The surprising link between mental health and oral health

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While it’s not well understood, studies show that mental health and oral health may be linked. And it’s a two-way street. In one direction, mental disorders such as depression and anxiety can lead to poor oral health care. In the opposite direction, gum disease is associated with a rise in mental health problems.

Here’s a deeper look at this interesting connection between poor oral health and mental health. Plus, find out how to keep your oral hygiene on track.

Mental and dental health: what’s the connection?

Studies have revealed the inextricable link between oral health and general health. From the risk of dementia and stroke to heart disease, evidence shows that poor oral health plays a role. We also now know that mental disorders, like depression and anxiety, can jeopardise our oral health.

People living with mental health problems are at higher risk of severe gum disease (periodontitis), tooth decay and even tooth loss compared to the general population.

A study published in the Canadian Journal of Psychiatry found that people with severe mental illness are 2.7 times more likely to lose all their teeth compared with those without a mental disorder. It also shows that people with severe mental illness are almost 50 times as likely to have periodontal disease.

There are several reasons for the connection between mental illness and oral health including:

Decrease in dental hygiene

People with mental health conditions may unintentionally let their oral hygiene habits slip. Symptoms of mental illness include fatigue, lack of motivation, and feelings of worthlessness. These traits can lead people to overlook daily oral health habits, like brushing and flossing.

Young lady brushing her teeth and smiling.
Symptoms of mental illness include fatigue, lack of motivation, and feelings of worthlessness. These traits can lead people to overlook daily oral health habits, like brushing and flossing.

Change in behaviour

People with mental health disorders may adopt coping habits. This might include smoking, increased consumption of alcohol and sugary drinks, as well as a reliance on fast or convenience foods. All these things increase the risk of decay, tooth loss and dental disease.

Anxiety

People with anxiety may also have dental phobia. As a result, they avoid dental visits. Minor dental issues can go unnoticed, worsen and become a bigger oral health problem.

Stress

Stress is an interesting topic, as it’s both a risk factor for poor oral health and mental illness. High cortisol levels associated with stress can cause insomnia. This can lead to an anxious or depressed mood. Studies have shown that people with insomnia may have twice the risk of developing depression than people who get a good night's sleep.

On the other hand—the release of cortisol can dampen the body’s immune response and raise blood sugar levels. Research links high cortisol levels in saliva to increased risk of periodontitis.

Associated eating disorders

Approximately 50-90% (NEDC, 2017) of people diagnosed with an eating disorder also have a mental illness. Eating disorders such as bulimia, anorexia and binge eating can cause vitamin and nutrient deficiencies. Poor nutrition can lead to enamel erosion, dry mouth, and tooth decay. However, frequent vomiting associated with eating disorders poses the biggest risk. Vomiting exposes the teeth to stomach acid, increasing the likelihood of tooth erosion. In fact, studies show that between 35-38% of patients with eating disorders suffer from tooth erosion.

Bruxism

Both stress and anxiety disorders are risk factors for teeth grinding (bruxism). Ongoing teeth grinding or clenching can cause tooth damage, sensitivity and jaw pain. It may also increase the risk of periodontal disease. This is because grinding is a major cause of tooth mobility. Grinding can cause trauma to the periodontal ligament, and worsen pre-existing periodontitis.

Medications

Some antidepressants can cause dry mouth, which in turn affects oral health. Saliva helps protect the teeth and gums, so having little or no saliva can drastically affect your teeth and gums, making you vulnerable to gum disease. 

Bruxism can also be a side effect of some medications for mental illness. Sore teeth because of grinding can be painful, causing people to stop brushing or flossing for a few days. 

Alt text Young man experiencing toothache from grinding.
Ongoing teeth grinding or clenching can cause tooth damage, sensitivity and jaw pain. Sore teeth because of grinding can be painful, causing people to stop brushing or flossing for a few days.

Can poor oral health affect mental health?

The short answer is yes. As we mentioned at the start, the connection between mental health and oral health is a two-way street. 

Take periodontal disease as an example. This is a chronic inflammatory condition, affecting the gums and jawbone. If left untreated, it can cause irreversible damage to the ligaments and bone which support your teeth. This in turn can lead to decay and tooth loss.

Having missing teeth can impact a person’s eating, speech and self-esteem. This can lead to social isolation and increased risk of mental disorders like anxiety and depression.

Making oral health part of your self-care routine

Understanding the link between mental health and oral hygiene is an important step towards better self-care. A few actions that can help maintain your oral health include:

  • Brushing twice a day with fluoride toothpaste
  • Try to limit sugary drinks and foods 
  • Seek support to quit smoking

Book a regular appointment with your dentist or periodontist

Final thoughts…

If you’ve been finding it difficult to take good care of yourself and perhaps your oral hygiene habits have slipped, know that you’re not alone. There is help and support available through several sources including:

If poor mental health has kept you from regular dentist visits, try not to let fear or shame stop you from accessing the dental care you need any longer. Dentists and periodontists are not here to judge. We’re on your side. Our focus is on providing you with the best treatment,management solution and support. If dental phobia is standing in your way, talk to your dentist or periodontist about strategies to help you get the treatment you deserve.

Information sources:

National Eating Disorders Collaboration (NEDC). (2017). Eating disorders prevention, treatment and management an updated evidence review. Sydney: NEDC. 

Oral Health Foundation. How eating disorders can affect your mouth

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