Dental Health Risks

About anxiety and depression

Anxiety and depression are the most common mental disorders in the United States, affecting about 50 million people each year.¹ Signs and symptoms are not always obvious or reported, so the actual number of people coping with these conditions is likely much higher.

Anxiety often results from a fear of real or imagined danger or feelings of uncertainty.² Symptoms may include restlessness, tension, increased heart rate, and acid reflux. While it is a different condition than depression, anxiety often presents itself in many people with depression.

General characteristics of depression include feelings of sadness, emptiness, reduced motivation, loss of focus, irritability, stress, changes in lifestyle choices, and an increase in high-risk behaviors.

Anxiety and depression have been shown to often accompany other medical conditions such as diabetes, cancer, and heart disease, especially in middle-aged and older adults. They can worsen the symptoms and progression of these conditions.

Anxiety, depression, and your oral health

Anxiety and depression can affect your oral health in a variety of ways. Understanding these connections can help you take the steps necessary to ensure you maintain good oral health while working to manage your depression.

• Behavioral changes: Anxiety and depression can cause some people to lack interest in caring for themselves. Less effective oral care at home, fewer dental visits, poor diet, and an increase in unhealthy behaviors are typical. Neglecting your oral health and postponing regular dental visits dramatically increases your risk of developing mouth pain, tooth decay, periodontal disease, and missing teeth. These problems can worsen anxiety and depression by impacting your smile, ability to chew and speak properly, and nutritional habits. The effects may also cause you to limit social interactions.³ In some people, anxiety and depression can result in subconscious grinding and clenching (bruxism), often while sleeping. Bruxism can lead to chipped or worn teeth and failing dental restorations like fillings and crowns.
• Physiological changes: Anxiety and stress cause an increase in the hormone cortisol, which normally regulates inflammation. When cortisol levels are increased for extended periods, it can increase inflammation throughout the body, including the soft tissues of the mouth, and accelerate the progression of periodontal disease. Maintaining normal cortisol levels can reduce gum inflammation and improve periodontal treatment outcomes.⁴
• Risk for depression: Interestingly, research has begun to reveal that inflammation caused by prolonged gum disease can increase inflammation throughout your body. Inflammation has been associated with an increased risk of mental illness.⁵
• Medications: Medication can help manage symptoms of anxiety and depression. Most antidepressants and antianxiety medications have side effects, which may vary or be aggravated if you take multiple medications at the same time.⁶ You should talk to your primary care physician or psychiatrist about medications they recommend and ask how to address potential side effects. Common oral side-effects of antidepressants and antianxiety medications include:
  • Dry mouth: Many antidepressant and antianxiety medications can cause dry mouth as a side effect. Reduced saliva can lead to other issues such as tooth decay, mouth sores, bad breath, and trouble speaking. These issues may cause further depression and anxiety, especially in social settings.²
  • Grinding or clenching: Some medications for anxiety and depression list bruxism as a possible side effect.
  • Jaw disorders (TMJ): Some anxiety medications can aggravate TMJ disorder symptoms by causing you to overuse your jaw muscles. This often occurs as an after-effect of bruxism. Even if you do not see signs of bruxism, you may still notice other TMJ disorder symptoms such as jaw joint pain, popping and clicking of your jaw, jaw muscle aches or pain, or trouble easily opening and closing your mouth.²
  • Hypersalivation: While less common than dry mouth, some psychoactive drugs used to treat depression or anxiety may cause your salivary glands to become over-stimulated. Producing too much saliva is not harmful but can lead to excessive drooling and spitting.⁷

Inform your dentist: Your dentist and hygienist are great frontline resources if you are suffering from depression or other mental illness. It's important to be open and honest with them. Both dentists and hygienists are in a unique position to identify possible symptoms, discuss the issues with you, and provide referrals to health care professionals who will help treat your illness.

• Inform your dentist or hygienist that you are being treated for depression or anxiety or have a family history of mental illness when they conduct a health history and current health status.
• Mention all medications you are taking. This includes any supplements or natural remedies.
• Let your dentist know if you've noticed any issues such as dry mouth, swollen or bleeding gums, mouth sores, or white or red rashes in your mouth.
• If you have pain in your jaw joints, be sure to tell your dentist this before treatment begins. There are specific types of X-ray images that can help your dentist get a better picture of these joints to check for inflammation or other problems.
• Provide your dentist and physicians with each other's contact information. This is important if they need to discuss your disease, oral health status, or medications.

Make oral health a priority:

• Be proactive about your oral health. This will put you in a better starting position if anxiety or depression leads to a decrease in your regular oral hygiene routine.
• To prevent and treat tooth decay, gingivitis, and periodontal disease, visit your dentist regularly for exams and professional teeth cleanings on the schedule your dentist recommends. If your oral conditions worsen as you undergo depression or anxiety treatment, your dentist may suggest more frequent visits.
• You and your dentist should let your physician know about any treatment your dentist recommends. Ask if any of the anxiety or depression medications you are taking have oral side effects, such as dry mouth.
• Make sure you are brushing at least twice a day with a soft-bristled brush and fluoride toothpaste. If you have symptoms of dry mouth, specially labeled toothpaste or gel are available to help reduce these symptoms. If your gums bleed, don't stop brushing your teeth. Bleeding gums may be a sign of inflammation or plaque build-up below your gum line, which requires more attention, not less.
• Flossing at least once a day helps remove plaque from between teeth where brushes do not reach.

Maintain a healthy lifestyle:

• Strictly follow your course of treatment.
• Avoid tobacco, drugs, and alcohol, which can affect your oral health.
• Focus on a proper diet and avoid sugary snacks.
• Exercise and maintain a healthy body weight.
• Try to engage in social activities, use relaxation techniques, and consider participating in groups that share your condition.

• Dental phobia: According to a recent study by the National Institutes of Health, nearly 20% of adults experience moderate to high dental fear or anxiety, preventing some from seeking needed oral health care.⁸ As a result, they stop seeing the dentist regularly, which can have a severe impact on their oral health. Let your dentist or hygienist know if you have any fears about being at the dentist or receiving dental care. Dental treatment options have changed significantly from years ago, and so have anxiety and pain management strategies. If your anxiety is severe, your dentist may recommend sedation.⁹
• Stomach (gastric) acids: Stomach acid that enters the mouth throughout the day can cause tooth decay and erosion. It can occur if you suffer from acid reflux or eating disorders such as bulimia, which are associated with anxiety and depression. Acid reflux is especially damaging when you're asleep since your mouth produces less saliva and you swallow less often.⁸
• Brushing actions: Overly vigorous or excessive brushing actions can result in enamel erosion on tooth surfaces or gum recession, particularly in an acidic environment. This behavior has been associated with bipolar, obsessive-compulsive, or similar disorders.⁸
• Children: As a caretaker of a child with depression or an anxiety disorder, you and their dentist should play a role in helping them understand the harmful oral effects of tobacco, drug, and alcohol use. By encouraging a healthier lifestyle, supporting them in a positive daily routine, and making them feel more comfortable with dental visits, you can help them effectively manage their oral health.⁸

• Pregnancy: Some antidepressant and antianxiety medications can have adverse effects on you and your unborn or newborn baby. Make sure your physician and dentist know if you're pregnant, planning on becoming pregnant, or breastfeeding.¹⁰