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Anxiety, Depression, Stress, and Oral Health

Course Number: 573


Poor oral health in individuals with common psychological problems remains a prevalent and unaddressed problem. Patients with anxiety, chronic stress, and depression experience increased risk for caries, periodontal disease and tooth loss. These conditions can have a significant effect of overall quality of life. Painful, unesthetic dentition and missing teeth may worsen social isolation and low-self esteem as well as result in problems with mastication and phonetics. For individuals who are suffering from psychological illnesses, this could contribute to increased severity of their psychological symptoms. Given the multiple facets associated with the interaction of oral health and anxiety and depression, a multi-pronged, interdisciplinary approach should be applied.

Clinical Recommendations:

  1. Physicians and mental healthcare providers should consider the effects of oral health within the focus on the physical health of patients with psychological illnesses. Identification of potential oral health issues, advice on dietary intake and oral hygiene, and early dental referral are critical to address and manage oral health in individuals with psychosocial illnesses.

  2. Identification of individuals with depression and anxiety in the dental office and an understanding of the effects that these conditions have on common oral health conditions is critical, given the stigma associated with mental health disorders and the large number of individuals who are undiagnosed, untreated, or undertreated.

  3. Developing relationships with primary care providers and/or mental health professionals to allow for bidirectional referrals to optimize physical and mental wellness of patients is critical.

  4. Risk assessment for caries and periodontal disease should be undertaken to allow dental healthcare and medical professionals to discuss artificial salivary products, administration of high fluoride dentifrices and gels, and increased dental maintenance intervals based upon the patients’ individualized risks and conditions.

  5. Additional recommendations to reduce overall levels of stress in patients with depression and anxiety may include addressing coping mechanisms, increased social networks, and physical exercise and should be reinforced by both medical and oral healthcare providers.