How stress affects your oral health

Stress shows up in the mouth more than most people realise. Some of it is direct — the body's response to stress changes the mouth's chemistry. Some of it is indirect, through what stress does to habits. Here is what to watch for, and what actually helps.

The short version

Grinding and clenching

The most common stress-related dental problem. Most people grind at night without knowing; some clench through the day at a desk or in traffic. The signs are worn or chipped teeth, cracked fillings, a sore jaw or temples on waking, and morning headaches.

Enamel worn away does not come back. A custom night splint protects the teeth from the wear; managing the stress addresses the cause. Read more on bruxism and stress.

How to tell if you grind

You will usually be the last to know, since most of it happens asleep. The tells:

• Waking with a tired or aching jaw, or a dull headache in the temples
• Flattened, shiny wear facets on the biting surfaces — your dentist can show you these
• Fillings that keep chipping or failing in the same teeth
• Increasing cold sensitivity across several teeth at once
• Scalloped edges on the tongue or a ridged line along the inside of the cheeks
• A partner who has heard it — the most reliable indicator there is

None of these on its own proves anything, but several together are worth mentioning at your next visit.

Jaw pain

Clenching loads the jaw joint and the chewing muscles. Persistent stress can turn occasional tightness into pain, clicking, restricted opening, or headaches that radiate from the jaw. See TMD and jaw treatment.

Things that help a flare, alongside whatever we do: a soft diet for a week, no chewing gum, heat on the muscles for fifteen minutes, gentle opening within a comfortable range, and avoiding wide yawns and biting big sandwiches. Things that make it worse: chewing on one side, resting your chin on your hand, and sleeping on your front with your head turned.

Dry mouth

Stress reduces saliva flow, and so do many of the medications prescribed for anxiety and depression. Saliva is your main natural defence against decay — it neutralises acid and repairs enamel — so a dry mouth raises decay risk substantially.

If your mouth is dry: sip water through the day, chew sugar-free gum to stimulate flow, avoid alcohol and caffeine late in the day, and tell us, because it changes what we recommend — often high-fluoride toothpaste.

Do not stop a prescribed medication over this. Tell us what you take and speak to your prescriber; sometimes there is an alternative and sometimes there is not, and either way the prevention can be adjusted around it.

Mouth ulcers and cold sores

Stress is a well-recognised trigger for recurrent mouth ulcers, and for cold sore outbreaks in people who carry the virus. Ulcers usually heal within a week or two. Any ulcer, lump, or red or white patch lasting more than two weeks should be examined, stress or no stress.

Managing an ulcer meanwhile: warm salt-water rinses, avoiding acidic, spicy and crunchy food, and an over-the-counter protective paste or gel from the pharmacist. Some toothpastes containing strong SLS foaming agents aggravate recurrent ulcers in some people; switching to an SLS-free paste is a cheap experiment worth running.

See a GP rather than assuming stress if ulcers are frequent, unusually large, appear in crops, or come with other symptoms such as joint pain, bowel symptoms or weight loss.

Cold sores start with a tingle before anything is visible, and antiviral creams work best applied at that point. Do not have elective dental treatment during an active outbreak — the lip is stretched during treatment and it can spread.

Other things stress shows up as

Burning mouth. A persistent burning or scalded sensation, often of the tongue, with nothing visible to see. It is a recognised condition, more common in women after menopause, and stress and anxiety are among the associated factors. Other causes — nutritional deficiency, dry mouth, diabetes, thrush, medication — need excluding first, so it is worth investigating rather than enduring.

Oral lichen planus. White lacy patches, usually on the inside of the cheeks, sometimes with soreness. Stress is commonly reported as a factor in flares. It needs diagnosis and monitoring rather than self-treatment.

Nail biting, lip and cheek chewing, pen chewing. Straightforwardly damaging — chipped front teeth, traumatic ulcers, and load on the jaw. Often unconscious, and worth substituting rather than suppressing.

Tongue thrusting or pressing against the teeth, which some people do when concentrating.

Gum disease

Stress affects immune function, and people under sustained stress show more gum inflammation and slower healing. Combined with the habits below, it is a genuine risk factor for periodontitis.

Reflux and erosion

Less often connected to stress, and worth knowing about. Stress can aggravate reflux, and stomach acid reaching the mouth dissolves enamel directly — typically on the inner surfaces of the upper front teeth and the biting surfaces of the molars, where you cannot see it happening.

Unlike decay, erosion is not caused by bacteria and brushing harder does not help. Do not brush straight after reflux or vomiting — the enamel is temporarily softened, and brushing then removes more of it. Rinse with water, wait half an hour, then brush.

If reflux is a regular thing, it is worth raising with your GP as well as with us.

The indirect route: habits

This is often the bigger effect. Under stress people snack more, particularly on sugar; drink more coffee, alcohol and soft drink; smoke or return to smoking; sleep badly; and — crucially — let brushing and flossing slip. A month of skipped night-time brushing does more damage than the stress itself.

People also postpone dental appointments when life is difficult, which means problems are found later and cost more.

A minimum routine for a bad month

When everything is slipping, this is the version worth defending. It is not the ideal routine; it is the one that prevents most of the damage.

1. Brush at night. Two minutes, fluoride toothpaste, spit and do not rinse. If only one brush happens in a day, make it this one
2. Water between meals. Not coffee, not soft drink, not sipping anything sweet at the desk
3. Clean between the teeth three times a week, if daily is not happening
4. Wear the splint if you have one
5. Keep the check-up. Ten minutes on the phone to reschedule is not the same as cancelling

That is the whole list. Perfection is not the target during a difficult period; not losing ground is.

What helps

• Protect the teeth first. A night splint if you grind. It does not fix the stress, but it stops the damage while you work on the rest
• Keep the basics going. Two minutes twice a day, clean between the teeth, water rather than sweet drinks. When everything else is slipping, hold the line on the night-time brush
• Notice daytime clenching. Teeth apart, lips together, tongue on the palate. A reminder on your screen works
• Sleep, exercise, less caffeine and alcohol — the things that help stress also help the mouth
• Talk to someone. Persistent stress and anxiety are worth raising with your GP. Psychological support is not a last resort; it is the treatment that addresses the cause rather than the symptoms
• Do not cancel the check-up. Tell us you are under pressure, and we can prioritise what matters and leave the rest

The resting position, which does most of the work

For daytime clenching, this is the single most useful habit: lips together, teeth apart, tongue resting lightly behind the upper front teeth.

Your teeth are only meant to touch when you swallow or chew — a few minutes a day in total. If yours are touching as you read this, that is the habit to break. A recurring phone reminder for the first fortnight works better than willpower, and most people are startled by how often they catch themselves.

Particular periods

Exam and deadline periods. Grinding, energy drinks, grazing, and a brushing routine that collapses. Usually short-lived. The splint and the night brush are the two things worth holding.

New parents. Broken sleep, snacking at odd hours, and one's own appointments going last. Statistically the period when adults most often lapse for a couple of years. Book your own check-up at the same time as the baby's first visit.

Shift work. Eating at 3am, when saliva flow is lowest, is harder on teeth than the same food at midday. Water through the shift, food at defined breaks, and a proper brush before sleeping.

Grief, illness or caring for someone. Everything above, for longer. There is no useful advice here beyond: tell us, keep the night brush, and come back when you can — nobody will comment on the gap.

When the mouth is the first sign

Occasionally the dental chair is where a stress problem is noticed first — wear that has appeared since last year, gums that have deteriorated without any change in cleaning, a jaw that has become painful. We are not the right people to treat the cause, but saying plainly what we are seeing is sometimes useful information at a moment when someone has not connected the two.

If that is you, it is a reasonable thing to take to your GP.

What we would not claim

A dentist cannot treat your stress. What we can do is protect your teeth from its effects, catch problems early, and be straight with you about what is stress-related and what is not.

The reverse is also worth saying: do not assume a symptom is stress. "It's probably just stress" is a reasonable thought and a poor diagnosis, and it is the most common reason a problem that needed looking at went unexamined for a year.

Questions we are asked

Will a splint stop me grinding? No. It protects the teeth from the wear and often eases morning jaw ache; it does not stop the behaviour.

Can I use a chemist mouthguard instead? For grinding, we would not recommend it. A soft, chewable guard can increase muscle activity rather than reduce it, and a poorly fitting one can aggravate the joint. See occlusal splints.

Is grinding in children a problem? Very common and usually outgrown. A splint is not normally appropriate for a growing mouth. Mention it and we will look at the wear.

My jaw clicks but does not hurt — should I worry? Painless clicking, on its own, usually needs no treatment at all. Clicking with pain, or a jaw that catches or locks, does.

Can stress cause tooth pain on its own? Clenching can make teeth ache and feel tender to bite on, and that is real. But a painful tooth should be examined rather than attributed to stress, because the treatable causes look the same from the outside.

Does my antidepressant affect my teeth? Some cause dry mouth, and some are associated with increased clenching. Neither is a reason to stop taking it. Tell us what you take so we can adjust the prevention around it.

I have not been to a dentist since things got difficult. Common, and not something anyone here will comment on. Say so when you book and we will keep the first visit short.

Victorian Dental Group — 291 Wattletree Road, Malvern East VIC 3145 · (03) 9088 5808 · book online

Victorian Dental Group is a general dental practice and holds no specialist registration. Where a symptom needs medical rather than dental care, we will say so.

Read more about occlusal splints or dental anxiety.

General information only, not personal dental or medical advice. If stress or anxiety is affecting your daily life, speak with your GP. See our disclaimer.