Stress and Oral Health
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Describe 2 pathways in which stress can affect oral health
• Direct - oral disease thought to result from prolonged and acute stress • Indirect - behavioural changes to oral health practices as a result of being stressed
Describe stress as an actual risk factor for poor oral health
Not an established risk as risk indicator-association between stress and oral health has not been established by longitudinal studies
What do current studies suggest in terms of stress and periodontal disease?
A role for psychosocial stress in aetiology of periodontal disease
Describe the research carried out which suggests the relationship between stress and periodontal disease
• Alveolar bone loss • Salivary levels of cortisol higher in those with severe periodontitis • Poor coping abilities mean even higher risk of bone loss (Genco, 1996) • Stress causes periodontal patients to be more resistant to treatment (Deinzer, 1998) • Stress alters health behaviour and compliance
What pathogen is often cited in the link between periodontal disease and cardiovascular disease?
P. gingivalis
What was the outcome of research into exam stress and oral health carried out by Deinzer et al.?
After exams significant higher rates of plaque and gingivitis were observed in exam students as compared with controls
What are 2 possible explanations for the link between exam stress and oral health?
• Stress increases inflammation / disease / infection 2. Stress alters oral health behaviours
Describe the Biological Model (Direct Pathway) of stress and oral health
• Psychological stress • Activation of CNS and hypothalamus • Pituitary gland signals adrenal cortex • Adrenal cortex releases cortisol which depressed immunity • Increase susceptibility to periodontal infection leading to periodontal disease
Describe the Behavioural Model (Indirect Pathway) of stress and oral health
• Psychological stress • Behavioural change • Increase susceptibility to periodontal infection by multiple routes • Periodontal disease
What are 4 behaviours which can increase susceptibility to periodontal infection?
• Neglecting oral health • Smoking • Alcohol consumption • Poor nutrition
What are 5 symptoms temporomandibular joint disorder associated with stress?
• Pain • Worn teeth • Sensitivity • Toothache • Grinding and clenching
How is periodontal disease caused by stress?
Alterations in the concentration of adrenal corticoids and response of oral tissues to bacterial toxins and other hormones involved in general adaption syndrome
What 2 reasons can mouth ulcers occur more often in stressed individuals?
• Stress suppresses immune system 2. Ulcers make it difficult to follow normal oral hygiene routine
Describe herpes simplex’s association with stress
Often triggered by stress and lack of sleep associated with stress
How does xerostomia occur?
Decrease in amount of saliva in mouth leads to dry, uncomfortable feeling in the mouth
What is burning mouth syndrome?
Pain throughout the mouth, often attributed to psychological problems and changes in the way nerves in the mouth send messages to the brain
What 2 ways can high levels of hormones release during stress affect oral health?
• Reduce saliva production, allowing plaque to form 2. Decreases immunity, leading to increased risk of oral infection
Describe oral lichen planus
Series of oral sores on the tongue or cheeks and is thought to be a reactions to stress-induced viral infections
How can anti-depressant medications affect oral health of a patient?
Cause dry mouth which increases the risk of developing tooth decay
How can stress affect healing?
Increased stress can reduce healing which causes a person to be prone to infection or complications
Suggest 4 ways a dentist can treat patients with stress induced oral health problems
• Be prepared to talk about true causes for dental problems and offer support and advice • Advise patient they need o address stress for the benefit of their overall health • Treat oral problem • Ensure patient practices good oral hygiene