Dentistry and psychological effects:

How oral health impacts mental well-

being

Abstract: Oral health is not only important for maintaining a healthy smile, but also for our
mental well-being. Poor oral health can affect our self-esteem, social interactions, mood and
quality of life. On the other hand, mental health problems can also impair our oral hygiene,
increase the risk of dental diseases and reduce the likelihood of seeking dental care. In this
article, we will explore the bidirectional relationship between dentistry and psychological
effects, and discuss some of the common mental illnesses that can have a negative impact on
oral health.
Keywords: body image; clinical psychology; oral health; dental treatment innovation;

Introduction

Health is an evolving construct that has a subjective meaning. In general, the term health
has expanded in its definition to be more inclusive and has transitioned from just physical
health to overall well-being. This shift all ows health to encompass total body well-being and
includes physical, mental, emotional, social, and spiritual components. To align with the
multi dimensional nature health has gained, the World Health Organization (WHO )created a
unified definition of health in 1948: “a state of complete physical ,mental, and social well-
being and not merely the absence of disease or infirmity.” This demonstrated the importance
of other aspects of health and created a unified definition; necessary for cohesion in practice,
policy, and health services. Although this definition is believed to be too narrow in some
respects, no other definition has received a wide range of consensus.
Individual well-being includes a positive state of mind, functioning, satisfaction, and
fulfillment in life. More specifically, well-being integrates all aspects of health, such a
ssocial, physical, and psychological health, with additional factors like life satisfaction,
development, and activity. This shows that overall health is crucial in developing or
determining one’s well-being. Additionally, this demonstrates why health is subjective.
Individuals have different views, priorities, and attitudes, which alter what health means and
create internal satisfaction standards. Because individual well-being is subjective and self-
reported measures can vary from objective measures, it is preferable to look at both the
subjective and objective indicators when providing care.
As the definition of health has evolved towards encompassing overall well-being, it is
essential to look at health disciplines similarly. In dentistry, for example, poor oral health
impacts not only physical health but also mental and social health.
Oral health is tied to one’s quality of life through oral function, overall health, self-
perception, social acceptance, and social interaction. For example, dental diseases such as
dental caries can cause pain, impaired chewing, reduced appetite, sleep disturbances, and
reduced daily per- formance. Dental diseases can also lead to edentulism, impacting speech
and facial shape, which affects the psychological well-being of individuals and confidence
during social interactions, self-perception, stress levels, feelings of depres- sion, isolation,
and frustration.
The link between social belonging and dental health has historical ties, which include
teeth alterations (shaping or filing, embedding jewels, bleaching, capping, and orthodontics)
to indicate status, power, or attractiveness. These compounding effects on an individual’s
well-being can lead to financial burden through costly treatments for oral health and possible
resulting comorbidities, medications, and other types of therapies. For instance, periodontal
disease and its treatment impacts glycaemic control in diabetes. Additionally, diabetes
requires pharmacologic treatment with insulin, with the adverse effect of weight gain, which
may require further intervention and management. These conditions together can result in
stress and create a need for psychological intervention. all of which create financial burden.
Overall, the effects of oral conditions are far-reaching and can impact one’s quality of life in
many regards.
Halitosis and xerostomia can further illustrate the relationship between oral health and
one’s quality of life. Halitosis is highly prevalent and can affect up to 50% of the population.
More than 90% of the time, halitosis can originate from poor oral hygiene, tongue coatings,
xerostomia, periodontal disease, trapped food debris, and deep carious lesions. However, it
can also arise from respiratory and gastrointestinal systems and be a symptom of
menstruation, hematologic diseases, or medications. This demonstrates that the aetiology of a
dental condition may be complex and shows the bidirectional nature of overall health.
Those affected by conditions such as halitosis and xerostomia are affected psychologically
and socially. Affected individuals may be more apprehensive of social intimacy, decrease
their overall social activity, and be predisposed to anxiety and other mental health disorders.
Because halitosis can have various causes, multidisciplinary treatment of dentists and
psychological caregivers is recommended for its management. This also solidifies the
importance of dentists having basic mental health training and knowledge of acces- sible
supports outside the dental field to better support their patients.
The interconnected nature of the body is bidirectional, meaning that nondental conditions
can also impact oral health. For example, uncontrolled diabetes and depression (with use of
antidepressant medications) can lead to xerostomia. The resulting xerostomia can increase the
risk of dental caries; make eating, swallowing, and speaking difficult and unpleasant; and
cause a sore throat or teeth sensitivity. Overall, this can affect dietary intake, physical health,
and quality of life.
The mouth has even been described as a mirror of the health in the rest of the body and
can be a social indicator. Some social indicators include stress levels indicated by bruxism,
overall health status, and oral health literacy. This mirror reflects that oral examination can
aid in detecting many general health problems, such as nutritional deficiencies, microbial
infections, immune disorders, cancer, and systemic diseases. Amongst the systemic diseases
are HIV, car- diovascular diseases, diabetes, Alzheimer’s disease, rheumatoid arthritis,
cancer, and respiratory diseases. This reinforces the idea that oral health is closely tied to
overall health.
Cultural, religious, spiritual, and personal considerations should be accounted for when
assessing oral health and quality of life. For example, some patients may believe that dental
pain is an inevitable part of an illness or a punishment or may not believe in western
medicine. These perspectives must be respected when providing care and, if possible, should
be integrated into treatment plans. This builds patient relationships and helps patients achieve
a good quality of life according to their own standards.
Dental anxiety has been a research focus over the past several decades. Despite the
advances in dental equipment and procedures, dental anxiety is still recognized as a major
issue in the provision of dental care. Patients with high dental anxiety recall more pain than
they actually experienced in tooth extraction. Empirical evidence demonstrated that a high
level of dental anxiety was significantly associated with irregular dental attendance, delays in
dental treatment, and dental avoidance. Armfield et al reported that high dental anxiety was
related to less frequent dental visits, more severe dental problems, and only visiting dental
clinics for painful dental problems. Hence, high dental anxiety is significantly associated with
poor oral health. In addition, it was found that parents’ dental anxiety and avoidance
behaviors were related to dental caries in children. Hence the vicious cycle of dental anxiety
not only affects a person’s oral health but may also affect the person’s next of kin.
Dental anxiety has a high prevalence, and this combined with a high impact on oral health,
constitutes a serious public health challenge. In a 2021 meta-analysis the global estimated
prevalence of dental anxiety was 15.3% (95% CI 10.2–21.2), meaning that general practicing
dentists are required to handle anxious patients nearly on a daily basis.
Cognitive behavioural therapy (CBT) is recognized as the treatment of choice for specific
phobias, including the most severe form of dental anxiety, dental phobia. A concern for
adverse reactions in patients if this sort of treatment (involving exposure) is applied by a
dentist without support from a psychologist or a psychiatrist has been raised. Both the
severity of the condition as well as common psychiatric comorbidities that could complicate
treatment have been proposed as arguments against CBT treatment by dentists. In evidently,
dentists do recurrently expose their dental anxiety patients to their fears through regular
dental treatment. In a study investigating how an invasive dental treatment (wisdom tooth
removal) affected patients, pain and frequency of previous traumatic experiences were found
to increase the risk for the development of symptoms of anxiety and post-traumatic stress
following the procedure. Although dental treatment may carry a risk for psychological
adverse effects, it is difficult to find evidence that justify a concern for adverse reactions
following dentist-administered dental anxiety treatments. Contrarily, favourable findings
have been reported in the few studies that do exist on the subject. Vassend and colleagues
even found positive effects on general distress after dentist administered treatments of dental
anxiety of varying severity.
 The daily management of patients with dental anxiety in general dental practices often
includes the use of sedatives . A hesitancy towards conscious sedation as part of dental
anxiety treatment is endorsed by reports revealing no positive long-term effects on dental
anxiety levels. Performing conscious sedation in an optimal manner requires good relational
skills as argued by Woolley in 2016. In line with this, studies that systematically combine
conscious sedation with basic skills for patient management generate more promising long-
term effects, including stable reductions in dental anxiety. The evidence-based
communication model “The Four Habits Model” is an example of a method that has proved
to be a helpful tool also in combination with sedation treatment. Awareness of the importance
of adequate communication and functional dentist-patient relationships for treatment outcome
in dentistry is growing. Still, reports on how dentists’ relational skills affect the outcome of
dental anxiety treatments are few. Clinical communication skills, including empathetic skills,
have been identified as important when dental students interact with fearful patients. Yuan et
al. proposed that effective patient-dentist interaction may reduce dental anxiety and shame
and thus function as a driver for regular dental visiting. Since empathy has been shown to be
particularly important to anxious patients, anxiety treatments could be particularly sensitive
to the dentists’capability to create bonds with their patients. Although studies on dentist-
administered dental anxiety treatments are promising, little is known about how the presence
of comorbid psychological symptoms may influence treatment effect, or how dental anxiety
treatment may influence pre-existing problems. Knowledge on how these symptom levels
fluctuate during and after dental anxiety treatment by a dentist in general dental practice is
also lacking. In addition, we know very little about how the dentist-patient relationship
influence outcome of dental anxiety treatments.
Poor oral health can have a detrimental effect on our mental health in various ways.
According to a study by Cleveland, people who are unhappy with their teeth tend to
experience more social anxiety, withdraw from social situations and have lower self-esteem.
Another study by Oral Health Foundation found that people with severe mental disorders are
2.8 times more likely to lose their teeth than the general population, due to neglect,
medication side effects and difficulty accessing dental care. This can further affect their
physical health, as tooth loss can impair their ability to chew and digest food properly.
Mental health can also have a significant impact on our oral health in various ways.
People who suffer from anxiety may grind their teeth at night or clench their jaws during the
day, resulting in worn enamel, tooth fractures and temporomandibular joint (TMJ) disorders.
People who suffer from depression may neglect their oral hygiene, skip dental appointments
or self-medicate with alcohol or drugs, leading to increased plaque accumulation, tooth decay
and gum inflammation. People who suffer from obsessive-compulsive disorder may over-
brush their teeth or use excessive amounts of mouthwash, causing damage to their enamel
and gums. People who suffer from bipolar disorder may have manic episodes where they
indulge in sugary foods or drinks, or depressive episodes where they lose their appetite or
vomit frequently, causing tooth erosion and cavities. People who suffer from schizophrenia
may have delusions or hallucinations that affect their oral health perception or behavior, such
as believing that their teeth are rotting or that they have parasites in their mouth.
Conclusion
Dentistry and psychological effects are closely intertwined, as poor oral health can affect
our mental well-being, and vice versa. Therefore, it is important to maintain good oral
hygiene habits, such as brushing twice a day with fluoride toothpaste, flossing daily and
visiting the dentist regularly. It is also important to seek professional help if we experience
any signs or symptoms of mental illness, such as persistent sadness, anxiety, mood swings or
irrational thoughts. By taking care of both our oral health and mental health, we can improve
our overall quality of life and happiness.

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