Most people are well-versed in the primary enemies of good oral health: plaque, acid and poor brushing/flossing routines.

However, there are more devious and sneaky enemies among us, now more than ever. Stress, anxiety and depression can all take a toll on your teeth and gums. Each of these mental health issues has been shown to clearly impact your oral health. Here is a look at how each one might dim your smile, as well as tools to combat them:

READ ALSO: Most Influential Women: Dr. Heather Schneider, Delta Dental of Arizona


Let’s start with the one we’ve all dealt with to some extent since last March. Data from the American Dental Association Health Policy Institute’s (HPI) COVID-19 impact poll reports that dentists have seen a rise in stress-related oral health conditions in their patients since the onset of the pandemic.

Heather Schneider, DMD, of Delta Dental of Arizona and 2021 Most Influential Women honoree.

More than half of the dentists polled reported an increase in teeth grinding (bruxism), which leads to jaw pain, earaches, headaches and – of course – worn down teeth; chipped and cracked teeth; and disorders affecting the jaw muscles (temporomandibular symptoms). Over a quarter of these same dentists saw a rise in conditions like cavities and gum disease as well.

Beyond the direct data, stress may also lead to bad habits such as drinking, smoking and overindulging in sugary dishes, each of which also may lead to cavities, gum disease and even oral cancer.

Each of the above can also wreaks havoc on the immune system. This means if you already have an infection in the mouth – for example, canker and cold sores – it may take longer to heal, or could get even worse.


Like stress, anxiety causes many to grind or clench their teeth, often unwittingly or even while sleeping. Anxiety can also lead to canker sores, and keep them from healing properly. There is also a connection between anxiety and tics – ranging from chewing gum to uncontrolled movements of the mouth to sucking motions – any of which can injure your tongue or cause physical damage to the teeth and gums. Anxiety has been linked to Burning Mouth Syndrome as well, which is ongoing and recurring burning in the mouth despite it not being physically scalded by any type of material, such as hot coffee or soup.


According to the Centers for Disease Control, one out of every six adults will have depression at some time in their life. Nearly two-thirds of these people may also get a toothache as a result. There are many reasons for this. First, the exhaustion and mental fatigue caused by depression often leads to avoidance of regular self-care, even things that seem routine such as brushing, flossing and visiting the dentist. In addition, those who are depressed likely have excess cortisol, the hormone that works to help the body fight what it construes as danger. It elevates blood pressure and heart rate, but as a result weakens the immune system, giving bacteria that cause gingivitis and gum disease a chance to invade your mouth.

In addition, several medications that effectively treat depression (as well as stress and anxiety) list dry mouth as a side effect. Lack of saliva (which moves food, plaque, and bacteria away from teeth as well as balances the pH of the oral environment) increases the risk for cavities.

Finally, the CDC also reports that people living with depression are more likely to smoke than those without depression.

Fight Back 

If you or someone you love is dealing with stress, anxiety, or depression, consider – in addition to seeking the help of a mental health professional – talking to your dentist. Armed with knowledge about what is happening in your head beyond just your mouth, he or she can offer instruction, advice and measures you may want to take to protect your teeth, gums and more. This might include something as simple as getting a mouth guard or changing toothbrushes, maybe drinking more water or using aids to help in saliva production. He or she may also provide information on smoking cessation programs or change the course in your long-term treatment to ensure an integrated approach to your care.

Dr. Heather Schneider is the dental director at Delta Dental of Arizona and has more than 19 years of experience in dental administration, dental education and clinical dentistry as well as a recipient of the 2021 Most Influential Women in Arizona business award by AZ Big Media. For more oral health tips and information, visit