Oral health care and psychology are intertwined

Dentists have remarked they can tell the psychology of a patient by their oral health. Is this true? Photo: Does a healthy smile mean good mental health?

WASHINGTON, April 6, 2013 — Every tooth in your head is more valuable than a diamond.”-Miguel de Cervantes, Don Quixote, 1605.

Oral and dental health issues are intimately related. Psychological well-being can affect oral health and oral health can affect one’s psychological well-being. Add to the mix is odontophobia, a psychological condition depicting an irrational and overwhelming fear of dentistry.

 Estimates suggest about 75 percent of adults experience some degree of ‘dental fear,’ with five to ten percent suffering ondontophobia. Those who not suffering odontophobia develop their fear from several source.

A primary source is vicarious learning of fear from oft embellished stories told by others: “The dentist came at me with a tire iron and a steel mallet swinging away like a madman!”

The problem is these stories are often told in the presence of children, planting the seeds of fearful discontent, causing dentists to be psychologists as they strive to overcome a powerful human primitive emotion: Fear.

The perception of loss of control and helplessness are issues that create fear. These perceptions stem from our limbic or primitive emotion system and require reasonable and logical executive level cognition to overcome.  Unfortunately, some cannot summon such resolve.

Chronic stress can manifest orally through over salivation or dry mouth.  Disrupting the pH balance in saliva can cause acidic saliva, which causes tooth decay. Dry mouth from stress affects bacterial growth, and many of the medications prescribed to reduce stress may cause dry mouth.

Many psychological issues result in fewer, if any, visits to the dentist. For depressives, a visit to the dentist is not high on their list of concerns. This can cause tooth decay or loss, causing additional depression. Additionally, having an unsightly smile can reduce self-esteem, restricting a healthy level of sociality, reinforcing or causing depression.

Agoraphobia, or the fear of leaving one’s home, prevents sufferers from obtaining the dental care they require, and oral issues can wreak havoc on the afflicted.

The more serious the psychological issue, the greater the issues with oral care. Some severely mentally disordered individuals do not understand why they are receiving dental care and physically battle the oral care provider and staff.

Recent studies by a team of neuro-scientists suggest there are dental markers that could indicate Alzheimer’s and MMI or mild memory impairment, a pre-clinical stage of dementia.  These studies are nascent but show promising information leading researchers to believe there is a possibility that inflammation from periodontal disease may find its way to the brain, affecting the hippocampus in particular.

Studies with rats clearly show the fewer teeth they have, the greater the deterioration in the cerebral cortex initially thought to be associated with less chewing which reduces sensory input.

Inflammation from oral disease is now well accepted as affecting cardiac function with many oral care patients using anti-inflammatories days prior to a dental procedure as a pre-cautionary safety measure

The good news is Peter Milgrom DDS and director of the Dental Fears Research Clinic at the University of Washington claims dentists are learning everyone does not have the same threshold for pain and are responding with and in kind.

Gone are the days of nausea creating ether and dentists with absolute clinical approach. Today, oral care providers have patient friendly environments, anesthetics to reduce pain, fear and anxiety greatly reducing or eliminating levels of discomfort physically and psychologically.

A pleasant and attractive smile goes a long way for self-esteem and sociality. In fact, a recent poll of males and females asking which aspect of the opposite sex would be the means to a quick dismissal of potential for dating, bad teeth came in number one.

As a humorous footnote, a friend of this author went to a funeral home for a viewing and upon arrival, realized he forgot his upper partial. He said he was fortunate that he was attending a somber affair where smiling was not essential.

Remember, you don’t have to brush all your teeth-just the ones you want to keep.


Paul Mountjoy is a Virginia based writer and a member of the American Psychological Association and the Association for Psychological Science.




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