It seems like every day we find more ways in which our mental health and our physical health are interconnected, and oral health is no exception. In fact, now more than ever, after two years of on and off isolation, fear, and a collective sense of heightened societal tension, we've seen first-hand how our physical selves suffer when our psyche is put under pressure.
Just one example is the notable increase in chipped teeth that dentists have seen since the beginning of the pandemic.
And research continues to find greater evidence for a relationship between mental health and oral health. Take, for instance, a study about chronic periodontitis and depression by the Journal of Psychiatric Research, released in June 2021.
Periodontitis is caused by infections and by an inflammation of the gums and bones that provide support to teeth. When this happens, gums may appear swollen and red and tend to bleed easily. In more advanced stages of periodontal disease, the gums begin to pull away from the teeth, and teeth can become loose and maybe even fall out.
The study followed 13,088 patients from general dental practices in the UK. 6,544 of those patients had chronic gingivitis, and 6,544 of them did not. Within 10 years, 16,3% of those with gingivitis were diagnosed with depression, while only 8.8% of those without gingivitis were diagnosed with depression, resulting in a positive correlation between the two.
A review by Clinical Oral Investigations that tested the association between depression and various oral diseases in 2018, found that depression increased the likelihood of decay and tooth loss as well.
So why is there a relationship between oral health and mental health? It’s not that being depressed means you will have tooth decay — the relationship is a bit more indirect. Rather, it’s about how poor mental health affects aspects of your life that contribute to poor oral health.
And even though the patients in the study by the Journal of Psychiatric Research were only diagnosed with depression after having been diagnosed with chronic periodontitis, it’s not to say that the periodontitis caused the depression.
What’s more likely is that the participants in the study were already exhibiting characteristics of depression, like lack of self-care, including neglecting a proper oral hygiene routine.
It has also been found that apart from behavioral factors, there are chemical and biological factors that can increase the risk of poor oral health. And as it turns out, these factors are also often related to a patient’s diagnosis of mental illness. Below, we’ll take a closer look at the behavioral and biological factors of mental illness that are related to poor oral health.
There’s no question that being depressed affects one’s motivation, and more and more studies are coming out to provide evidence for the claim.
Researchers from the University of California, Berkeley have identified biomarkers in mice that show low motivation resulting from chronic stress, which the researchers associated with depression, anxiety, and lack of motivation in the mice.
In practical terms, and in humans, this lack of motivation translates to low productivity and more difficulty completing normal daily routines, including oral hygiene, like brushing and flossing teeth. There is also a greater likelihood of canceling preventative dental visits, especially if a patient already experiences dental anxiety.
This neglect in oral hygiene leads to decay, gum disease, and even tooth loss.
Apart from poor oral and personal hygiene in general, people suffering from depression and anxiety are also more likely to drink more alcohol and smoke tobacco. These habits, especially in excess, can lead to gum disease, decay, and oral cancer.
Depression and anxiety create a lot of stress in the body’s system and stress transforms into the hormone cortisol. Cortisol causes the immune system to weaken, which can increase a patient’s risk of gum disease, inflammation, and other problems like infections.
Medications and xerostomia
People who suffer from depression may be prescribed medications to help. Some medications can cause dry mouth, reducing saliva production. This, in turn, creates an environment in the mouth that is perfect for the overgrowth of bacteria, again, resulting in a greater risk for cavities and gum disease.
The case for a holistic approach
A more holistic approach to oral health, general medicine, and psychological health could greatly aid in reducing problems with oral health caused by mental health.
A holistic approach does not mean visiting a holistic dentist. Instead, it’s an argument for fostering better communication between healthcare professionals in all fields.
For example, if a psychiatric patient is suffering from depression, their dentist may recommend an increased volume of visits. Or if a general physician sees a patient with high levels of cortisol, they could communicate this to the patient’s dentist, who could, in turn, watch out for dry mouth and increased bacterial production.
The parts that make up the whole of our bodies don't exist in a vacuum. They are closely related and what affects one part of the body will undoubtedly affect another. We need to take greater steps in healthcare to create better communication between medical professionals and increase the overall health of patients.
Futurity.org: Biomarker May Clear Up How Depression Saps Motivation. Consulted 10th January 2022.
PubMed.gov: Is depression associated with oral health outcomes in adults and elders? A systematic review and meta-analysis. Consulted 10th January 2022.
ScienceDirect.com: Relationship between chronic gingivitis and subsequent depression in 13,088 patients followed in general practices. Consulted 10th January 2022.
Nytimes.com: A Dentist Sees More Cracked Teeth. What's Going On? Consulted 11th January 2022.