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When Jessica Chia visited the dentist for her annual check-up, she was surprised when he asked her if she was experiencing a stressful time at home or at work. He pointed out that she had a couple of ulcers on her tongue and observed that she had been grinding her teeth unconsciously during the night. 


“He was right, I was experiencing a great deal of stress at work at the time,” the 38-year-old executive shares. “My dentist said that he could tell I wasn’t coping very well, just by looking in my mouth.”


Stress and anxiety do not just present as fatigue, sleep disturbances, headaches, gastrointestinal problems, or muscle tension. Very often, they can show up as a variety of oral health problems too, from dry mouth and gum disease to jaw pain. 


“If we notice these symptoms when examining a patient’s mouth, we may ask the patient a few questions to figure out the possible causes, because the symptoms are multi-factorial and may be smoking- or diet-related or due to poor oral hygiene,” says Dr Sherina Daryanani, principal and dental surgeon at Teeth @ Tiong Bahru Dental Clinic. “We may ask what’s happening in her life, if the symptoms are ongoing, and so on, to determine if stress is the culprit.” 


If your dentist notices any of these five problems during an oral examination, it’s time to get serious about managing the stress in your life:


1 Oral lesions

Dr Jeffrey Sng, dental specialist in prosthodontics at Raffles Medical, says that canker sores, cold sores, lichen planus (lacy, white inflamed patches in the mouth), and burning mouth syndrome, are just a few examples of lesions that may appear in the mouth during times of stress or emotional upheaval. Stress affects the body’s immune system, and a lowered immunity also contributes to these lesions, he explains. 


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2 Bruxism 

Bruxism refers to the unconscious grinding and clenching of the teeth. Stress is the main cause, although it is not the only one, says Dr Daryanani. Bruxism can cause pain in the joints of the jaw and the muscles used for chewing, a condition called temporomandibular disorder (TMD). 
When examining your mouth, Dr Daryanani says that dentists typically assess the range of movement in the patient’s jaw (she may not be able to open or close her jaw entirely), listen out for clicking sounds, and ask if she experiences discomfort when chewing or talking. These problems may signal that the patient is grinding and clenching her teeth.


Hairline fractures or cracks in the teeth may also point to bruxism, Dr Daryanani adds. 


3 Worn teeth

Do you bite your nails when you’re anxious? Dr Sng says these habits can wear down your teeth faster, as well as overwork your chewing muscles, leading to myalgia or muscle pain. Bruxism can also wear down the edges of your teeth over time.


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4 Dry mouth syndrome

Dr Daryanani says that a dry mouth – a condition known as xerostomia – is another oral manifestation of stress. Saliva has a protective function, so when the inside of your mouth lacks moisture, it can lead to a host of problems, such as an increased risk of tooth decay, cracked lips, or oral yeast infection. 
Dr Sng adds that patients with dry mouth syndrome may also have difficulty eating, swallowing, chewing or speaking. 


5 Cavities and gum inflammation

When you’re under stress, you may neglect to clean your teeth as often or as thoroughly as you should. You may also eat more unhealthy foods and drink more energy drinks or coffee. All these habits can increase your risk of developing cavities, gum inflammation and a dry mouth, says Dr Sng.


How your dentist can help you manage stress

Dr Daryanani says if your dentist notices any of these problems during an oral examination, she will suggest solutions to address them. For instance, if you grind your teeth while you sleep, she will prescribe a mouth guard to wear during the night to prevent damage to your teeth. Other problems may require medication or changes to your oral hygiene routine.  


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Ideally, you should get rid of, or at least try to manage, the source of your stress to begin with, says Dr Sng. But there are many other ways to keep your mouth and teeth healthy every day: Eating a well-balanced diet to help boost your immunity when life get stressful, practising good oral hygiene to minimise your risk of developing cavities and gum inflammation, reducing your sugar intake, and finding healthy ways to relax instead of smoking or taking coffee breaks, to reduce muscle tension and anxiety, and thus slash your chances of developing TMD.