Brush the stress away

04/02/2010
By Eveline Gan, TODAY

SINGAPORE: While most people get migraines and acne when they are stressed, Ms Teo A L complains about painful mouth ulcers.

"Whenever work becomes hectic, I get ulcers. My mum says it's due to 'heatiness', but I think it's just stress," said the 30-year-old bank officer.

Ms Teo's ulcer problem was especially bothersome last year, in the days leading up to her wedding. "Imagine getting married with a mouth full of ulcers. To make matters worse, I also had gum inflammation around that time," she lamented.

Ms Teo isn't alone. Dental experts TODAY spoke to said studies have shown that emotional stress can take a toll on one's oral health.

"During stressful situations, the brain releases stress hormones into the bloodstream. While small doses of stress hormones are beneficial as it enhances alertness and memory, and activates the immune system, higher and prolonged levels associated with chronic stress can have many negative health effects," said Adjunct Associate Professor Adrian Yap, dental director and consultant prosthodontist at Raffles Dental, Raffles Hospital.

According to Assoc Prof Yap, stress-induced oral problems include mouth sores, gum diseases, and unconscious clenching and grinding of the teeth.

Dr Leong Hon Chiew, dental surgeon at Dr H C Leong Dental Surgeon LLP, explained that physiological changes in the mouth can occur as a result of lower immunity in times of stress. He added that emotional upheavals can also cause changes in the saliva, which has antibodies that protect the teeth and gums.

"When our immunity is down, antibodies are also reduced. As a result, 'dormant' problems which don't normally ail the person, such as an impacted wisdom tooth, gum problems or dental abscesses and cysts, can 'flare up', causing pain and discomfort."

Mouth sores

Besides stress, fatigue and allergies can also increase the risk of getting mouth ulcers, said Assoc Prof Yap. "Although the exact relationship is not known, mouth ulcers have been linked to decreased body immunity and the presence of bacteria and viruses."

Dr Leong added that certain infections, such as a dormant herpes simplex, may also "reactivate" when one is under stress, resulting in ulcers and cold sores around the mouth.

Thankfully, most mouth ulcers usually disappear after seven to 10 days.

"To reduce pain and irritation, don't eat spicy, hot foods or foods with high acid content. Over-the-counter topical anaesthetic or antiseptic gels may be useful," the doctor advised.

Teeth grinding

Bruxism (medical lingo for teeth grinding) is another common stress-related oral condition that the dental experts see on a daily basis.

According to Dr Leong, unconscious teeth grinding can occur when the person is awake or asleep.

"Sleep bruxism is particularly damaging as the forces exerted on the teeth, chewing muscles and jaw joints can be up to eight times that of normal eating," said Assoc Prof Yap.

In the long run, teeth grinding can lead to a host of problems such as chipped and cracked teeth, and Temporomandibular Disorders (TMD). TMD refers to a collection of medical and dental conditions affecting the jaw joints, chewing muscles and associated structures. Sufferers may experience headaches, ear pain, jaw pain and jaw function difficulties.

Local studies by Assoc Prof Yap and the National Dental Centre (NDC) showed that approximately half of the patients with TMD are depressed and have other psychological problems.

They added that many of their patients tend to have stressful lifestyles or work in stressful jobs.

For instance, Assoc Prof Yap, who sees more than 100 patients each month for sleep bruxism, noted that he treats more younger patients during examination periods, especially during the O- and A-level examination seasons.

Dr Leong's patients include those in the commodity trading industry, or hold high level-corporate positions and often deal with hectic deadlines. However, he added that any job can be psychologically stressful depending on the makeup of the person.

While teeth grinding "cannot really be stopped", Assoc Prof Yap said it can be managed using a combination of drugs, psychological and dental strategies including wearing mouth guards or splints during sleep.

Gum disease

According to Assoc Prof Yap, research has found that the severity of gum disease increases with the amount of stress experienced in the previous year.

Stress can also affect a person's lifestyle and habits, which in turn affect oral health negatively.

"People under stress generally tend to smoke more, snack more and drink more alcoholic or energy beverages. These can increase the risk of tooth decay and gum disease," said Dr Leong.

Commonsense strategies include maintaining a good oral hygiene routine, drinking enough water, having a sensible diet and getting enough rest.

"These things also benefit our general well-being and improve our ability to cope with the stress," said Dr Leong.