Stress shows up in our lives in various ways. It might cause you to fidget or bounce your leg when you’re in a meeting or on a first date. If you’re anxious while speaking, you might talk faster than usual or sweat profusely.
Anxiety and stress are intertwined with overall health, and the mouth, as part of the body, can be affected by your mental health. “Our mouths play a psychological role in communication, self-expression and social interaction,” said Sheila Stille, DMD, faculty at the University of Colorado School of Dental Medicine (CU SDM).
“People with oral health issues often don't want to be around others, so they can become more isolated and more depressed,” she explained. “They don’t feel like themselves.”
Anxiety disorders are common in the U.S., affecting 40 million adults or more than 19% of the population each year. Women are twice as likely to be affected as men, according to the Anxiety & Depression Association of America.
Stress from work, reading about or getting bad news and medical issues can lead to bruxism — grinding and clenching your teeth — which causes headaches and fractured teeth, Stille said.
In a recent meta-analysis published in the Journal of Clinical Medicine, researchers found that globally, one in four individuals may experience bruxism while they are awake. The team estimated that the prevalence of sleep bruxism is 43% and that, in general, women are significantly more affected than men.
Clenching and grinding your teeth can also lead to jaw problems.
“Temporomandibular joint, or TMJ, disorders or jaw problems are predominantly muscular. They happen because of parafunctional habits, the manifestation of anxiety in many people,” Stille explained. “Broken teeth are common because you're putting so much stress on your tooth that it often splits in half.”
Parafunctional habits are repetitive behaviors related to the mouth, including bruxism, nail biting and tongue-thrusting.
Stille has seen these conditions and their effect on patients firsthand in the CU Dental clinics.
“Patients feel bad that they've delayed seeking care,” she said. “That's why a lot of people avoid the dentist. It’s a vicious cycle.”
Neglecting your oral health can potentially lead to infections. Individuals with obsessive-compulsive disorder might brush their teeth aggressively or all the time, causing damage to their gums.
In a 2021 survey by the American Dental Association’s Health Policy Institute, more than 70% of dentists said they noticed signs of teeth grinding and clenching in their patients, an increase of nearly 10% over the previous year. Learn more about teeth grinding and jaw pain from the ADA.
Stille said that anxiety and medications, including psychotropic drugs, can lead to dry mouth, which results from an inadequate flow of saliva. Typically, the saliva in your mouth is protective, washing away food and other debris.
“People don't necessarily drink enough water, so they're not rinsing their mouths out, which increases the cavity rate,” she said.
Stress can also contribute to canker sores. Known medically as aphthous ulcers, these sores are typically tiny (less than one millimeter) and appear on your tongue, gums, inside your lip or under your tongue.
“When you have these mouth sores, you don't want to talk, so then you retreat again,” Stille said. If you’re not careful with what you eat and you avoid the dentist, they also may not clear up right away.
Fortunately, there are solutions to help decrease anxiety and stress when it affects the mouth. Stille said she advises patients to:
If you still feel stressed, talk to your dentist about trying a flat plane night guard. You can protect your teeth and, sometimes, you may even stop grinding, due to a lack of feedback from the cusp tips interacting, said Stille.
Night guards may not be the best solution for every patient.
“Sometimes using a night guard will increase tension in your jaw,” Stille explained. “At first, it helps, but some patients will habituate to the device and grind on that all night. So that’s not solving the problem.”
Discuss with your dentist the best options for reducing stress and maintaining good oral health. The solution might be easier than you think.
“It is up to us as dentists to understand what our patients are going through that is contributing to stress and anxiety,” she said. “If our patients are receptive to our ideas, it will help them feel better and get rid of issues leading to poor oral health. And then, everything else falls in place. You start feeling a little bit more relieved, less stressed, and better about your oral hygiene and yourself.”