In recent years, the connection between oral health and overall wellbeing has garnered increased attention from both medical professionals and the general public.
It is widely acknowledged that poor oral hygiene can lead to physical ailments such as gum disease and tooth decay but emerging research suggests that the impact extends beyond the mouth potentially influencing mental health as well.
This growing body of evidence underscores the importance of adopting a holistic approach to healthcare where the mouth is not viewed in isolation but rather as an integral component of one’s overall health.
It is estimated that oral diseases affect nearly 3.5 billion people globally. Untreated dental caries (tooth decay) in permanent teeth is the most common oral health condition according to the Global Burden of Disease, 2021. On the other hand, in 2019, 1 in every 8 people, or 970 million people around the world were living with a mental disorder with anxiety and depressive disorders being the most common. In 2020, the number of pe
ople living with anxiety and depressive disorders rose significantly because of the COVID-19 pandemic. Initial estimates showed a 26% and 28% increase respectively for anxiety and major depressive disorders in just one year. In light of the above staggering figures, the FDI World Dental Federation launched a 3 years’ campaign from 2024 to 2026 to raise awareness about oral health.
In 2024, the theme was ìA HAPPY MOUTH IS A HAPPY BODY,î which highlighted the strong connection between oral health and general health. In 2025, the focus shifted to the mouth-mind connection, with the tagline ìA HAPPY MOUTH IS A HAPPY MIND.î
On Thursday, 20th March, 2025, the Ministry of Health of Zambia joined the rest of the world in commemorating the World Oral Health Day themed “A Happy Mouth Is A Happy Mind.” As we reflect on this important theme, you will discover that oral health and mental health are intricately connected just as stated earlier.
Therefore, in this article, you will learn how mental health conditions influence oral health with regard to issues such as dry mouth, gum disease, and tooth decay and how poor oral health can aggravate mental well-being. Preventive measures, treatment approaches, and solutions to overcome these barriers are also discussed.
According to the World Health Organization (WHO), oral health is the state of the mouth, teeth and orofacial structures that enables individuals to perform essential functions such as eating, breathing and speaking, and encompasses psychosocial dimensions such as self-confidence, well-being and the ability to socialize and work without pain, discomfort and embarrassment. On the other hand, mental h
ealth is a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community. It is an integral component of health and well-being that underpins our individual and collective abilities to make decisions, build relationships and shape the world we live in.
Mental health is a basic human right. And it is crucial to personal, community and socio-economic development. Mental health is more than the absence of mental disorders. Individual psychological and biological factors such as emotional skills, substance use and genetics can make people more vulnerable to mental health problems.
Exposure to unfavorable social, economic, geopolitical and environmental circumstances including poverty, violence, inequality and environmental deprivation also increases people’s risk of experiencing mental health conditions.
The mental health disorders such as anxiety, depression, and schizophrenia are frequently brought on by systemic inflammation, medication side effects, and lifestyle modifications. These conditions have a substantial impact on many facets of our health including our oral and physical health.
Individuals experiencing severe mental health difficulties often struggle with poor oral health which can exacerbate their mental health issues. This is due to factors such as pain, infections, and neglect of oral hygiene. Studies indicate that people experiencing mental health challenges face a greater chance of developing conditions such as dental caries, gum disease and edentulism (tooth loss).
It also shows that dental health issues such as advanced gum disease (periodontitis) can promote systemic inflammation which worsen mental health issues like anxiety and depression. Similarly, untreated mental health conditions can result in neglect of dental health care that produces a feedback loop of declining health.
People’s self-image and perception of their dental aesthetics affect their social and psychological welfare and this is reflected in their behavior and self-confidence. Oral health has significant consequences for the quality of life of patients. Painful, unsightly dentition or ill-fitting dentures can exacerbate social withdrawal, isolation, and low self-esteem as well as cause problems with both speaking and eating.
In addition, there is an association between dental disease, coronary heart disease, stroke, diabetes, and respiratory disease which eventually affect an individual mentally.
It is also worth noting that about one half of all dental patients experience some anxiety about their dental visits, and in some cases this leads to dental phobia, a form of specific fear. Perception of dental pain may also be worsened by depression or anxiety regardless of the degree of oral disease. For example, burning mouth syndrome is a somatic symptom disorder in people with clinically healthy oral mucosa that is often associated with depression or anxiety. In the other direction, psychiatric illness can lead to poor oral health.
People with mental illness, particularly severe mental illness, are at greater risk of oral health problems like tooth decay and gum disease because of poor nutrition and oral hygiene and the heavy consumption of sugary drinks. Substance misuse including tobacco, alcohol or psychostimulants drugs may negatively affect oral health.
There are many oral health conditions that exist in such instances. Dry mouth (xerostomia) is one of them. It is another major risk factor for oral health problems and is often compounded by gum disease a result of nutritional deficiencies due to psychosis or anorexia nervosa. Anorexia nervosa refers to an eating disorder characterized by restriction of food intake leading to low body weight, usually accompanied by intense fear of gaining weight and disturbed perception of body weight and image.
This condition may contribute to dry mouth through multiple mechanisms due to dehydration, malnutrition, and medication use. Individuals with anorexia often have reduced fluid intake and electrolyte imbalances, leading to decreased salivary gland function. Nutritional deficiencies particularly in essential vitamins and minerals like vitamin A and zinc, impair saliva production and the health of salivary glands. Additionally, frequent vomiting in those with purging behaviors exposes salivary glands to stomach acid that may cause inflammation and dysfunction.
The use of medications such as antidepressants, commonly prescribed for anorexia, can further exacerbate dry mouth by interfering with normal salivary flow.
Patients with depression can develop caries, partly due to poor oral hygiene secondary to self-neglect and partly from xerostomia secondary to antidepressants. This again can be exacerbated by heavy caffeine and tobacco use. In addition, prostheses may no longer fit or may be lost. Poor oral health hygiene can result in total tooth loss. Patients with bipolar affective disorder face additional problems. In the manic phase, overzealous brushing or flossing may cause teeth abrasion as well as mucosal or gum lacerations.
Furthermore, studies suggest a significant association between bruxism in patients stressed especially in emotional disorders and occupational exposures.
The association between eating disorders and oral health problems was initially reported in the late 1970s. The most common diagnosis is erosion due to acidic fruit and drinks, as well as the presence of gastric reflux or frequent vomiting. Between 35% and 38% of patients with eating disorders suffer from tooth erosion. Patients with self-induced vomiting (SIV) are most at risk, and tooth wear is greatest on the surfaces of the palate.
Based on the close correlation between oral health and mental health, closer collaboration between mental health clinicians and dentists is important to remove barriers to care, whether these are psychosocial or financial. A dentist may be the first clinician to suspect a diagnosis of eating disorder given the reluctance of some patients to present for psychiatric treatment.
Oral hygienists can help through education in the use of artificial salivary products (to address xerostomia), mouthwashes, and topical fluoride applications. Patients should be advised to reduce their intake of acidic drinks and citrus fruit as well as the use of alcohol and tobacco. Avoidance of caffeinated beverages reduces xerostomia while sugar-free chewing gum helps to stimulate salivary flow. Frequent sips of water throughout the day also relieve symptoms. Lastly, patients with eating
disorders should avoid vigorous brushing after self-induced vomiting because the softened, demineralised surface is more susceptible to wearing out during that time.
Given this correlation, collaboration between mental health professionals and dentists is crucial in addressing both the physical and psychological barriers to care with preventive strategies like fluoride treatments, artificial saliva, and dietary modifications playing an important role in managing these conditions.
Happy World Oral Health Day.
