Depression Causes Tooth-Loss?

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Dentists are no longer the only ones recommending that we brush our teeth - Psychologists are now recommending that we brush twice a day and floss at night. Yes, you read that correctly—an association exists between dental and mental health. Researchers from West Virginia University, Morgantown, have found that people with depression and anxiety are susceptible to tooth loss. 

The Research

The scientific team analyzed telephone surveys conducted through the Centers for Disease Control (CDC). Of the 76,292 eligible participants, 13.4% claimed to have depression, 16.7% claimed to have anxiety, and 5.7% claimed tooth loss. When compared to those without these conditions, the study indicates that depression and anxiety have a significant effect on dental hygiene and may lead to chronic conditions that lead to tooth loss.  

Moreover, in 2011, the CDC conducted a survey regarding tooth loss and the existence of depression and anxiety. Both men and women with tooth loss were more likely to have current diagnoses of depression or anxiety. In particular, women who did not visit the dentist within the past year were 29% more likely to have depression than women who attended their regular dental exams. The association is clear, but why does depression and anxiety lead to possible tooth loss?

Really?!  Depression & Anxiety Cause Tooth-Decay?

The presence of major depressive disorder and anxiety in a person’s life can significantly alter his or her dental hygiene. People with depression or anxiety are more prone to suffer from periodontal (gum) disease. Gum disease can be chronic and serious, leading to tissue and bone damage, and eventually tooth loss. Depression and anxiety can increase the presence of many risk factors for gum disease, which are smoking, grinding and clenching teeth, suppressed immune systems, use of certain medications, hormonal changes, the existence of other illnesses (diabetes, AIDS), and general neglect.

Not only can depression and anxiety lead to gum disease, but the presence of depression and anxiety may prevent dentists from treating this disease effectively. In one study, researchers found that patients with a diagnosis of depression are two times more likely to exhibit negative results from periodontal treatment. People with depression typically have more issues with tooth attachment and alveolar bone loss (tooth sockets in jaw bone). Researchers indicate that people with depression may be less likely to follow through with dental recommendations post-treatment, may be more likely to smoke, and may have suppressed immune systems.

Depression may also cause extensive decay. Low levels of serotonin, a chemical in the brain, may lead to depressive symptoms. People with low serotonin levels may crave more carbohydrates and sugars, putting them at risk for tooth decay. Depression, anxiety, and many other illnesses linked to these psychiatric disorders can also cause chronic dry mouth, which often leads to tooth decay. Medications may decrease a person’s salivary output. In addition to these complications, an overall disinterest in hygiene, which is a common side-effect of depression, will typically lead to dental decay.

Depression & Anxiety = Bad Breath Blues

Other effects of depression and anxiety on oral health are chronic pain in the mouth and face, bad breath, and candidiasis (oral yeast infection). The latter is common among those with immune issues, poor hygiene, dry mouth, chronic medical conditions, and is most common among the elderly (dentures) and infants.

According to two studies published by the International and American Associations for Dental Research, two global populations are at an increased risk for poor oral hygiene: the elderly and low-income individuals. By itself, income inequality increases the chances of tooth loss by 20%. When combined with old age, the probability increases significantly, especially when compared to elderly with wealth. The findings are significant, because both low-income and age are risk factors for depression. Compounded with depression, the danger for tooth loss is considerable.

Besides eating problems, the loss of teeth can lead to a number of issues that may cause more serious consequences. Tooth loss can lead to speech issues, embarrassment, poor self-esteem, facial tension, and problems with nutrition. Overall, these issues can lead to less pleasure, poor health, little social interaction, and ultimately, symptoms of depression and anxiety.

Together with a dentist (and possibly a mental health professional), people with depression and anxiety can work toward better oral health. Each individual should create a plan with their dentist, including medical and substance use history. It is recommended that each person perform dental hygiene routines at home and visit the dentist twice per year for regular cleanings. Antidepressants and other medications to ease pain or reduce infections may be necessary. People are encouraged to quit smoking and to stay hydrated. Sedation dentistry is available to patients with overwhelming fears of dental work. In addition to these, therapy or activities to promote wellness and self-esteem may help in the process of taking control of complete health.

- Melissa Lavery, M.S.
 

References

Depression and Dental Health. (2008, February 6). Retrieved January 19, 2015, from http://www.dentalgentlecare.com/depression_and_dental_health.htm

Garavaglia, B. (2011, October 5). Gerotalk: Cause of Depression and Anxiety: Tooth Loss? Retrieved January 19, 2015, from http://community.advanceweb.com/blogs/ltc_2/archive/2011/10/05/cause-of-depression-and-anxiety-tooth-loss.aspx

International & American Associations for Dental Research. (2014, March 20). Tooth loss linked to depression, anxiety. ScienceDaily. Retrieved January 19, 2015 from www.sciencedaily.com/releases/2014/03/140320111903.htm

International & American Associations for Dental Research. (2011, April 24). Oral health inequalities in older people. ScienceDaily. Retrieved January 19, 2015 from www.sciencedaily.com/releases/2011/04/110424152500.htm

Periodontal (Gum) Disease: Causes, Symptoms, and Treatments. (2013, September 1). Retrieved January 19, 2015, from http://www.nidcr.nih.gov/OralHealth/Topics/GumDiseases/PeriodontalGumDisease.htm

World Psychiatric Association. (2011, February 4). Income inequalities are increasing the occurrence of depression and suicide attempts during the current financial crisis. ScienceDaily. Retrieved January 19, 2015 from www.sciencedaily.com/releases/2011/02/110204130416.htm