Within the dental sphere, anxiety and stress are often talked about in the context of patient comfort. But the trials and tribulations of everyday life extend far beyond the practice walls.
The Mental Health Foundation found that 73 per cent of the general population would have felt anxious in any two-week period, with a fifth of people being anxious most or all of the time. Individuals most notably affected were single parents, carers, unemployed people, LGBTQ+ individuals, young adults and people from a minority ethnic community, amongst others.
When anxiety is so heavily prevalent, clinicians must be prepared to aid individuals with subsequently impacted dentitions. The potential effects of these stresses vary between patients, so comprehensive knowledge is necessary.
Coping mechanisms
Everyone reacts to stress and anxiety differently. However, some academics have found that patients displaying anxiety symptoms are linked with a lower tooth brushing frequency and self-perceived need of dental treatment – though the regularity of dental visits is not affected.
Therefore, patients living with anxiety may be less inclined to take action on an oral health problem before an appointment. This leads to the progression of oral diseases with limited attempts to disrupt it.
Research has also shown that maladaptive coping mechanisms, such as alcohol use and unhealthy eating strategies, are used to combat stress. Individuals may try to self-medicate their anxiety with alcohol, but those with alcohol use disorder tend to have higher plaque levels on their teeth and are three times as likely to experience permanent tooth loss.
Anxiety symptoms are also shown to have a positive relationship with emotional eating, where some individuals are predisposed to eat in response to negative emotions; the food of choice is usually energy dense, poor in nutrients and high in sugars. Excessive sugar consumption is considered the main cause of dental caries, and without adequate oral hygiene routines, anxious patients could experience severe tooth pain and a higher need of tooth extraction.
Clenched jaws
Anxiety can also cause patients to form subconscious habits that they may not notice in the moment. Bruxism is one such problem; the NHS notes that stress and anxiety are the most common causes of the issue.
In the dental practice, patients with effects of awake bruxism on the dentition may experience state (transient) anxiety. When questioned about the presence of mandibular tension, they often answer that it isn’t always present, but is common in stressful situations.
Awake bruxism is related to emotions and how they are processed. It’s not a new idea – Charles Darwin was noting that bruxism gave relief in moments of pain and agony in the 19th century – but today we understand it much better. Evidence suggest that mastication reduces negative mood, cortisol release, and the production of salivary chromogranin. It is no surprise that in moments of anxiety, the body enacts the masticatory muscles to seek such effects.
However, for patients that experience heightened levels of anxiety for an increased period of time, such bruxist habits can affect the dentition. Attrition, in particular, can be especially detrimental. With an aetiology often linked to bruxism, attrition is the loss of tooth structure due to tooth-to-tooth contact; it is generally seen occlusally. The effect is visible wear to the dentition, causing aesthetic and functional issues, which could contribute toward newfound social anxieties.
Practitioners should help patients identify the effects of bruxism early, and attempt to help them manage the problem. This could include the use of occlusal splints, mandibular advancement devices, or behaviour management attempts. Once bruxism habits have been arrested, restorative work may be carried out – the habit will only damage any provided treatment if it is left unmanaged.
Solutions for smiles
Whether patients still struggle with anxiety, or have found a way to manage it (and its effects on the dentition) effectively, they may present at the dental practice with a variety of needs for the dental practitioner to meet. Professionals must be prepared to actively encourage effective oral hygiene routines, and provide brilliant treatment results, addressing issues such as tooth decay and tooth wear with confidence.
Effective composite restorations may be all that are necessary, but clinicians must ensure they are functional and aesthetic no matter the case. The Filtek Easy Match Universal Restorative from Solventum, formerly 3M Health Care, provides an optimal solution in many cases. Just three shades – bright, natural and warm – can match across the classical VITA shade guide, making the choice of composite simple, but the aesthetic results extraordinary. The universal restorative composite features excellent wear resistance and strength, as well as naturally-adaptive opacity, making it an easy and intuitive choice for many direct anterior and posterior restorations.
Patients dealing with anxiety should know that at the dental practice, this doesn't have to be the case. With the identification of the impacts of stress in the dentition, and brilliant treatment choices that combat them, clinicians can send patients home smiling.
References available on request.