Depression and Tooth Loss: The Link Between Mental and Dental Health

Your dentist used to be the only person nagging you about brushing and flossing. That has changed. Some psychologists now give the same advice, telling patients to brush twice daily and floss before bed. The reason sounds strange at first: what happens in your mouth and what happens in your mind turn out to be connected. A research group at West Virginia University in Morgantown reported that people dealing with depression and anxiety face a higher risk of losing teeth.

The team worked from telephone survey data gathered by the Centers for Disease Control. Out of 76,292 people who qualified for the analysis, 13.4% reported depression, 16.7% reported anxiety, and 5.7% reported tooth loss. Stack those groups against people free of the conditions and a pattern shows up: depression and anxiety appear to drag down dental hygiene, which can open the door to chronic problems that cost people their teeth.

A separate CDC survey from 2011 looked at the same question from the opposite direction. Men and women who had lost teeth were more likely to carry a current diagnosis of depression or anxiety. The gap widened for women who had skipped the dentist. Those who hadn't been seen in the past year were 29% more likely to have depression than women keeping up with regular exams. So the association holds. The harder question is why.

Living with major depression or an anxiety disorder tends to change how someone cares for their teeth, and gum disease is one of the clearest casualties. Periodontal disease can turn chronic and nasty, chewing through soft tissue and bone until teeth give out. Depression and anxiety tend to pile on the things that make gum disease more likely: smoking, clenching and grinding, a weakened immune system, certain prescriptions, shifting hormones, other illnesses such as diabetes or AIDS, and plain neglect.

The problem doesn't stop at causing gum disease. These conditions can also make the disease harder to treat. In one study, patients carrying a depression diagnosis were twice as likely to respond poorly to periodontal treatment. They showed more trouble with tooth attachment and with alveolar bone, the sockets that hold teeth in the jaw. Part of this comes down to follow-through. Someone who is depressed may ignore post-treatment instructions, keep smoking, or be fighting a suppressed immune response that slows healing.

Decay is another route. Depression has been tied to low serotonin, a brain chemical whose shortage can produce depressive symptoms. People running low on serotonin often crave carbohydrates and sugar, and that appetite sets up the mouth for decay. Dry mouth makes things worse, and it shows up across depression, anxiety, and the related conditions that travel with them. Plenty of medications cut down how much saliva a person produces, which strips away a natural defense. Add the general disinterest in grooming and hygiene that so often rides along with depression, and cavities follow.

Oral health takes other hits too. Chronic pain through the mouth and face, persistent bad breath, and candidiasis, an oral yeast infection, all turn up more often. Candidiasis tends to prey on people with immune trouble, poor hygiene, dry mouth, or long-term medical conditions, and it runs highest among the elderly who wear dentures and among infants.

Two studies from the International and American Associations for Dental Research flagged two groups worldwide as especially vulnerable to poor oral health: older adults and people on low incomes. Income inequality on its own raises the odds of tooth loss by 20%. Pair it with advanced age and the risk climbs well past that, particularly when you compare poorer seniors to wealthy ones. What makes this matter for mental health is that low income and old age are themselves known triggers for depression. Once depression enters the picture, the threat to someone's teeth grows serious.

Losing teeth brings its own cascade beyond the obvious trouble with eating. Speech can suffer. People grow embarrassed and watch their self-esteem erode. There's facial tension, and nutrition gets harder to manage. Bit by bit these losses shrink a person's pleasure, health, and social life, and that withdrawal can circle back into fresh depression and anxiety.

The way out runs through a dentist, and often a mental health professional as well. Someone coping with depression or anxiety can build an oral health plan that accounts for their medical and substance use history. The basics still apply: a solid hygiene routine at home and two cleanings a year. Antidepressants or medications to manage pain and infection may be part of it. Quitting smoking helps, and so does staying hydrated. For patients whose fear of the chair is overwhelming, sedation dentistry exists. On top of all that, therapy and activities that rebuild wellness and self-esteem can help a person take hold of their health as a whole.

- Melissa Lavery, M.S.