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Throughout modern history, stress has generally been categorised as a “risk indicator” for periodontal disease as opposed to a “risk factor,” meaning that correlations are observed but without strong evidence of a causal relationship.
As the evidence in this field matures with additional clinically controlled trials, more homogeneous data collection methods, and a better grasp of the biologic underpinnings of stress-mediated dysbiosis, emerging evidence suggests that chronic stress and related diseases (depression, anxiety) may be significant contributing factors in periodontal/peri-implant disease progression and inconsistent wound healing following periodontal-related therapeutics.”
Another recent study by Coelho et al. concludes that “an association exists between stress and periodontitis, signalling the necessity of a multidisciplinary attention when considering the psychological status in the management of oral and general health conditions of the individual.”
It is critical, first and foremost, that helping patients understand stress and how it impacts their oral health is part of a dental practitioner’s job. Just as it is in your interest to dissuade smoking due to its clearly adverse relationship with periodontal outcomes, you also should seek to address the topic of chronic stress head-on. Serve as an advocate for your patient, projecting confidence and expertise while acknowledging that you don’t specialise in the area of mental health.
“The role of the dental specialists is to discuss lifestyle in a broader concept than just oral hygiene, they should be more psychologically oriented,” wrote Reners et al. in a 2007 article on stress and periodontal disease that still holds up today. With evidence continuing to reinforce a meaningful relationship between the two conditions, the article’s concluding guidance only further resonates: “it should be mandatory for us to help patients to have less stress and, when needed, to refer them to a psychologist or other specialists in the field of stress medicine.”
This all contributes to a growing narrative around the expanded role of a dental professional in patient success. Our focus must go beyond the teeth and gums, in accordance with the reality that oral health is irrevocably tied to systemic health and patient behaviours.
At a basic level, the most useful thing you can do as a dentist to help patients reduce and cope with stress is to adamantly promote a healthy lifestyle. Many of the most helpful and proven techniques for stress reduction relate back to this core objective: getting physically active, eating a nutritious diet, and avoiding harmful habits like drinking alcohol, smoking, or eating unhealthy foods.
You might also use this line of reasoning to reinforce coinciding strong oral care rituals at home. After all, treatments for cavities and other oral health issues tend to become major sources of stress for many patients. Avoiding such outcomes is a win/win scenario from this perspective!
