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April was stress awareness month, so with this in mind our colleague and award winning hygienist – Claire Berry discusses the various effects stress has on oral health.

74% of Adults felt stressed 

The mental health foundation reports that 74% of UK adults have felt so stressed at some point over the last year, they felt overwhelmed or unable to cope. 81% of women said this compared to 67% of men and 83% of 18-24 year-olds said this compared to 65% of people aged 55 and over.

We know that times of stress alters our priorities when it comes to self-care. Because of this, maintaining optimal oral health can often suffer when an individual is experiencing a period of difficulty. So, I thought it would be good to look at the role stress plays on our oral health.

Low immunity

When you are chronically stressed, your immune system becomes compromised. This makes it harder for your body to be able to fight infections. This can result in an increase in dental issues such as ulcers, infections like that seen in pericoronitis (an infection around the wisdom teeth) and herpetic lesions, such as cold sores.

Dental disease

Psychological stress is recognised as a risk factor for dental caries and periodontal disease. This is because of higher cortisol levels, dry mouth, change in diet if comfort eating and inadequate plaque control (reduced self-care due to stress). It’s important we ask our patients about stress levels if we are seeing it making an impact on their oral health and we should feel confident enough to offer them advice on how to manage it. You may advise seeing a GP or seeking therapy, but as healthcare providers we need to help them to help themselves, especially if we are seeing psychological stress manifest in their mouth.

Increased cortisol levels

Under stress we produce elevated amounts of the hormone cortisol. As your body perceives stress, your adrenal glands makes and releases this hormone into your bloodstream. Often known as the “stress hormone,” cortisol causes an increase in your heart rate and blood pressure. It’s your natural “flight or fight” response that has kept humans alive for thousands of years. It’s what helped you react to a saber toothed tiger when we were cavemen and women. Over thousands of years, we have kept this important defence mechanism, although stresses have changed over time.

When released, cortisol itself feeds oral bacteria, allowing it to flourish and stimulate mast cells to produce more proteins, which increases inflammation and leads to the progression of periodontal disease. We need to learn to manage stress levels so that it doesn’t become chronic and lead to issues such as these. We can help our patients by teaching them the role cortisol plays on dental disease and how they need to learn to manage it for their health.


Amitriptyline and other medications prescribed to treat stress and anxiety can cause xerostomia (dry mouth). Reduced saliva flow can lead to increased risk of decay, gum disease and both conditions can lead to tooth loss. Dry mouth can also cause halitosis, which can also influence self-confidence and add to our stress levels.


This is a condition also known as tooth grinding, which can be caused by stress and anxiety. It can often lead to grinding and clenching, especially at night and can cause damage to the opposing surfaces of the teeth and resulting in tooth fractures, reduced tooth height by attrition, jaw pain and frequent headaches. The good news is that we can treat this with a gum shield. Education will lead to a potential upsell but more importantly a solution for the client, minimising further damage.

Man placing a bite plate in his mouth to protect his teeth at night from grinding caused by bruxism

As a profession, we may overlook these things while we focus so intently on our patients’ teeth and oral health. However, we must always remember that we treat the person and not just the disease. Patients don’t associate stress with oral health manifestations, so some direction is often helpful so they can make the links.


You can help start these conversations by educating your patients by utilising a waiting room TV solution. I recommend the Envisage Dental TV service as it is full of up to date content written by dental clinicians, hygienists and nurses, so you can trust the videos to be accurate and relevant. If patients resonate with the information on display, the call to action will advise your patient to discuss these issues in their dental appointment. If you use Envisage Dental TV then log in to the system and update your playlist with our latest videos.

To find out more about Envisage Dental TV or to book your demonstration click here.