Dear Patient: Your teeth get stressed out, too

Your coworkers leaving all the end-of-day tasks undone as they slide out the door …

Family members coming for an extended visit … that seems to keep extending…

Your kids letting you know about the two dozen cookies they need for school tomorrow as you are tucking them into bed ….

All of these scenarios can fill your body with stress. Your blood pressure skyrockets as your muscles tighten. You might experience headaches, stomach aches, or a flareup of a dormant condition. We all know that stress is not good for our overall health. It weakens the immune system and increases cortisol levels (hello, weight gain!). But stress can have a negative effect on the mouth, too.

Inflammation that gets worse

The body’s inflammatory response is triggered by stress. It jumps into action, trying to eliminate the stressor and bring the body back into balance. This can be a good thing when it comes to an isolated incident, but when the body is in a constant state of stress, the inflammatory response keeps responding, and the cortisol keeps flowing.

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I’ve seen patients go from minimal bleeding one visit to a bloodbath in three months. When I ask about it, they often report a stressful event going on in their lives. That stress is reflected in their gums, causing severe inflammation or gingivitis. If left unchecked, the gingivitis can quickly progress into periodontitis, or full-blown gum disease eating away at the bone that holds in their teeth.

Oral infections or sores

An immune system depleted by stress can allow dormant viruses and conditions to wake up. Conditions such as lichen planus can form lacy white patches and painful sores throughout the mouth. Many people report feeling that onset tingle warning them that an aphthous ulcer (canker sore) or herpetic lesion (cold sore) is coming. And, of course, sores love to pop up before big events and ruin all the pictures. 

Clenching and grinding

Stress has to go somewhere, and for many of people, it’s the jaw that bears it. Clenching your mouth shut to keep from rear-ending the guy in front of you in the left lane … or spending the night grinding your teeth as you process your day in your dreams. Many people have adopted these bad habits and don’t even realize they’re doing it until they feel jaw pain, headaches, and a sore neck. 

All of this clenching and grinding can lead to painful popping and clicking when you chew or open your mouth; it can even progress into issues opening and closing your mouth. I started grinding my teeth back in college, and my canines went from nice and pointy to flat as I wore down the enamel.

Increased sensitivity

All that grinding can eventually lead to sensitive teeth. During grinding, teeth flex back and forth in the socket. This can affect the entire tooth, from the tip of the roots to the chewing surface. When enamel is ground away, it reveals the underlayer of your tooth, called dentin. This layer is softer and more prone to cavities, and doesn’t have the thermoconductive layer of enamel—meaning hot and cold can feel like a zinger!

Surprisingly, even the sides of your teeth can be affected by grinding. As that flexing occurs, the enamel at the gumline can ditch out. This is called an abfraction lesion. Recession can also happen in these areas. All of this is exposing more of the dentin layer of your teeth. And cold drinks can find those areas in a flash.

Fractures, root canals, and extractions

Over time, clenching and grinding can end up in your teeth breaking, affecting the nerve of the tooth and even causing you to lose that precious chomper. Repeated flexing can cause a hairline stress fracture that allows the tooth to open and close, which causes fluid to push in and out of the nerve canal. This can cause pain when biting and allow bacteria to enter the nerve canal. If left untreated, the crack may grow, eventually breaking off or affecting the nerve. The size and place of the fracture would determine if you can save the tooth.

If you find yourself suffering from any of these conditions, be sure to reach out to your dental home for help on how to treat the effects of stress—and take a yoga class!

Amanda Hill, BSDH, RDH, describes her career in dental hygiene as an adventure. Growing up and marrying into the military, she experienced dentistry throughout the world. She is a speaker, consultant, and award-winning author. A member of the advisory board for RDH magazine, frequent author on DentistryIQ, and the recipient of OSAP’s Emerging Infection Leader award, Hill strives to make topics in dentistry accurate, accessible, and fun. You can reach her at [email protected].