Stress and Oral Health

Question 1

Describe 2 pathways in which stress can affect oral health

Answer 1

1. Direct - oral disease thought to result from prolonged and acute stress
2. Indirect - behavioural changes to oral health practices as a result of being stressed

Question 2

Describe stress as an actual risk factor for poor oral health

Answer 2

Not an established risk as risk indicator-association between stress and oral health has not been established by longitudinal studies

Question 3

What do current studies suggest in terms of stress and periodontal disease?

Answer 3

A role for psychosocial stress in aetiology of periodontal disease

Question 4

Describe the research carried out which suggests the relationship between stress and periodontal disease

Answer 4

• Alveolar bone loss
• Salivary levels of cortisol higher in those with severe periodontitis
• Poor coping abilities mean even higher risk of bone loss (Genco, 1996)
• Stress causes periodontal patients to be more resistant to treatment (Deinzer, 1998)
• Stress alters health behaviour and compliance

Question 5

What pathogen is often cited in the link between periodontal disease and cardiovascular disease?

Answer 5

P. gingivalis

Question 6

What was the outcome of research into exam stress and oral health carried out by Deinzer et al.?

Answer 6

After exams significant higher rates of plaque and gingivitis were observed in exam students as compared with controls

Question 7

What are 2 possible explanations for the link between exam stress and oral health?

Answer 7

1. Stress increases inflammation / disease / infection

2. Stress alters oral health behaviours

Question 8

Describe the Biological Model (Direct Pathway) of stress and oral health

Answer 8

• Psychological stress
• Activation of CNS and hypothalamus
• Pituitary gland signals adrenal cortex
• Adrenal cortex releases cortisol which depressed immunity
• Increase susceptibility to periodontal infection leading to periodontal disease

Question 9

Describe the Behavioural Model (Indirect Pathway) of stress and oral health

Answer 9

• Psychological stress
• Behavioural change
• Increase susceptibility to periodontal infection by multiple routes
• Periodontal disease

Question 10

What are 4 behaviours which can increase susceptibility to periodontal infection?

Answer 10

1. Neglecting oral health
2. Smoking
3. Alcohol consumption
4. Poor nutrition

Question 11

What are 5 symptoms temporomandibular joint disorder associated with stress?

Answer 11

1. Pain
2. Worn teeth
3. Sensitivity
4. Toothache
5. Grinding and clenching

Question 12

How is periodontal disease caused by stress?

Answer 12

Alterations in the concentration of adrenal corticoids and response of oral tissues to bacterial toxins and other hormones involved in general adaption syndrome

Question 13

What 2 reasons can mouth ulcers occur more often in stressed individuals?

Answer 13

1. Stress suppresses immune system

2. Ulcers make it difficult to follow normal oral hygiene routine

Question 14

Describe herpes simplex’s association with stress

Answer 14

Often triggered by stress and lack of sleep associated with stress

Question 15

How does xerostomia occur?

Answer 15

Decrease in amount of saliva in mouth leads to dry, uncomfortable feeling in the mouth

Question 16

What is burning mouth syndrome?

Answer 16

Pain throughout the mouth, often attributed to psychological problems and changes in the way nerves in the mouth send messages to the brain

Question 17

What 2 ways can high levels of hormones release during stress affect oral health?

Answer 17

1. Reduce saliva production, allowing plaque to form

2. Decreases immunity, leading to increased risk of oral infection

Question 18

Describe oral lichen planus

Answer 18

Series of oral sores on the tongue or cheeks and is thought to be a reactions to stress-induced viral infections

Question 19

How can anti-depressant medications affect oral health of a patient?

Answer 19

Cause dry mouth which increases the risk of developing tooth decay

Question 20

How can stress affect healing?

Answer 20

Increased stress can reduce healing which causes a person to be prone to infection or complications

Question 21

Suggest 4 ways a dentist can treat patients with stress induced oral health problems

Answer 21

• Be prepared to talk about true causes for dental problems and offer support and advice
• Advise patient they need o address stress for the benefit of their overall health
• Treat oral problem
• Ensure patient practices good oral hygiene