative attitude towards health providers and non cooperation in dental treatment.

A 2021 study found that individuals with mental illness had more decayed, missing and filled teeth surfaces than controls. The researchers concluded that the rates of oral health problems like dental decay, periodontal disease and tooth loss are higher for patients with common mental disorders than the general population.

Depression and Neglect of Oral Hygiene

Lack of motivation a common symptom of depression or feeling of worthlessness and fatigue can affect oral hygiene behaviors. Brushing and flossing can feel like too much to ask for someone with severe depression.

Over time neglecting oral health can lead to oral health problems like cavities, periodontal disease and even tooth loss. These can worsen feelings of sadness, fatigue, hopelessness and loneliness, reduce quality of life and possibly be associated with poorer mental and overall health. This feedback loop between mental health and oral health decline is common as one condition feeds into the other.

Anxiety and Dental Phobia

Many people have anxiety about dental visits sometimes to the extent of developing a fear or dental phobia. This can cause them to avoid regular check ups and necessary dental treatments. The longer oral health problems are left untreated the worse they become and often require more invasive, painful or costly procedures which can fuel anxiety and reinforce avoidance behaviours.

Breaking the Cycle: Holistic Dental Care and Mental Health

Since oral and mental health are closely linked it’s clear that when we address the physical health of patients with poor mental health we should also address oral health and better collaboration between dental and mental health professionals and adopt a holistic approach to this issue. A holistic approach will address both the above issues effectively and overall health and well being.

Mindfulness and Stress Management for Better Oral Health

Mental illnesses cause stress and affect the body’s ability to function normally. Mindfulness and stress management techniques can help both mental and oral health. Practices like meditation, deep breathing and yoga can reduce stress and reduce the risk of bruxism and other stress related dental problems. Incorporating these practices into daily life can also improve mental well being and create a positive feedback loop for overall health.

Regular Dental Visits

For those with poor mental health seeing a dentist can be very difficult. They fear going to the dentist because of embarrassment about their oral health and put it off for as long as possible.

Dentists however play a crucial role in detecting early signs of oral diseases and the oral effects of common mental illnesses like dental erosion, signs of self harm etc. and provide care that can prevent further problems down the line. When the dentist knows the patient’s mental health condition they can take a holistic approach to dental care and provide multidisciplinary support while working with mental health professionals.

Counselling and Therapy

Cognitive behavioural therapy (CBT) and other forms of counselling can help with dental phobia, obsessive compulsive disorder and anxiety related to oral health. Therapists can help patients confront their fears and learn coping mechanisms to manage anxiety during dental visits. In some cases medication or sedation may also be prescribed to make dental procedures less stressful.

Healthy Habits

By taking a holistic approach patients are more likely to adopt healthy habits that support both oral and mental health. Holistic care often involves lifestyle changes – like proper nutrition, hydration and sleep – that benefit both mind and body and lead to long term overall health.

A holistic approach means a more comprehensive, balanced and patient centred way of addressing oral and mental health together. It recognises the link between the two and focuses on prevention, early intervention and sustainable lifestyle changes to improve oral health care, mental health and overall well being.

In a nutshell

Oral health and mental health are linked but we must consider both when we address either. Good oral health supports good mental health and vice versa so dental teams must address both holistically.

A dentist may be the first to suspect an eating disorder or other mental health related oral symptom as some patients may not present for psychiatric treatment. So closer collaboration between mental health professionals and dentists is key to removing barriers to care whether psychosocial or financial.

At Zental we believe in a holistic approach to patient care, we recognise the link between mental and oral health. By treating our patients with a focus on both we address the dental issues but also the psychological and emotional factors that affect their overall well being. Our treatments combine advanced dental care with stress reduction techniques, mindful practices and personal patient support in a calm, comfortable and relaxed environment. So our patients leave our clinic with a healthy smile, improved mental health and peace of mind.

Our priority is your oral health and helping you live a healthier, happier and longer life. Find a dental practice near you.