The effects of stress on overall health are probably not surprising, but the statistics are staggering: reports of stress have increased steadily over the past five years and according to the American Psychological Association and the American Institute of Stress, anywhere from 60-75% of the population report physiological or emotional symptoms as a result of stress. The number one cause of stress for several years has been financial, while work-related stress comes in at a close second.
The manifestations of stress on overall health are many. The body’s response to stress, also known as the flight-or-fight response, triggers a series of physiologic changes, impacting teeth, gums, and other structures in and around the mouth.
Here is a short list of how stress can affect oral health:
Clenching or grinding teeth is the most common and obvious manifestation of stress in the mouth. About 60% of people who grind their teeth are not aware of it. The long-term effects of clenching include tooth wear, fracture and/or tooth loss in some instances.
Temporo-mandibular joint disorder (TMD) is a related condition to clenching that affects the jaw and surrounding muscles. Muscle tension as a result of stress can cause or exacerbate a TMD condition, which can include jaw pain, difficulty chewing, and pain when opening the mouth.
Reduced saliva production leads to dry mouth. Saliva plays a significant role in chewing, swallowing and lubricating the mouth. Furthermore, saliva has anti-bacterial properties and is a natural buffer, responsible for maintaining a neutral pH in the mouth. Stress directly affects the salivary glands where saliva is produced, therefore reducing salivary flow. Consistently low saliva production leads to dry mouth which can lead to cavities, gum disease, mouth sores and problems with swallowing and chewing.
Stress increases the hormone cortisol in the body. Consistently high levels of cortisol can lead to inflammation and a weakened immune system. As a result, oral inflammatory conditions such as periodontal (gum) disease and gingivitis have been associated with chronic stress. In fact, an oral infection known as acute necrotizing ulcerative gingivitis (ANUG), characterized by painful bleeding and ulcerated gums is historically observed amongst college students during periods of high stress and anxiety.
High cortisol levels also weaken the immune system, which means the body has difficulty fighting off bacterial and viral infections of the mouth. Oral lesions such as cold sores, canker sores and other immune-mediated lesions can be associated with chronic stress.
Outside of the direct physiologic effects, harmful habits associated with chronic stress such as poor dietary choices, smoking or use of oral nicotine products and neglecting oral hygiene can have a detrimental effect on oral health.
Several measures can be taken to counteract the effects of stress on oral health. Consistent oral hygiene – brushing twice a day and flossing – and a low-sugar diet goes a long way in managing inflammation and reducing the risk of developing cavities. Over the counter products that help with dry mouth along with staying hydrated are equally important. The effects of clenching or grinding on teeth can be managed with the use of a dentist prescribed night guard. Physical therapy, combined with basic jaw exercises are effective in relieving muscle tension and jaw pain associated with TMD. More importantly, stress management through meditation, mindfulness, physical activity and human connection have proven benefits in reducing cortisol levels and reducing stress.
