Anxiety / panic disorder

Oral health effects

• Increased tooth decay and tooth loss (dental caries)

  A meta-analysis of 26 studies (334,503 people) found anxiety, depression and dental phobia were all linked to more decayed, missing and filled teeth and greater tooth loss. Periodontal disease was not increased overall, except in panic disorder.

  Mechanism: Avoiding or delaying dental visits, diet changes, and medication-induced dry mouth.

  Clinical management: Make the next visit easy to keep: short, predictable appointments, a stop signal, and a fluoride and caries-prevention plan that works between infrequent visits.

• Teeth grinding and jaw pain (bruxism / TMD)

  Stress and anxiety are associated with clenching and grinding, which can overload the chewing muscles and joints and cause temporomandibular disorder symptoms.

  Clinical management: Look for wear facets, masseter hypertrophy and TMJ tenderness; refer for a nightguard and offer breaks to rest the jaw during long procedures.

• Dry mouth from anxiety medications (xerostomia)

  SSRIs, SNRIs, benzodiazepines and other anxiolytics commonly reduce salivary flow; anxiety itself can also cause a transient dry mouth.

  Clinical management: Check the medication list; recommend saliva substitutes, frequent water and high-fluoride toothpaste.