There is an old song about how the bones of the skeleton are connected to each other: “the foot bone connected to the leg bone, the leg bone connected to the knee bone, knee bone connected to the thigh bone,” and so on, up the entire body to the neck bone, which is connected to the head bone. Whenever I hear this song, which admittedly is not often, I think of how, indeed!, things in our body are intricately connected, like when you have a foot injury and it throws off your gait and spine alignment, and you start having low back pain, neck pain, and head aches. That is a manifestation of the interconnection described in that song.
The song was composed a hundred years before it was discovered that there is another connection in that sequence: the teeth are connected to the head bone. Research in recent years has shown that the health of the teeth has a significant impact on the overall health of the body and on mental health.
Do you know who lives in your mouth?
Believe it or not, the mouth is rich in micro organisms -- 700-1,000 species, according to the National Institute of Health -- beneficial bacteria, harmful bacteria, fungi, viruses. A mega metropolis of microbes coexisting in different neighborhoods in your mouth! The teeth, gums, palate, tongue, gum pockets around the teeth, the back of the throat all provide residence for this teeming ecosystem or microbiome. The balance of these microorganisms is key for the health of the mouth and that of the body.
Check out this little video. It's quite entertaining,
although I have to say that as soon as it was over,
I ran to brush my teeth.
Some of the little creatures living in your mouth have important jobs to perform for the benefit of your health. They start the digestive process by doing some initial prep work - chopping up the proteins and carbs in the food you eat before it heads down to the stomach for further processing. When the good bacteria have appropriate nutrients to feed on, they establish vibrant colonies that crowd out and limit the growth of the harmful bacteria. However, if the population of good bacteria decreases for various reasons, like illness, medications, unhealthy habits, the colonies of harmful bacteria increase causing a whole host of ailments and diseases. At a “local” level, they cause cavities, bad breath, gingivitis, periodontal disease, and increased risk of oral cancer.1 At a more systemic level, they can trigger serious illnesses, such as inflammatory bowel disease, ulcerative colitis, obesity, liver disease, pancreatic disorders, colon cancer. If the bad bacteria enter the blood stream they can cause respiratory illnesses and endocarditis, an inflammation of the heart lining. Recent studies have even found links between bad oral bacteria and Alzheimer’s disease. Clearly, they are called bad for a good reason!
But they don’t stop there!
When I started to write this post, people I told about it expressed surprise that dental problems and mental health would be related at all. But in fact, there is a two way interaction between them. People with mental health problems have more difficulty maintaining a regular routine for mouth and dental care. For someone suffering from clinical depression, for example, finding the will to get through the day and stay alive takes all the energy they have. Brushing teeth or flossing feel peripheral and irrelevant by comparison. Or for someone with ADHD, who is distractible, can't manage time, and is forever procrastinating (click here to read about how procrastination affects your health), brushing and flossing might just never make it on their list of things to do.
But the relationship goes the other way, too: the state of a person’s mouth and teeth has a dramatic impact on one’s psychological well being, quality of life, and opportunities. A quick search on Google for “the effects of good teeth on success” uncovered 144,000,000 results. It appears that good teeth and success have a strong association. People with straight, white teeth are perceived as more attractive, desirable, successful, confident, and employable, Not surprisingly, they make more money.
By comparison, people with dental problems tend to experience the reverse. In one study, for example, adolescents with dental disorders, such as poorly aligned teeth, missing front teeth, untreated decay and gum disease were found to have significantly lower self-esteem and lower social self-confidence. Adults with periodontal disease have increased rates of depression, anxiety, shame, and isolation.4,5
So Is There an Action Plan?
1.Brush and Floss Twice a Day.
Taking the time to brush and floss can feel like one more thing you have to do when you are rushed or tired. But these two simple steps are not optional - they are essential for preventive dental care and your overall health.
Harmful bacteria congregate in communities in your mouth in the form a biofilm, which, if left undisturbed, turns into plaque. That sticky feeling you have in your mouth first thing in the morning is biofilm. You would probably agree, pretty gross, right? When the good bacteria are plentiful, the bad bacteria are kept in check. But many things, such as sweets and highly processed foods, dry mouth from medication, and illnesses can alter that balance and lead to the proliferation of bad bacteria. Brushing and flossing disrupt the biofilm and prevent the formation of plaque. However, once they are established, the bacteria surround themselves in polymers that are hard to remove. Remember your last dental cleaning when the hygienist had to use a sharp steel implement to remove the plaque? Those bad bacteria don’t mess around! It takes steel weapons to take them down.
We all thought that we knew how to wash our hands, but during the pandemic we learned how to do so properly. Along the same lines, here is a little video about how to brush properly.
2. Visit the dentist regularly
The research on what “regular” means is not clear. The standard recommendation is twice a year. There is evidence that 6 months is about a good span of time to catch developing dental problems in the beginning phase. A small filling is cheaper and more easily addressed than a root canal.
But studies also find that twice a year may not be necessary and that once a year visits are sufficient for people who don’t have health problems, who brush every day, who don’t take medications that can affect saliva production (some antidepressants are notorious for causing dry mouth, which leads to proliferation of bad bacteria), who don’t indulge in many sweets or processed foods, who don't smoke, and who eat a diet rich in complex nutrients and fresh fruits and vegetable. That’s probably about 5 people - they can go to the dentist once a year. The rest of us should stick with the twice a year program. It’s for our health!
3. Avoid smoking and vaping
Smoking alters the balance of oral bacteria, leading to decreased diversity of microorganisms and increased harmful bacteria that cause gingivitis and oral inflammation. Fortunately, the percentage of smokers has decreased to 11% of the population over the last 50 years. But this improvement has been cancelled out recently by a significant increase in vaping. Although vaping is regarded as safer than smoking, the mouth microorganisms would disagree. The microbiomes of vapers are similar to those of smokers.
4. Feed your biome
The typical western diet is shockingly deficient in the nutrients that feed and replenish your microbiome. The health of all those microorganisms living inside you, from the beginning of the digestive system (the mouth) all the way to the end (the intestine), are impacted by the foods you eat. We are the hosts to this rich ecosystem, so what we eat affects us because it affects our "guests," whose well-being depends on us. The saying goes “you are what you eat,” but at the end of the day, “THEY are what we eat,” so if they're not happy, we're not happy.
5. Manage your stress!
Might seem surprising, but hormones released during chronic stress have a damaging effect on oral and dental health. They cause a decrease in mouth biodiversity, which allows harmful bacteria to spread and grow more readily. The good bacteria are also affected by the decreased salivary production triggered by chronic stress. Anyone who has anxiety can remember times when they were so nervous that their mouth felt as dry as sandpaper. That is the effect of the stress hormones that suppress digestion at all levels as part of the fight-or-flight response.
If you find that chronic stress is affecting your health, ask your primary care doctor for a referral to a mental health professional who can help you explore the sources of stress in your life and develop effective stress management strategies.
Smile, and your micro biome will smile back at you!
Dr. Dana Watts
Clinical Psychologist
Helping Clients in the Greater Cleveland Area
440-895-1100
1 https://www.sciencedirect.com/science/article/pii/S2213453018301642
2 https://www.news-medical.net/health/What-Microorganisms-Naturally-Live-in-the-Mouth.aspx#:~:text=Broadly%20these%20microorganisms%20belong%20to,Peptostreptococcus%2C%20Treponema%2C%20Actinomyces%20genera.
3 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4520114/
4 https://www.medicalnewstoday.com/articles/study-links-gum-disease-to-mental-health-conditions#The-widespread-influence-of-gum-disease
5https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4804721/#:~:text=Furthermore%2C%20periodontal%20disease%20may%20increase,Pham%20et%20al.%2C%202012%3B
Another wonderful article, although I’ll admit to wanting to stop halfway through to brush my teeth too!
I had never heard about the correlation between mental health and oral hygiene, but it absolutely makes sense. Thank you for shutting light on this.
Wow! Ok, now that I've brushed my teeth, I can leave a comment. What an informative post! I, too, did not realize that oral health is directly linked to mental health.