When it comes to your body, it’s helpful to remember that everything is, quite literally, connected. Your gut health can affect your mood, and your menstrual cycle can affect your muscles and joints. The same is true for your mental and oral health—they impact each other in very real ways. Patients with severe mental health conditions are 2.7 times more likely to lose all of their teeth, and multiple studies have shown that patients grappling with their mental health have higher rates of gum disease and tooth decay, says Greg Grillo, DDS, practicing dentist at Express Dentist.

It’s also worth mentioning that mental and dental health care are largely cost-prohibitive and discriminatory against people of color and other marginalized groups. “Even in countries with universal health care, coverage does not comprehensively include dental treatment,” says Steve Kisely, MD, PhD, writes in the Canadian Journal of Psychiatry. When two very vital, yet often stigmatized, healthcare fields are hard to navigate, cost-prohibitive, and compounded by marginalizations like race, gender, socioeconomic status, and more, it makes sense why there would be larger consequences.

The bottom line is that struggling with dental hygiene and mental health isn’t a moral failing, and many barriers make addressing both difficult. Below, we explain how your mental health might impact your oral health and what to do if you’re dealing with both.

1. It can be harder to stick to an effective routine

Mental health issues like depression might cause low energy, which makes performing daily tasks more difficult, and people with attention-deficit/hyperactivity disorder (ADHD) often struggle with executive function, the cognitive set of abilities that allow us to monitor and track tasks, inhibition, task initiation, planning, and memory. When executive functioning is disrupted, so is your ability to maintain a schedule and regulate your tasks. This can impede someone’s ability to stick to a brushing routine.

Additionally, antidepressants can cause dry mouth as a result of reduced saliva flow, Dr. Grillo explains. Less saliva can put you at a higher risk for cavities, so—even if you have a solid oral health care routine—finding solutions for this or visiting the dentist more frequently might be necessary.

If you find these tasks challenging over a long-term period, it’s easy to feel ashamed or scared to address the problem, Dr. Kisley says, adding that these fears are often compounded by a dentist that makes disparaging comments about patients, only furthering the shame spiral.

2. Dental-related fears and anxieties might make you avoid regular check-ups

Many individuals have intense anxiety about going to the dentist, which can harm their dental health, Dr. Grillo adds. This can be because of an anxiety disorder or past traumatic experiences at the dentist. It’s also a common fear—whether or not you have a diagnosable mental health condition.

In a 2017 study from the American Dental Hygienist’s Association, 20 percent of participants reported some form of dental anxiety, and 8 percent of participants reported missing dental appointments because of this feeling. The study identified that the root causes behind dental anxiety included fears of negative experiences, previous negative experiences, cost of treatment, gag reflex, or fear of bad news. So if you’ve been avoiding dental offices because you’re afraid of the dentist, you aren’t alone.

3. Sensory sensitivities can make dental visits more difficult

The dental care experience is full of sounds, smells, sights, and tastes. It can be challenging for individuals with Autism Spectrum Disorder to perform or receive dental care because of these sensory sensitivities. Sensory sensitivities related to dental health include stiff bristles, unpleasant chalky toothpaste, bright lights of a dentist’s office, uncomfortable dentist chairs, and more.

When folks avoid tasks because of sensory sensitivity, they’re often labeled as “lazy” or “unhygienic.” This, obviously, isn’t the case. That’s why it’s essential to find an informed oral care provider, therapist, or both, who can help you develop a care plan suited to your needs. This can look like a provider lowering the fluorescent lights, extra verbal reassurance about what’s happening while treating you, recommendations for non-chalky toothpaste.

4. Stress-related behaviors have an impact on your oral health

“With the obvious stress and anxiety that the pandemic has caused, I am seeing more and more patients who are presenting with chronic jaw and headaches,” says Saul Konviser, BDS MSc BSc and lead general dentist at Montagu Dental. This is directly related to stress-induced clenching and teeth grinding that cause muscle tension and tooth damage. He adds that this has led to an increase in fractured fillings.

“I also see many patients who seem to take out their daily stresses on their teeth when they brush them,” says Dr. Konviser. Excessive brushing causes recession of the gums, and as such, this exposes the root surface. On its own, this can lead to sensitivity, but with further aggressive brushing, it can wear away the tooth structure making it more susceptible to fracture, sensitivity, and decay.

5. Disordered eating can cause tooth decay or nutrient deficiency 

It’s also worth noting that frequent purging from disordered eating and eating disorders, like bulimia, can contribute to oral health problems. This is because the acidic nature of stomach bile can chemically erode tooth enamel over time, Dr. Wisely explains. These already isolating conditions can be challenging to discuss in the first place, let alone their health consequences. In a small study, 70 percent of participants who experienced purging had some form of tooth decay.

The intensity and isolating nature of disordered eating can make it difficult to discuss, but talking openly is the best way to destigmatize the illness and find support. There is a way to find treatment for your disorder and your teeth. Consider seeking support groups through the National Eating Disorder Association, talking to a trusted loved one, and consulting a clinical mental health professional.

You deserve treatment that works for you

You deserve respect, attention, and dignity as you navigate the health care system. It can help to find a gentle, trustworthy, and understanding provider who listens to what you are going through and can help you develop a routine that works for you.

Shame and stigma might make you hesitant to seek help from a dentist, but there are oral care providers who are willing to help. If you are struggling to find a dentist that suits your needs, the American Dental Association (ADA) has a Find-a-Dentist database where you can find ADA-certified dentists with information about their practice and accepted insurances.

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