Stress and Periodontal Disease: Questions and Answers with Dr. Varon

Health Professional

1. What is the cause of the link between psychiatric conditions and periodontal disease?

Periodontal disease does not develop by itself, and poor self- care behaviors are the most significant practices leading to its development. There are also several other factors that influence the occurrence of periodontal disease:

  • The presence of plaque and calculus. Plaque forms due to bacteria in your mouth. The bacteria forms a 'biofilm' on your tooth structure. To see what I mean, wait about 2 hours after you brush your teeth. Then, use your fingernail to scrape your tooth. The whitish material you see is biofilm. If plaque is left unchecked, calcium ions will be incorporated into the tooth's matrix and form calculus, also known as tartar. Accumulation of plaque occurs when brushing and/or flossing is inadequate.
  • A susceptible host. A person's immune system can be impaired for a variety of reasons. For example, increased cortisol levels from stress or a systemic disease can both directly or indirectly impair the white blood cells that fight off infection.
  • Complications causing impaired cognitive function from a variety of diseases including musculoskeletal and rheumatologic diseases (arthritis, carpal tunnel syndrome), neuropathies and vascular diseases, just to name a few.

2. Are certain mental health problems greater risk factors for tooth troubles than others?

Psychiatric disorders that are severe enough to render a person unable to engage in Activities of Daily Living (ADL) and prohibit a person from administering adequate self-care pose the greatest risk. Medications that manage ADL, or other related issues, have side effects that also increase the risk of developing tooth troubles.

3. Are there any medications currently on the market that contribute to tooth decay/gum disease? (For example, see Depression Expert Patient Deborah Gray's SharePost about suffering from decalcified teeth after taking a medication for 10 years that causes dry mouth).

Yes. There are several classes of prescription medications and over-the-counter drugs that list dry mouth as a side effect. Decreased salivary flow will lead to increased plaque and calculus formation and an increase in the caries rate. Increased plaque and calculus heightens the chance of periodontal infection. The occurrence of dry mouth in any two patients on the same medication is highly variable, however.

In addition, there are some medications that will cause a gingival inflammation. The most notable are Dilantin and Phenobarbitol (used for seizure disorders) and calcium channel blockers (a class of blood pressure medication). My position is that there is an indirect effect between these medicines and gingival inflammation. It is not adequate to simply acknowledge the "root" cause of changes in the environment that leads to these problems. Other environmental factors play a role. For instance, effects are possibly due to soft drink consumption (see my blog on sodas).

4. In what ways do psychiatric conditions impact the outcome of periodontal and other types of treatment?

There is no firm evidence, only speculation, that cortisol levels associated with psychiatric disorders cause periodontal disease. However, there are more studies indicating that these disorders influence self-care activities.

5. What can individuals with mental health problems do to protect their teeth and gums?

More frequent visits to the dentist's office for examinations or dental prophylaxis might be necessary to curtail dental diseases. Alternative methods, such as use of a high-end electric toothbrush and electric floss, may help maintain oral health without the dentist. Through a process of trial and error and consultation of a dental team, an oral hygiene routine can be developed to maintain good oral health.

6. What can individuals with gum disease or other periodontal issues do to improve their course of treatment?

The best way for individuals with gum disease or other periodontal issues to improve their treatment course is to comply with the recommendations of their dental team. Taking medications as prescribed is also important to better mental status and improve self-care.