Dentist and bacteriologist Dr Harold Katz looks into the relationship between stress and oral health…

April 2018 marked the launch of Stress Awareness Month and the Mental Health Foundation states “research has shown that around 12 million adults in the UK see their GP with mental health problems each year. Most of these suffer from anxiety and depression and much of this is stress-related”.

Dentist, bacteriologist, and founder of The Californian Breath Clinics and The Breath Company, Dr Harold Katz, answers questions about how stress can impact your oral health.

What oral hygiene problems can be attributed to stress?

Dr Katz says: “It is well documented that stress can have a huge impact on our general health and can cause a plethora of physical conditions such as heart disease and obesity as well as serious mental health disorders such as anxiety and depression. Specifically, when taking our oral health in to account, stress can really take its toll and be attributed to various oral health issues including bad breath, gum disease and mouth ulcers to name a few.”

How does stress cause halitosis?

It is estimated that 50 per cent of the population has bad breath. When individuals find themselves in high-stress circumstances, their bodies react by using the sympathetic nervous system as a form of protection. This system essentially triggers the fight-or-flight response mechanism, providing you with a boost of energy so you can react quickly to the situation. In cases of chronic stress, your body is kept in “fight or flight” mode and conserves energy by turning off certain digestive functions such as the production of saliva. The mouth then produces a lower level of saliva – saliva is mandatory for moistening food for easier digestion, but the body deems it unnecessary in critical situations.

Saliva evaporates and the mouth becomes dry, leading to bad breath. This happens because the odorous gases created by bacteria in the mouth, which are generally suppressed by spit and swallowed away, are free to be released into the air. Additionally, bacteria are much more likely to stick to the surfaces of a dry mouth, which can further enhance the sour smell. Drinking plenty of water, chewing sugar-free gum and rinsing with a non-alcohol mouthwash can help to minimise the effects of stress related halitosis.

How can stress cause gum disease?

A small amount of blood in the sink when you clean your teeth might not seem like a big deal, but consistently bleeding gums should not be ignored. Bleeding gums are a visual symptom of gum disease, which can be caused by stress. There are a few factors that link stress to bleeding gums and the onset of gum disease. Firstly, when the body is under stress it produces elevated amounts of the hormone cortisol, which acts as an anti-inflammatory agent. When cortisol is produced peripherally in the gums, it stimulates mast cells to produce more proteins, simultaneously increasing inflammation and the progression of gum disease. In addition, individuals with high stress levels tend to adopt bad oral hygiene and lifestyle habits, and this in turn can have a negative impact on their oral health. If gum disease isn’t in advanced stages then good oral hygiene habits can reverse it so it’s essential to adopt a robust oral hygiene regimen coupled with regular trips to your dentist who can offer sound advice on correct brushing and flossing techniques.

How can stress cause mouth ulcers?

Chronic stress suppresses the immune system and can leave you open to disease and infection. Mouth ulcers are one example of this and although are relatively harmless can make life unbearable when eating, drinking, speaking or swallowing. They occur on the inside of the mouth and are white or yellow surrounded by a dark red area. Minimising your exposure to stressful situations and adopting some simple lifestyle changes can reduce your chances of developing moth ulcers.

How can I minimise stress and its effects on my oral health?

Stress can often be an unavoidable part of modern day living, but that can really hinder your day-to-day life. You can help to minimise the impact that stress has on your oral health by adopting the following:

Start with some lifestyle changes. Stress can often lead us to make bad lifestyle choices that will impact our oral health. Limiting consumption of sugary foods and drinks, alcohol and quitting smoking will all contribute to healthier gums and mouth. Smoking in particular dries out the mouth and can lead to gum disease as a result of bacteria and toxins causing plaque to form in the mouth.

Exercise. Fitting exercise into your lifestyle will do wonders for your stress level. When you exercise, you’re using physical activity to shed the mind of stressful thoughts. Regularly practicing yoga for example, may be great for the body and mind. Similarly, deep breathing exercises can be very beneficial, and any form of exercise may boost endorphin production and help you better handle your emotions in high-tension situations.

Adopt a robust oral health regimen. Brush and floss regularly but avoid harsh soap in toothpaste. Brushing helps eradicate the plaque and bacteria on your teeth, however some toothpaste contain sodium lauryl sulphate (SLS), a soapy detergent that creates foam but has no cleaning benefit. The additive has recently been linked to serious side effects including canker sores. Flossing is an extra step, but it’s an important one, as it helps gets in between the teeth where toothbrushes sometimes miss. In addition, regular and specific application of alcohol-free mouth rinses such as The Breath Company Healthy Gums Oral Rinse will help calm the gum area and work to both eliminate germs associated with gum disease and reduce the formation of biofilm, which leads to plaque and tartar build-up. It’s important to steer clear of alcohol-based mouthwashes as these can cause dry mouth, and just mask odours rather than killing off bacteria.

Stay hydrated throughout the day. The fight-or-flight reaction to stress can make you dehydrated and this leads to dry mouth and bad breath bacteria forming which can both contribute to the onset of halitosis gum disease. If you keep your mouth and body well hydrated, you will minimise the chance of developing dry mouth that can lead to these problems.

Talk to your dentist and make regular check-ups. They are the very best source of advice and will be able to check for any signs of any stress-related gum disease and bad breath issues. In addition, they will be able to offer advice on how to prevent stress affecting your oral health and put in place a care plan that is bespoke to you.

Dr Harold Katz is a dentist with an advanced degree in bacteriology and a lifelong advocate of good oral health. He is the founder of The California Breath Clinics and the developer of the The Breath Company line of premium oral care products, and the internationally recognised expert in the fields of bad breath, taste disorders, tonsil stones and dry mouth. Known as the ‘Bad Breath Guru’ due to his numerous television appearances on US television shows, he has helped millions of people around the world eliminate their bad breath problems.

Dr Katz is a graduate of the UCLA School of Dentistry. In the 1970s he established a thriving dental practice in Beverly Hills, California and he has perfected his dental techniques while working with some of Hollywood’s biggest stars.