6 signs of stress to be aware of in patients

As dental professionals, we recognize stress and try to alleviate it. That's why we paint our dental office in soothing colors, display photos of relaxing locales, have a children's area, and play calming music. But we also need to recognize signs of prolonged everyday stress in our patients, because the symptoms can first appear in their mouths.

Leslie Townsend, DDS.

Leslie Townsend, DDS.

Here are six common signs that may indicate your patients are stressed-out.

• Teeth grinding: Eighty percent of bruxism (teeth grinding) occurs subconsciously during sleep, and about 70% of those cases are thought to be stress-related. Bruxism is also strongly associated with obstructive sleep apnea, which can contribute to stress levels (Sleep Medicine, November 2002, Vol. 3:6, pp. 513-515).

• Nail biting: If a patient suffers from temporomandibular disorder (TMD), has front teeth that are worn down, or is displaying signs of bruxism, check their manicures to see if nail biting may be an issue.

• Eating (or overeating) the wrong foods: If you see a marked increase in plaque or tooth decay, you may want to ask if your patient is eating more sugary foods than usual.

• Drinking more alcohol than usual: If your patient complains of dry mouth or has a noticeable decrease in saliva production, alcohol may be to blame.

• Canker sores: Though the exact cause of mouth sores (aphthous ulcers) isn't known, stress is a trigger for some people. In fact, studies have shown that students often get canker sores during the school term, but that the incidence lessens during breaks and after graduation (General Dentistry, November/December 2003, Vol. 51:6, pp. 510-516).

• Increased symptoms of gum disease: Research has shown a definite link between stress and dental health. Stress affects the immune system, which fights the bacteria that causes periodontal disease, making a person more prone to gum infection (Periodontology 2000, February 2014, Vol. 64:1, pp. 127-138).

When you notice a combination of these issues, or if patients with no previous symptoms begin to exhibit signs of stress in their mouth, gently inquire about their stress level. Some short-term solutions to help alleviate stress-related oral health issues can be suggested. Specific treatments can help with the following:

• Bruxism: Dental guards or splints may help. Braces and corrective dental work may be needed in some cases.

• Nail biting: Habit-breaking remedies include putting a nasty-tasting (but nontoxic) substance on fingertips, using Band-Aids on fingers as reminders, and keeping nails groomed to the point where they're hard to bite.

• Canker sores: Advise patients to avoid acidic foods. You may want to use aloe, which studies have found to be more effective than over-the-counter remedies.

Drinking more water is a good general short-term remedy, as consumption may wash away bacteria, help with dry mouth issues, and provide a healthy substitute for alcohol and sugary drinks.

It's doubly important to underscore the importance of ongoing good oral hygiene. Patients under stress tend to skip brushing, flossing, or seeing a dentist, which, as we all know, just leads to more trouble -- and more stress -- down the line.

We like to alert our patients of signs of ongoing stress, because in the end we may be doing more than helping them achieve better oral health. According to the American Psychological Association, stress is linked to the six leading causes of death: heart disease, cancer, lung ailments, accidents, cirrhosis of the liver, and even suicide. Older patients may be at even more risk: Stress increases the risk of death fivefold for those older than 65 (Journal of Clinical Endocrinology & Metabolism, November 2010, Vol. 95:11, pp. 4959-4964).

So take the time to notice stress-related symptoms in your patients. As dental professionals, we have the opportunity to help save a life.

Leslie Townsend, DDS, practices at Jefferson Dental Clinics in Dallas. Dr. Townsend is considered a mentor of her dental practice and takes ownership of the well-being of patients through moral business practices and high-quality patient care.

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