Posted on Nov 12, 2018 12:53 pm by Sasha Asthana, ASDOH ’22
The word stress refers to the body’s biological, nonspecific adaptations to states of strain. We encounter stressors constantly– when talking about dental school, exams, bills, being away from family, meal prepping, etc. Our limbic system detects these stressors and tries to help us by stimulating the sympathetic nervous system. This causes many downstream effects, including a heightened respiratory rate, heart rate, blood pressure, and even increased blood glucose levels. There is a reason you can hear your heart pounding during a Dr. Fischione exam.
Stress has a widespread effect on our dental health. Increased sympathetic stimulation causes muscle tension at an abnormal level. Our resting muscle tension is controlled by alpha motor neurons, regulated by gamma motor neurons in the ‘gamma loop’. 📷Excessive resting tension causes muscle fatigue, so the neuromuscular system works hard to release this excess tension. One method it does so is by engaging the masticatory muscles. Primordially, stress moved us to an adrenergic state — “fight or flight”. Today, most of our stressors do not utilize the fight or flight response, so we have to suppress the emotional and physical manifestations of stress. This suppression creates tension, resulting in excess resting muscle tone in the gamma loops, as previously mentioned.
The resulting occlusal stresses occurring outside of normal function are referred to as parafunction. Some examples include bruxism, clenching, excessive gum-chewing, nail-biting, and even thumb-sucking. Bruxism is an oral habit consisting of involuntary rhythmic or spasmodic nonfunctional grinding or clenching of teeth. 📷Direct dental effects of bruxism can include tooth attrition, exacerbation of periodontal disease, and even tooth fracture. Other effects of bruxism can include temporomandibular disease, constant dull headaches, jaw pain, eating disorders, tinnitus, insomnia, anxiety, and even depression. Stress also impacts dental disease. Studies show that people with higher stress tend to show decreased salivary flow, losing protection against bacterial colonization and dental caries. Stress also negatively impacts our immune system, which allows periodontal pathogens to establish periodontal disease more quickly than they would in a non-stressed person. Imagine what chronic stress means in an immunocompromised patient. Together, the increased risk for caries and periodontal disease can mean a person who lives a high-stress lifestyle is at greater risk of premature tooth loss.
So why does this even matter? Clinical studies suggest that the main reason that patients seek out medical advice and therapy is, by and far, stress. In practice, our patients will be 📷living in high-stress lifestyles, and it is going to be incumbent on us as their oral healthcare providers to identify their stress-related risk factors to treat and prevent things that we know stress can cause. Modern lifestyles are filled with stressors, and I don’t think anybody is going to predict that those stressors are going away any time soon. It is also important for us as dental students to monitor our own stress levels and be aware of what we are at risk of. We, as current dental students and future dentists, should take time to focus on our dental health from time to time. Dealing with stress is nuanced and personal, but being aware of the dental health effects is a good starting point. Sasha Asthana, ASDOH ’22 Asthana, Samarth. (January 2017). Bruxism in the Modern Age. UT Health San Antonio. Retrieved October 28, 2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5768958/
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