Anxiety is a common mental health condition that involves excessive and persistent worrying, nervousness, and fear. While anxiety is often thought of as mainly affecting the mind, research has found that it can also impact the body in various ways, including potentially increasing the risk of tooth decay.
What is the relationship between anxiety and tooth decay?
There are several ways anxiety may contribute to an increased risk of tooth decay:
- Dry mouth – Chronic anxiety activates the body’s fight-or-flight response, which reduces saliva production. Saliva helps neutralize acids in the mouth and wash away food particles, so less saliva means less protection against cavities.
- Poor oral hygiene – Anxiety may make it difficult to develop or maintain a consistent oral hygiene routine. Neglecting proper brushing and flossing leaves more plaque on teeth, allowing acid and bacteria to cause decay.
- Gastrointestinal issues – Anxiety can cause acid reflux, vomiting, and other GI problems that expose teeth to stomach acids, eroding tooth enamel.
- Medication use – Anti-anxiety medications like benzodiazepines often reduce saliva flow as a side effect, increasing dental risks.
- Stress weakening the enamel – Chronic stress from anxiety may reduce minerals in tooth enamel, making it softer and more prone to cavities.
- An unhealthy diet – Anxiety may lead some people to consume more sugary or acidic comfort foods and drinks that feed the bacteria that cause dental decay.
- Clenching/grinding – Many anxious people unconsciously clench their jaws or grind their teeth, chipping enamel and exposing dentin to cavities.
The combination of these factors means that ongoing issues with anxiety appear to create an oral environment conducive to tooth decay and other dental problems.
Dry mouth and anxiety
One of the most significant ways anxiety contributes to cavities is by causing chronic dry mouth or xerostomia. Saliva is vital for preventing tooth decay because it:
- Washes away food debris and neutralizes acid in the mouth
- Provides antimicrobial compounds that kill cavity-causing bacteria
- Contains minerals like calcium and phosphate that strengthen and remineralize tooth enamel
When saliva production drops, these protective mechanisms are impaired. Even a minor reduction in saliva flow can allow acid and bacteria to accumulate and weaken enamel over time.
Studies show at least 40% of people with anxiety disorders have clinically dry mouth compared to only around 10% of the general population. This dry mouth persists even when anxiety is well-managed with therapy and medication. The chronic activation of the body’s stress response from anxiety appears to permanently disrupt the salivary glands.
Poor dental hygiene and anxiety
While dry mouth creates favorable conditions for cavities, poor oral hygiene provides the bacteria that does the actual damage. Good brushing and flossing removes plaque biofilm before acid produced by the bacteria eats through enamel. But dental care is often neglected during periods of high anxiety due to:
- Loss of motivation and energy
- Feeling too nervous to leave home and buy supplies
- Prioritizing coping with anxiety over self-care
- Difficulty concentrating on tasks
- Wanting to avoid seeing people so not visiting the dentist
Anxiety sufferers may go through periods of days or weeks where they rarely brush or floss properly. This allows plaque to build up and decay to set in quickly if teeth are also exposed to acidic foods, drinks, or stomach acids from GI problems.
Gastrointestinal issues
Anxiety commonly causes symptoms like acid reflux, vomiting, and nausea. Bringing up stomach acids can erode tooth enamel, especially on the inside surfaces. Acid reflux also creates heartburn that makes acidic gastric juices rise up and coat the teeth.
One study found 75% of patients with acid reflux had tooth erosion typical of exposure to gastric acids. Frequent vomiting has also been linked to a six times higher rate of tooth decay among sufferers of eating disorders, which often involve severe anxiety.
Medication use
Many medications used to treat anxiety like benzodiazepines and tricyclic antidepressants reduce saliva production as a side effect. This drying effect is well-documented and can exacerbate the decrease in saliva already caused by anxiety itself.
Common culprit medications include:
- Alprazolam (Xanax)
- Clonazepam (Klonopin)
- Diazepam (Valium)
- Lorazepam (Ativan)
- Oxazepam (Serax)
- Imipramine (Tofranil)
- Amitriptyline (Elavil)
Always consult your doctor before adjusting medications, but using the lowest effective dose, sugar-free versions, and proper oral hygiene may help reduce dental risks.
Stress weakening enamel
Teeth are living structures dynamic enough to respond to external factors like diet and stress levels. Prolonged activation of the body’s stress response from chronic anxiety may reduce mineral content in tooth enamel over time.
Enamel constantly goes through demineralization and remineralization processes. Demineralization removes small amounts of minerals when exposed to acid, while remineralization replaces them using calcium and phosphate ions from saliva. Ongoing stress seems to disrupt this balance by increasing demineralization and decreasing remineralization.
This leads to weaker enamel more prone to erosion and decay. Studies have found up to 30% lower mineral levels in the teeth of people with high anxiety. Managing stress levels may therefore help maintain healthy enamel mineralization.
Diet and anxiety
The foods and drinks people consume can also contribute to the link between anxiety and dental health. Many anxious individuals turn to sugary or acidic comfort foods and beverages like:
- Candy
- Chocolate
- Baked goods
- Ice cream
- Soda
- Coffee
- Alcohol
These items give a quick energy and mood boost by spiking blood sugar or serotonin levels. But the sugar feeds acid-producing oral bacteria while the acidity directly erodes enamel. People with chronic stress and anxiety tend to have diets higher in these unhealthy foods that promote tooth decay.
Teeth grinding
Many people with anxiety grind their teeth at night due to tension. This is called bruxism and involves involuntarily clenching and grinding the jaws together forcefully. It often occurs during sleep so patients may not realize they have the habit unless a dentist notices unusual wear patterns on their teeth.
Bruxism can chip and crack enamel, exposing sensitive dentin underneath. The excessive pressure can also over-stimulate cells in the pulp inside teeth. This may lead to inflammation and cell death that makes teeth extremely sensitive to hot and cold temperatures.
Mouthguards and bite splints can protect teeth from damage during anxious grinding episodes. Managing stress through relaxation techniques may also help reduce bruxism habits.
Can anxiety treatment help prevent tooth decay?
Since anxiety appears to be a key risk factor for tooth decay through various mechanisms, addressing it with professional treatment could potentially improve dental health. Some ways anxiety treatment helps:
- Increasing saliva flow – As anxiety is reduced with therapy or medication, saliva production may increase and better protect teeth.
- Improving oral hygiene – Lower anxiety makes it easier to stick to regular brushing and flossing habits.
- Reducing acid reflux – Treating anxiety and related GI issues cuts down on acidic stomach fluids contacting teeth.
- Lessening medication use – Successfully managed anxiety may require lower medication doses with less oral side effects.
- Stabilizing mineral levels – Lowering anxiety could help restore normal enamel mineralization.
- Promoting a healthier diet – Coping better with anxiety reduces the need to overuse sugary or acidic comfort foods.
- Decreasing teeth grinding – Relief from anxiety minimizes a key cause of bruxism and its dental damage.
Studies do show certain anxiety treatments like cognitive behavioral therapy (CBT) and medications like SSRIs can increase salivary flow and decrease teeth grinding habits. Overall, proper professional treatment gives patients the tools to better control anxiety and its effects on dental health.
Tips for protecting your teeth from anxiety
Along with seeking treatment for anxiety itself, patients can also take steps to minimize its impact on oral health:
- Use fluoride toothpaste and mouthwash to strengthen enamel against acid attacks
- Chew xylitol gum to stimulate saliva and inhibit cavity-causing bacteria
- Drink plenty of water to prevent dry mouth and flush away acids
- Limit sugary or acidic drinks and use a straw to bypass some contact with teeth
- Avoid constant snacking and sip drinks slowly to decrease duration of acid attacks
- Get regular dental cleanings and check-ups to catch problems early
- Ask your dentist about prescription strength fluoride gels, rinses, or varnishes
- Use a bite guard at night if you notice any teeth grinding or clenching
Making oral health a priority despite anxiety challenges can reduce the risks of tooth decay and other dental issues.
Takeaways
Anxiety both directly and indirectly increases the risk for tooth decay in various interrelated ways. Learning to manage anxiety effectively through techniques like CBT and implementing protective oral health habits can help prevent dental problems.
While more research is still needed, the balance of evidence suggests chronic anxiety negatively impacts the mouth environment and makes teeth more susceptible to cavities, erosion, and other damage over time. But with professional treatment and good home dental care, it is possible to have good oral health even with ongoing anxiety issues.