THE EFFECT OF PSYCHOLOGICAL ASPECTS ON ORAL HEALTH: HOW EMOTIONAL TENSIONS INFLUENCE ORAL WELL-BEING

O EFEITO DOS ASPECTOS PSICOLÓGICOS NA SAÚDE BUCAL: COMO AS TENSÕES EMOCIONAIS INFLUENCIAM O BEM-ESTAR ORAL

EL EFECTO DE LOS ASPECTOS PSICOLÓGICOS DE LA SALUD BUCAL: CÓMO LAS TENSIONES EMOCIONALES INFLUYEN EN EL BIENESTAR ORAL

REGISTRO DOI: 10.69849/revistaft/cs10202410181607


Lucas Cavalcanti de Lima Félix1; Pedro Guimarães Sampaio Trajano dos Santos2; Luciano Barreto Silva3; Rosana Maria Coelho Travassos4; Ailton Coelho de Ataíde Filho5; Juliana Perez Leyva Ataíde6; Eudoro de Queiroz Marques Filho7; Maria Eduarda Corrêa dos Santos8; Maria Julia Pimentel Fragoso9; Rita de Cássia Vieira de Vasconcelos Cavalcanti Brandão10


Abstract

Objective: To discuss how psychological effects can interact in a harmful way in the oral cavity, showing that it is an axis that goes far beyond the psychic, often causing it to become a physical evil. Therefore, in this article, we show the problems of emotions in the aspect of oral health. Methodology: The research was conducted online, based on data published in BVS/BIREME in conjunction with PUBMED Central. The searches were carried out on platforms such as: Google Scholar, CAPES Portal, Web of Science, Science Direct, Research, Society and Development Journal. Gray literature was also used to compose this work due to its great wealth of information. Results: Our research found scientific foundations that point to the psychic potential of human beings as something that can easily bring about oral diseases. Conclusion: The research confirms that oral health is interconnected with psychological well-being, highlighting the importance of an integrated approach to the prevention and treatment of oral problems.

Keywords: Oral Health; Psychologically Stressful Conditions; Dental Treatment Anxiety.

Resumo

Objetivo: Discutir sobre como os efeitos psicológicos podem interagir de forma maléfica na cavidade oral, mostrando que se trata de um eixo que vai muito além do psíquico, fazendo com que muitas das vezes se torne um mal físico. Portanto, neste artigo, mostramos os problemas das emoções no aspecto da saúde bucal. Metodologia: foram pesquisadas on-line, com base em dados publicados na BVS/BIREME em conjunto com o PUBMED Central. As buscas foram realizadas em plataformas como: Google Acadêmico, Portal CAPES, Web of Science, Science Direct, Research, Society and Development Journal. A literatura cinzenta também foi utilizada para compor este trabalho devido à sua grande riqueza de informações. Resultados: Nossa pesquisa encontrou fundamentos científicos que apontam o potencial psíquico do ser humano como algo que pode trazer de forma fácil as doenças bucais. Conclusão: A pesquisa confirma que a saúde bucal está interligada ao bem-estar psicológico, destacando a importância de uma abordagem integrada para a prevenção e tratamento de problemas bucais. 

Palavras-chave: Saúde Bucal; Condições Psicologicamente Estressantes; Ansiedade ao Tratamento Odontológico.

Resumen

Objetivo: Discutir cómo los efectos psicológicos pueden interactuar de manera nociva en la cavidad bucal, mostrando que este es un eje que va mucho más allá de lo psíquico, provocando que muchas veces se convierta en una dolencia física. Por ello, en este artículo mostramos los problemas de las emociones en el aspecto de la salud bucal. Metodología: fueron investigados en línea, a partir de datos publicados en la BVS/BIREME en conjunto con PUBMED Central. Las búsquedas se realizaron en plataformas como: Google Scholar, Portal CAPES, Web of Science, Science Direct, Revista Investigación, Sociedad y Desarrollo. También se utilizó literatura gris para componer esta obra debido a su gran riqueza de información. Resultados: Nuestra investigación encontró fundamentos científicos que señalan el potencial psíquico del ser humano como algo que fácilmente puede provocar enfermedades bucales. Conclusión: La investigación confirma que la salud bucal está vinculada al bienestar psicológico, destacando la importancia de un enfoque integrado para la prevención y el tratamiento de los problemas bucales.

Palabras clave: Salud Bucal; Condiciones Psicológicamente Estresantes; Ansiedad por tratamiento dental.

1. Introduction

For a long time, oral health was treated mainly in a technical and clinical manner, focusing on the treatment of oral diseases such as cavities, gingivitis and periodontal complications. However, recent research has shown an increasingly clear link between mental health and oral health. This new area of ​​research emphasizes that people’s emotional and mental state can directly affect their oral health, with the connection between mind and body being a crucial element in the origin of several oral conditions (Wilber, 2007). The link between psychological elements and oral health should not be overlooked, especially in a scenario where stress, anxiety and depression are becoming increasingly common in our contemporary society. 

These feelings not only impact quality of life and the ability to cope with daily challenges, but also directly influence the way people take care of themselves, including personal hygiene and oral health (Greenberg, 2002). Anxiety, for example, can result in increased sensitivity to pain and excessive fear of dental procedures, which can lead patients to avoid frequent visits to the dentist. On the other hand, continuous stress is known to weaken the immune system, increasing susceptibility to inflammatory diseases such as periodontitis, and can also cause conditions such as bruxism, which harms the health of teeth and temporomandibular joints (Cruz et al., 2008). On the other hand, depression can lead to neglect of basic oral hygiene care, worsening problems such as cavities and gum disease (Esteves & Galvan, 2006).

This article aims to discuss how psychological effects can interact in a harmful way in the oral cavity, showing that it is an axis that goes far beyond the psychic, often causing it to become a physical illness. Therefore, in this article, we show the problems of emotions in the aspect of oral health. Advocates a holistic approach that considers both the physical and emotional aspects of patients. The article highlights the importance of integrating dentistry and psychology to promote more complete and effective care, with health professionals working together to ensure the physical and mental well-being of patients.

2. Methodology 

In this narrative literature review article, the study by Rother (2007) was used as a reference, which is the basis for guiding how to construct a work of this type. Along with other articles that were researched online, based on data published in BVS/BIREME in conjunction with PUBMED Central. The searches were carried out on platforms such as: Google Scholar, CAPES Portal, Web of Science, Science Direct, Research, Society and Development Journal. Gray literature was also used to compose this work due to its great wealth of information. During the construction of the article, descriptors from the DeCs platform were used: Oral Health; Psychologically Stressful Conditions; Anxiety regarding Dental Treatment.

3. Results 

3.1 Pathologies and disorders that can be caused by chronic stress 

Stress is the human body’s response to situations that are perceived by the organism as challenging, threatening and overwhelming. Therefore, it is a great ally in triggering physical problems through the psychic environment (Greenberg, 2002). In this sense, when stress is stimulated, the body produces a series of hormones that are crucial for preparing the organism for such a situation. However, if it is something that occurs on a daily basis, it can generate a chain of problems for the organism that can directly affect oral health (Bernabé, 2009). These factors can cause several oral problems, such as gingivitis, so that stress can weaken the immune response, making the body more susceptible to infections, including gum infections. In addition, it can cause xerostomia, so that chronic stress raises cortisol levels, which can impact the function of the salivary glands and reduce saliva production (Cruz et al., 2008). Furthermore, bruxism is also an oral disorder that can be caused by excessive stress, causing tension in the jaw muscles to increase the likelihood of the individual grinding their teeth. This habit can cause a series of problems, such as tooth wear, which affects tooth enamel and can lead to problems such as cavities and sensitivity. In addition, another associated problem is the impact on the temporomandibular joint, which can cause pain and difficulty opening or closing the mouth (Araújo et al., 2023).

3.2 The influence of patient anxiety on dental consultations and procedures

Anxiety is a reaction of the human body to feelings of worry, fear or apprehension regarding future events. Although it is a physiological process of the organism, it is a mechanism that harms health, whether psychologically or physically. This condition can be caused by a combination of genetic and environmental factors, life experiences and daily stressors, in addition to being associated with chemical imbalances in the brain (Frota et al., 2022). Anxiety can trigger several problems when carrying out routine or emergency dental appointments, so that anxious thinking causes the patient to have a significant increase in fear, generating a negative expectation of pain or discomfort, making the experience of the office more stressful and agonizing. Furthermore, in more complex cases with a surgical bias, there may be some difficulty in relaxing, generating physiological reactions that can cause unexpected effects to the patient, such as increased blood pressure, tachycardia and muscle tension, thus making it impossible to perform the surgical procedure (de Carvalho & Carvalho, 2023). When a person is anxious, pain may seem more intense and more difficult to control, which is why anxiety and pain are directly linked, and this happens because anxiety can reduce pain tolerance. In dentistry, there are several ways to deal with anxiety during the consultation, which can be through medication or without pharmaceutical bias, such as the use of complementary therapies. When the dentist uses these techniques to help control anxiety, in addition to making the pain easier to deal with, it also prevents problems such as fainting and changes in blood pressure or blood sugar levels. Therefore, it is important that the dentist treats both the patient’s pain and anxiety equally (Gaudereto et al., 2016).

3.3 The Impact of Depression on Oral Hygiene

Depression is a psychiatric condition that is associated with changes in neurotransmitters, such as dopamine. This condition causes the individual to dwell on their thoughts and persistent feelings of sadness, causing the desire to perform pleasurable activities to decrease drastically. This also leads to the individual losing the desire to perform activities and tasks that are necessary for the daily life of a normal individual, such as taking care of their hygiene (Esteves & Galvan, 2006). In this regard, more specifically, oral hygiene is also affected in the individual when they have this psychological disorder, so that with the decrease in motivation and neglect of basic care, the person’s oral health can become extremely impaired, even if this attitude is involuntary or not. Consequently, this does not correspond to a search for diligence in relation to oral hygiene, making depression extremely influential in the oral cavity (Hugo et al., 2012). In short, neglecting oral health can lead to the development and worsening of tooth decay, which can cause intense pain as it progresses into the deeper tissues. In addition, when decay reaches the pulp (the deepest tissue of the tooth), endodontic treatment is necessary. Failure to do so can lead to an infection, resulting in an abscess at the root of the tooth, causing severe pain and swelling. Furthermore, if these treatments are not performed and the importance of these treatments is not emphasized, the individual may lose their tooth (Cheng et al., 2022). In addition, other diseases such as periodontitis can be aggravated by neglect. Bacteria present in the mouths of people with periodontitis can enter the bloodstream and reach the arteries, facilitating the accumulation of fatty plaques on the arterial walls. This can harden and narrow the arteries, impairing blood flow and increasing the risk of heart attack or stroke (Rodrigues et al., 2023). Therefore, it is valid to state that the lack of attention to the health of the oral cavity caused by depressive disorder is extremely harmful to the individual as a whole.

3.4 Eating Disorders and Their Outcomes on Oral Health

Beauty standards are increasingly influencing contemporary society, so that the individual who takes this standard as something important is willing to do everything to contribute to aesthetics, even if this means carrying out certain practices and actions that can trigger harmful processes in the body, harming health instead of improving it, all of this motivated by an insatiable desire to be within the beauty standards imposed by society and which is attributed as something “harmonious and beautiful”. An example of this practice is the disorder called bulimia, a problem in which the person feels the need to take measures to avoid gaining weight, mostly by doing a lot of physical exercise, since this will trigger caloric loss. The main practice within this disorder is to induce vomiting, which will cause all ingested food to be thrown out, interrupting certain processes of digestion, all with the aim of maintaining a “thin” body seen as the ideal body for that person and who probably has this vision motivated by some personal factor, such as a person who was already obese and is “afraid” of becoming overweight again, or motivated by external factors such as the standard of beauty created in society. This condition is a serious problem that, in addition to affecting the person’s psychological well-being, affects oral health as a whole, when vomiting becomes a constant, even daily occurrence in the person’s life, passing a large amount of acid that will make up the vomit, which will trigger the process of tooth demineralization, something that will occur routinely and that, after a certain point, can cause tooth decay processes, triggered by these demineralization processes caused by the HCL that will make up the vomit, being a problem that brings harm to oral and mental health at the same time (Lazey, 2015: Kessler, 2014: Ganss & Mühlhans, 2008: Mínguez & Ramos, 2018).

4. Discussion

Over the years, the world has increasingly advanced in improved directions, new technologies, equipment, and revolutionary procedures. However, there are certain aspects that have actually worsened over the years, even with the advancement of health and technology in the world. Psychological illnesses and problems have been worsening, caused by a set of biopsychosocial factors, but in fact, most of the time, they are seen by people as problems caused by a single factor. This is wrong and incorrect at a time when a large portion of psychological problems are triggered by more than one factor, leading to the development of a problem. This highlights the need for an interprofessional relationship between health professionals, bringing together nutritionists, dentists, psychologists, and doctors, who must come together and share their information and knowledge in order to improve and elevate the life of a patient that they both care for and monitor. From this, it is in fact that the areas of health must relate and work together, aiming to treat problems that both areas are related to. 

This is how it works with dentistry and psychology, both areas are related, even though most of them are seen as areas that have no connections. Over the years, research has been done in relation to different psychological problems and results have been obtained that show that these conditions such as anxiety, depression and stress have an impact on the person’s oral health, causing a series of options of problems that will reduce the health of the oral cavity, problems such as: TMD, periodontal diseases, cavities, bruxism, gingivitis and edentulism. Thus, both psychological problems can lead to oral problems and oral cavity problems can trigger these psychological problems, at a time when most people with periodontitis and caries have teeth and gums that are considered “unaesthetic” and frowned upon within society, lowering the person’s self-esteem and potentially triggering depression and anxiety in the individual, or for example, a person with TMD is constantly stressed by the pain they feel, increasing their stress levels. Thus, it is clear that the areas of psychology and dentistry are related, in that a psychological or oral problem can influence the appearance of another problem within the other area, and it is extremely important that the patient is viewed from a biopsychosocial perspective by both professionals, and that there is this connection between areas, elevating and promoting better health for the patient.

5. Conclusion

Today’s society is increasingly made up of people with mental problems, which increases not only psychological disorders, but also physical ones. Therefore, in the field of dentistry, it is worth noting that pathologies and disorders such as bruxism, gingivitis, xerostomia and others are directly or indirectly linked to psychological factors, causing the individual to suffer continuously. However, the dentist, in addition to dealing with pain and dental treatments, needs to correlate sciences such as psychology and make the patient feel good in all aspects. Furthermore, it is seen that this interprofessional relationship between the psychologist and the dentist is essential for patients with mental disorders, so it is known that oral health influences the psychological bias, and the psychological scope influences oral health. It is important for the dentist to have a vision beyond the clinical perspective, and to see the patient as a whole. Thus, it is valid to conclude that dental treatment, in certain individuals, is undeniably the intracellular use of psychology with dentistry, aiming at the holistic well-being of the individual.

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1ORCID: https://orcid.org/0009-0007-7677-591X – Faculdade de Odontologia do Recife, Brazil. E-mail: lucascavalcanti209@gmail.com
2ORCID: https://orcid.org/0009-0001-5720-603X – Faculdade de Odontologia do Recife, Brazil. E-mail: pedroguimaraessampaio@gmail.com
3ORCID: https://orcid.org/0000-0002-1508-4812 – Universidade de Pernambuco, Brazil. E-mail: lucianobarreto63@gmail.com
4ORCID: https://orcid.org/0000-0003-4148-1288 – Universidade de Pernambuco, Brazil. E-mail: rosana.travassos@upe.br
5ORCID: https://orcid.org/0000-0002-8105-4259 – Faculdade de Odontologia do Recife, Brazil. E-mail: ailtonataide@hotmail.com
6ORCID: https://orcid.org/0009-0000-3673-7651 – Universidade de Pernambuco,  Brazil. E-mail: juliana.ataide@upe.br
7ORCID: https://orcid.ogr/0000-0001-9794-0311 – Faculdade de Odontologia do Recife, Brazil. E-mail: eudoromarques@hotmail.com
8ORCID: https://orcid.org/0009-0001-9139-5671 – Faculdade de Odontologia do Recife, Brazil. E-mail: meduardac123@gmail.com
9ORCID: https://orcid.org/0009-0004-7510-9497 – Faculdade de Odontologia do Recife, Brazil. E-mail: Julhinhapimentel@gmail.com
10ORCID: https://orcid.org/0000-0003-3616-6208 – Faculdade de Odontologia do Recife, Brazil. E-mail: ritabrandao2005@yahoo.com.br