By A/Prof Adrian Yap, Specialist in Prosthodontics

1. We’ve heard of stress causing headaches, bad skin and even tummy upsets. Stress can affect one’s oral health as well. Is this true? Why is there a link between emotional stress and oral health?

Stress is a non-specific natural biological response to demands made on a person and is synonymous with change. During stressful situations, the brain releases stress hormones into the bloodstream, setting in motion a “fight or flight” response. While small increases in stress hormones are beneficial, higher and prolonged levels of stress hormones associated with chronic stress have been shown to many negative effects including impairment of mental processes, increased blood pressure and lowered immunity. The oral symptoms of stress include mouth sores, gum disease, bruxism (uncontrolled and unconscious clenching and grinding of teeth) and Temporomandibular Disorders.

2. My colleagues and I tend to complain about getting mouth ulcers whenever it’s crunch time. Is there a reason and is it stress-related? How do we get rid of ulcers in the mouth?

Stress, as well as fatigue and allergies, can increase the risk of getting mouth ulcers. Although the exact relationship is not known, mouth ulcers have been associated with decreased body immunity and the presence of bacteria and viruses. Most mouth ulcers will usually disappear after seven to 10 days. To reduce pain and irritation, don’t eat spicy, hot foods or foods with high acid content. Over-the-counter topical anaesthetic or antiseptic gels may be useful.

3. I notice my jaw aches when I wake up (presumably from all the teeth grinding and clenching while sleeping), especially during high-stress periods. Why do people grind their teeth at night when they are stressed, and how commonly do you see such cases in your practice?

The grinding and clenching of teeth during sleeping is known as sleep bruxism. Many people also clench their teeth while awake when stressed, anxious or exercising. Sleep Bruxism is particulary damaging as the forces exerted on the teeth, chewing muscles and jaw joints can be up to eight times that of normal eating. In additional to stress, sleep bruxism has been attributed to genes, altered brain chemistry, sleep disturbance, the consumption of coffee and alcohol. As a tertiary referral centre for jaw and bite problems, we see many such cases on a daily basis.

4. What long-term oral health problems do teeth-grinding lead to, and how to get rid of this problem?

Teeth grinding can lead to tooth wear, sensitivity, mobility and fracture. It can also lead to the premature failure of fillings / prostheses, poor appearance of anterior teeth, reduced facial height, over-developed facial muscles and Temporomandibular Disorders (TMD). The latter refer to a collection of medical and dental conditions affecting the jaw joints, chewing muscles and associated structures. Symptoms include headaches, ear pain, jaw pain, jaw joint sounds and jaw function difficulties. Sleep bruxism can also have social effects as it affects the sleep of others. It cannot really be stopped but is managed using a combination of drugs, psychological and dental strategies including the use of mouth guards or splints.

5. What are some other potential oral health problems that can occur with too much stress?

Another oral symptom of stress is gum disease. Research had found that the severity of gum disease increases with the amount of stress experienced in the previous year. Besides decreasing one’s resistance to gum infection, stress may also encourage habits that have a negative impact on oral health including neglect of routine oral hygiene and regular professional care, smoking, consumption of alcohol, coffee and unhealthy snacks.

6. From experience, do you tend to see more of these oral health problems during the economic downturn? What about patients with more stressful jobs?

We see patients with stress-related problems all year round. The number of younger patients tends to increase during examination periods especially the “O” and “A” level examinations. Many patients with stress-related oral health problems tend to have stressful lifestyles. Our research in Singapore has shown that approximately 50% of patients with TMD are depressed and have other psychological problems.

For more information or to make an appointment, please call our appointment hotlines or email us at dental@raffleshospital.com