Summary
Emotional stress and oral hygiene are positively related, according to a growing body of evidence. This paper will show that stress has been linked to oral conditions such as TMD, RAS or ulcerative conditions. Stress is also known to aggravate oral conditions like oral plaque. Stress can cause or worsen some oral conditions, but the exact mechanisms are not known.
Stress can affect the immune system, the microbiome, or even cause behavioural changes such as smoking, excessive alcohol consumption and poor hygiene. This association is often overlooked despite the large amount of research that has been done on the subject. Because it is less publicized than other conditions linked to stress, the link between stress and oral health goes unnoticed. The purpose of this paper is to explore the many oral disorders strongly linked with stress. The paper is a review of literature available, although not exhaustive. It will attempt (where possible), to identify the mechanisms.
An opening statement Original: This paper will explore the effects of deforestation. Paraphrased: This document will investigate the consequences of cutting down trees.
The pressures of modern life are a natural cause of stress. Stress is the result of a combination of physiological and psychological reactions that occur when an individual faces changes or demands they cannot handle. In the modern world, there are many factors that contribute to stress. These include solitary careers, striving for perfection, economic pressure, career pressure, personality complexes, time constraints, and lack sleep. In the modern world, stress is a result of many factors, such as solitary career, striving for perfection, economic and career pressures. In the modern society, stress is caused by a variety of factors. These include internal or/and environmental ones. Though the negative effects of stress are exaggerated, it can also be neutral, positive or negative from a biochemical perspective. Stress affects us all differently and there has been a great deal of research done on the different pathological responses. Stress causes hormonal and behavioural modifications. This explains the link between stress and diseases. For this study, emotional stress and its effects on oral care are of great interest.
Many studies have shown that anxiety and depressive disorders can be linked to oral health. Some of the conditions most closely associated with dental emotional well-being are bruxism and canker ulcers. The emotional stress can also increase the risk of infection, such as gum disease (periodontitis). People who are emotionally stressed tend to disregard personal hygiene or engage in destructive behavior such as smocking. Several studies on the effects of drugs used to treat depression have shown that they can cause dry mouth. In patients with oral diseases such as those mentioned above, stress can cause relapses following treatment.
Explanation
Stress can take many forms. Stress is subtle and can be difficult to identify. However it often manifests in anxiety disorders such as depression and panic attacks. Emotional stresses have been linked to several diseases. Emotional stresses can trigger and exacerbate chronic inflammatory disorders like rheumatoid arthritis, multiplesclerosis, psoriasis or inflammatory colon disease.
Stress and its cardiovascular effects have been the focus of much attention. Stress and oral care are often ignored. Few people are aware that this is the case. Unfortunately, stress can have an impact on the mouth in the same way as it does other parts of our bodies or minds. The impact of emotional distress on dental care should be assessed and public education on this subject is essential.
A study of previous texts in the field Original: The research question was addressed by carrying out a survey Paraphrased: An investigation was conducted to answer the inquiry through a poll.
Stress is an interactional and dynamic process that involves complex body systems. The components are operationalised at various levels. Stress is defined currently as the physical and metabolic disturbances caused by a variety of aggressive agents. Also, stress can be the psychological and physiological response of an organ to threats or challenges. Stress is caused by a number of factors in modern society, including solitary careers and the struggle for perfection. Other causes include economic pressures, career pressures, personality issues and time pressures. Emotional distress has been identified as a factor that contributes to the pathogenesis and aetiology of many diseases.
Stress can negatively impact the immune systems and behaviour. Stress affects immune system in mice by reducing tumour necrosis factors and changing leucocyte responses. Stressful events in humans can also affect the immune system. There is a complex interaction between psychology, immunology, endocrinology, and neurology. This highlights the importance of physiological and psychological vulnerability to stress. Ringsdorf and Cheraskin's (1969) research showed that mental strain has a direct impact on dental hygiene and lifestyle. Recent research has confirmed their findings, which show that stress affects alcohol consumption, smoking and eating habits. Accordingly, stress is known to affect health primarily through the immune system. According to current research, emotional stress plays a role in aetiology as well as pathogenesis in several diseases.
Stress and recurrent Aphthus Stomatitis
Recurrent Aphthous Stomatitis (RAS), the most common form of ulcerative oral disease, can cause painful ulcers. RAS is a disorder that has been studied extensively and occurs all over the world. However, the cause of RAS is unknown. Numerous factors, such as genetic, psychological, nutritional and infectious factors have all been linked with this condition. The disorder is associated with a poor quality of living, yet available therapies are inadequate. As stated earlier, stress and psychological factors are linked with an increase in RAS. This disorder could be caused by the effect of psychological factors on the immune response.
Stress and temporal disorders
Temporomandibular disorders are a group of clinical syndromes that affect the masticatory muscle and/or temporomandibular joints. The condition manifests as facial pain due to a variety of factors, including sleep bruxism or other psychological factors. TMD and stress are linked. Studies have indicated that up to 75% of TMD patients had experienced stressful circumstances before developing TMD symptoms. TMD has been linked to increased masticatory muscles activity and stress. Stress is also thought to exacerbate bruxism during sleep and/or clenching at night. Psychotherapy can be beneficial to patients with TMD, as part a multidisciplinary treatment plan for pain.
Stress is thought to trigger a number of physiological reactions involving the nervous systems (both peripheral and central NS). Stress and anxiety increase the activity of acetylcholine on the motor endplate. They also trigger a cascade that leads to pain and a decrease in threshold. It is known that psychological and physiological factors contribute to pain. However, it is unclear whether these factors are responsible for TMD. TMD sufferers may have higher levels of anxiety than those with no symptoms.
Stress and orthodontics treatment
A recent study showed that orthodontic tooth movement alone can evoke emotional stress and emotional stress results in increased cellular cementum resorption and particularly to decreased tooth movement. This study also demonstrated that progressive chronic emotional and physical stress leads to significant morphological changes in oral dental tissues in rats. The researchers therefore concluded that chronic stress can lead to periodontal pathology, exacerbate the exhaustion of protective immune responses, impair the functioning of the masticatory muscles and affect the growth and development of the dentomaxillomandibular system. The severity of these effects positively correlates with the strength of the stressor and negatively with the tolerance of the individual test animal. Psychological stress influences various immune functions in various ways.
Stress and dental Caries
Dental caries also called dental decay is a preventable infectious disease characterised by erosion of the mineral tissues of teeth caused by organic acids produced by bacterial fermentation of dietary carbohydrates. It has been rated the most common childhood chronic disease affecting up to 40-50% of British and USA children and 60-90% children in the world in the age bracket of 2 to 11 years.
Early childhood caries (ECC) is associated with an interaction of multiple factors including psychological, biological and behavioural factors. Though the association between this condition and stress remain amorphous studies have been conducted to establish the link. One such study investigated psychological stress as a risk factor in the aetiology of ECC by determining and comparing the salivary cortisol levels as a response to stress related events in children with ECC and those without. The study also compared the adaptability of children with ECC and those without to different dental procedures.
Research indicates that psychological and biological factors seem to interact in two distinct and interactive ways to influence dental decay. Children from lower SES families appeared to acquire higher levels of cariogenic oral bacterial than their peers from higher SES families. This indicated a strong correlation between SES and counts of Lactobacilli (LB) and oral mutans streptococci (MS) which were therefore implicated for mediating the SES-caries association. Secondly cortisol reactivity to stress and higher production of salivary cortisol undermines local defences and protective microanatomical structures thus compromising dental health. The presence of cariogenic bacteria as well as elevated basal HPA activation was linked to dentition while increased cortisol reactivity was associated with changes in the physical characteristics of dental enamel. The association of cortisol and bacteria with caries agrees with earlier findings that chronic stress can affect sIgA (secretory IgA) secretion, that cortisol can affect local mucosal immunity and oral microflora, and that the compromising of the mucosal immunity encourages bacterial colonization and growth. It is important to note that sIgA plays a vital role in regulating the oral microflora and that gluco-corticoids suppress the immune responses through such mechanisms as reducing lymphocytes in circulation, inhibiting the aggregation of immune cells,reducing chemotaxis and degranulation and reducing production of cytokines such as IL-1, IL-2, interferon gamma and tumour necrosis factor. These reports lead to the conclusion that socioeconomic categorization of ECC is a culmination of stress related elevation of cortisol production and the increase in the population of cariogenic bacteria.
Stress and Oral lichen planus
Oral lichen planus is a condition that involves the inflammation of the oral mucosa and is characterized by red swollen tissues, open sores and white lacy patches. It begins as a small raised swelling that progressively turns into white lacy patches that eventually spread through out the mouth. It is also accompanied by moth pain, sores and blisters, a burning sensation in the mouth, a feeling of rough texture in the mouth and sore gums. The patient may also bleed when brushing his/her teeth and have a metallic taste in the mouth.
The precise aetiology of oral lichen planus remains unknown but it seems to be an autoimmune response in which the immune system attacks the oral epithelial cells leading to necrosis. In most cases it occurs unexpectedly thus referred to as idiopathic oral lichen planus. It may also occur due to certain drugs, mechanical trauma, viral infection and contact with allergens.
Although the exact link between oral lesions and stress has yet to be identified, it is known that oral lichenplanus occurs when an overactive immune response occurs. Oral lichenplanus is exacerbated by psychological stress, but the mechanisms are unknown. Stress is also associated with periodontitis – inflammation of tissues that support teeth. Periodontitis, unlike oral lichen folium planus, has a well-known cause. Infectious bacteria are the cause of periodontitis. Stress can alter the microbial flora in the mouth and the local immune system, causing periodontitis.
In summation
Growing evidence suggests that emotional stress is positively related to oral health. This paper demonstrates that stress has been linked with oral issues such as TMD, RAS or ulcerative conditions. Stress is also known to worsen certain oral conditions. One example is oral lichen splanus. Stress can cause or aggravate some conditions. However, it is not always clear how. Stress can alter the microbial and immunological flora of the area or cause behavioural changes, such as drinking too much alcohol, smoking, or not being hygienic. In order to effectively manage stress it is best to avoid as many stressful situations as possible.
