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Did you know, most mental health disorders show up in some form in the oral cavity- right from stress, to bipolar affective disorder?

1. Depression-

Which is commonly known to cause a lack of will/motivation to perform basic self-care acts (brushing teeth for example), inevitably leading to poor oral health. People with mental illnesses are at greater risk of oral health problems because of poor nutrition and oral hygiene, heavy consumption of sugary drinks, comorbid substance misuse including tobacco, alcohol, or psychostimulants. This can result in gum disease and tooth decay.

You knew this. What you didn’t know is that the perception of dental pain may also be exacerbated by depression or anxiety, regardless of the degree of oral pathology. For example, burning mouth syndrome is burning pain in your mouth that doesn’t have a known cause. Occurring in people with the clinically healthy oral mucosa, this syndrome is often associated with depression or anxiety.

2. Bulimia-

Bulimia nervosa is characterized by attempts to curtail food intake, interspersed with binge eating, followed by self-induced vomiting to rid the body of food.

Dentists are often the first health care providers to recognize the physical and oral effects of eating disorders, such as

-- tooth erosion and increased sensitivity in the teeth, which occurs as the gastric acid from the stomach comes in contact with teeth due to repeated vomiting

-- Self-induced vomiting in bulimic patients may cause trauma to soft tissues around the palate, causing ulceration.

-- Low levels of calcium are also common, due to poor nutrition, which could affect the health of the teeth

-- Patients with bulimia also exhibit changes in salivary gland pathology.

The association between eating disorders and oral health problems was initially reported in the late 1970s. patients with eating disorders had 5 times the odds of dental erosion compared with controls.

3. Excessive stress-

which a lot of us face without consciously realizing it- has a very significant effect over a long period of time.

Under high stress, we tend to do one of three things

  1. Clenching our teeth real tight during the day, or sometimes while asleep, without realizing it. If you wake up with an aching jaw, this could be why. What happens is, when you grind/clench your teeth for long periods of time, the enamel starts to wear away. The process is known as attrition.

  2. Taking out all our frustration while brushing- brushing really violently. If your toothbrush gets frayed too often, check-in with yourself, because we suspect something’s on your mind. This leads to abrasion, where the enamel is being worn away by an external agent such as a toothbrush.

  3. High stress leads us to get acid refluxes, frequent vomiting or over drink colas, or sports drinks which lead to erosion (where there is the chemical dissolution of the tooth), again leading to a decrease in tooth structure.

  4. Patients with bipolar affective disorder, too, tend to subconsciously engage in over-vigorous brushing, typically In the manic phase, causing dental abrasion as well as mucosal or gingival lacerations.

  5. Ever had one of those annoying painful ulcers in your mouth? Also stress related, I tend to get aphthous ulcers or cankers sores every time exam season rolls around.

  6. Another oral problem that also starts as a result of stress among other etiologic factors, is oral lichen planus. Classified as a premalignant condition, this has potential to turn into cancer. (that escalated quickly, didn’t it?)

  7. Medication used in mental health disorders usually leads to xerostomia, also known as dry mouth, which is a result of reduced saliva flow. Xerostomia in turn leads to a host of other disorders.

So we see, there is a close connection between the health of the body and that of the mind. There is evidence to suggest that those who experience mental illness also suffer with poor oral health.

During the difficult period of the pandemic, what are some measures you can take to better care for your mental health?

What you can do-

  1. Don’t neglect your oral hygiene. Yeah, you heard it a billion times. But times are already hard and this is a small step that makes a big difference.

  2. Identify stress- take note of ulcers you may have in your mouth, of how frayed your toothbrush is, and of whether you might be clenching your teeth. If you find these to be true, make sure you take targeted stress reduction measures- feel good activities, talking to someone, physical exercise. It's important to identify stress in order to work on it.

  3. Notice if your jaw hurts in the morning, because it means that you may be grinding your teeth at night due to subconscious stress. We don't always consciously realize how stressed we are, and that's normal. Along with working on your stress, you must make sure your jaw and teeth are not bearing the brunt of your stay-at-home frustration. You can call up your dentist and get fitted for a night guard, which basically cushions the blow of your stress on your teeth.

Mental health- is not just in your mind. It affects your physical health too.

The burden of mental disorders is likely to have been underestimated because of inadequate appreciation of the connectedness between the two.

No mental health, no dental health.

We often underestimate our feelings, only because we feel like it's not as serious as something like anxiety or depression. But now you know, that something as seemingly simple as stress can have such detrimental effects on our physical well being. If your mental health can have such an impact on your oral cavity, which is a tiny part of your body, imagine the impact it has on other systems of your body.

Times are tough, and we must take your mental health seriously. If you do find yourself struggling, reach out to our helpline and we will help guide you to a professional.

Written by Kareena Rajani

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