I enter the treatment room, happy to see Nancy, a patient I haven’t seen in quite a while.
“Welcome back,” I greet her, “We’ve missed you!”
Nancy tells me that she’s had a rough year. Her mom passed away after a difficult battle with breast cancer, and Nancy has been grieving and having trouble getting back on track with her regular routines. She only made it into the office today because her back tooth cracked, and it’s hurting her.
A quick look is all I need to see there’s a lot more going on than that. Nancy’s gums are swollen, with visible plaque on her teeth, a number of which are chipped. Her mouth is a very different place than it was the last time I saw her.
“I’m so sorry for your loss,” I tell her, “looks like you’re having a hard time.”
“You’re right,” Nancy admits, and she goes on to describe how her loss has triggered depression and anxiety that are interfering with her sleep as well as her ability to work. She confides that she’s been seeing a therapist and is taking medication to help manage the situation.
Depression, anxiety and other mental health issues often lead to dental problems. Lack of motivation, changes in routine and dry mouth from medication can lead to poor oral hygiene, periodontal (gum) disease, worn and cracked teeth from clenching and grinding, and dental decay. Getting a patient with mental health disorders back on track with their dental care can be a real challenge.
What most people don’t realize though, is that it can work in the reverse as well. Inflammation, in the form of periodontal disease and bruxism, leads to psychological changes too. Short term inflammation, like that caused by a virus or injury, makes us lay low and conserve energy, helping our bodies heal. But chronic inflammation as seen in gum disease persists beyond that limited need for rest and acts continuously on our nervous system. The effect is an interference with motivation and motor activity as well as the chemicals in our brain that affect mental health, like Dopamine, Norepinephrine and Seratonin. The specific condition it triggers – depression or anxiety or others – is determined by other factors such as life events, genetics and preexisting tendencies.
The result is a “Chicken Egg” situation in which both conditions can cause the other and it’s difficult to figure out which came first. The important thing to remember is that either way, all the problems must be addressed if any of them are to be resolved. That’s why my team and I have collaborated with mental health professionals over the years.
We fixed Nancy’s broken tooth and we’ve also worked with her to reestablish a good home care routine to reduce and prevent inflammation. Bringing back her beautiful, healthy smile has increased her confidence and sense of well-being. Remember that your dentist is part of your total health team – and that includes your mental health. Sharing information about psychological and emotional struggles is safe and can be a helpful part of your path to optimal wellness.
Now I’ve said a mouthful.