Stress can have many effects on oral and dental health, because it directly creates physiological reactions in the body and indirectly affects the habits and behaviors of the person. In the following, we will examine the impact of stress on oral and dental health. **Biological changes caused by stress** The impact of stress on oral health can include the following: - ### **reduction of the immune system** Stress increases hormones such as cortisol, which can reduce the body's ability to fight bacteria and inflammation in the mouth. Result: increased risk of gum disease (periodontitis) and oral infections. - ### **dry mouth (xerostomia)** One of the first consequences of chronic stress is the dysfunction of the salivary glands and a decrease in the volume and quality of oral saliva. Saliva plays a vital role in neutralizing acids produced by plaque bacteria, washing away food particles and providing mineral ions for enamel regeneration. Dry mouth (xerostomia) leads to the overgrowth of decay-causing bacteria and fungi such as Candida. - ### **exacerbation of inflammation** Chronic stress by stimulating the sympathetic nervous system causes the release of inflammatory mediators. These cytokines and pro-inflammatory proteins (such as IL-1 and TNF-α) lead to the destruction of gum fibers and alveolar (gingival) bone and provide the basis for gum disease and bone loss. ### **Behavioral changes due to stress** Stress threatens oral health not only through biological mechanisms but also through changing behavioral habits. - Anxious people usually show less care in taking care of their teeth; Regular brushing and flossing are omitted - The tendency to consume sweet or caffeinated foods and drinks (coffee, energy drinks) increases, which intensifies the acidic environment in the mouth. - Smoking and alcohol consumption, both of which are known factors in the destruction of gum tissue and decrease in saliva flow, usually increase during times of stress. Common dental problems caused by stress In the impact of stress on oral and dental health, other common dental problems arise, which include the following: - ### **Braxim (grinding teeth)** Nervous pressures cause constant contraction of the chewing muscles and grinding of the teeth together. Severe wear of tooth enamel, occurrence of microcracks, tooth sensitivity to cold and heat, and jaw muscle pain are the consequences of this habit. - ### Temporomandibular joint disorders Chronic stress can lead to inflammation of the temporomandibular joint (TMJ), which is accompanied by localized or diffuse pain in the ears, neck, and shoulders. Locked jaw, sound in the joint when opening and closing the mouth and restriction of mouth movement are also among the most common symptoms. - ### **tooth decay** Dry mouth and changing the diet towards sugary substances increase the acidity of the oral environment and the attack of decay-causing bacteria on tooth enamel. Over time, this process leads to cavity formation, toothache and even the need for endodontic treatment. **Dental laminate** and **Dental implant** are recommended if you are looking to replace missing teeth. - ### **gum diseases** Because stress weakens the local immune system and intensifies inflammation, the occurrence and progress of periodontitis (inflammation and erosion of the gums and bone supporting the tooth) accelerates. Early symptoms include bleeding while brushing, swelling and discoloration of the gums. - ### **Oral wounds and canker sores** Aphthous or titric wounds (pseudo-aphthous) are common during chronic stress. These sores are painful and prevent eating and speaking, and they usually recur frequently. **How to prevent and manage the problem of stress** In the following, we discuss how to prevent and manage stress: 1. ### **control and adjustment of stress** Regular practice of meditation or diaphragmatic breathing helps reduce cortisol levels and softens the body's response to mental stress. Aerobic sports such as fast walking or running play an effective role in modulating stressful feelings by releasing endorphins. Teaching cognitive behavioral techniques (CBT) in identifying destructive thought patterns and replacing them with constructive thoughts reduces the tendency to lock the jaw and grind the teeth. 2. ### **Strengthening oral and dental health** Careful brushing with fluoride toothpaste at least twice a day helps make tooth enamel more resistant to wear and tear caused by bruxism. Daily use of dental floss or oral waterjet reduces the accumulation of bacterial plaque and prevents gum inflammation. Drinking plenty of water and chewing sugar-free gum increases saliva secretion and reduces the acidity of the oral environment. Also, we should not forget **the effect of drinking water on tooth decay**. 3. ### **Modification of lifestyle habits** Limiting the consumption of caffeine and sugar reduces nervous pressure and prevents excessive stimulation of the chewing muscles. Eliminating or reducing the consumption of alcohol and tobacco increases the healing power of oral tissues and the overall immunity of the body. Observing a regular and quality sleep pattern helps to restore the function of the nervous system and reduce muscle tension. **Management of complications caused by stress for dental health** Managing the effects of stress can improve your oral health. 1. ### **Night Guard** Night guards are thin plastic devices that are placed between the upper and lower teeth. These protectors neutralize the penetrating forces when grinding the teeth and prevent the wear of tooth enamel. Also, reducing the pressure on the chewing muscles minimizes pain and morning cramps. 2. ### **Physiotherapy and corrective jaw exercises** Gentle massage of the temporal and jaw muscles in the trigger points reduces chronic tension and balances the neuro-muscular connection. Daily stretching exercises for gentle opening and closing of the jaw and lateral movements improve the range of motion of the TMJ joint. Electrotherapy or ultrasound under the supervision of a physiotherapist can reduce local inflammation. 3. ### **dental interventions** Periodic examinations by the dentist help to identify and treat changes in tooth enamel and gums soon. In cases of extreme propensity to bruxism, careful molding and adjustment of the plastic shield can distribute the pressure evenly. In case of inflammation or severe joint problems, injection of local anti-inflammatory drugs or injection of Botox is recommended to reduce excessive activity of chewing muscles.