Trauma and Dental Health

oral health

Recent research has uncovered a connection between childhood trauma and poor dental health later in life.

According to researchers at the University of Michigan, experiencing childhood adversity and trauma increase our risk of tooth loss later in life.[1] It is documented that childhood trauma can lead to a greater risk for certain health conditions, such as cardiovascular issues and lung disease.[2] However, less research has been carried out investigating the relationship between trauma and oral health.

Trauma can cause those affected to engage in unhealthy behaviours, explains SAMHSA.[3] Such behaviours are alcohol and drug abuse, including nicotine, and neglect of personal hygiene. A common symptom of PTSD is bruxism  (constantly clenching one’s jaw). This can also take a toll on our oral health.

 

The Mind-Body Connection

Scientists and clinicians alike are beginning to understand more clearly the connection between the mind and body. Good mental health promotes good physical health and vice versa. In the same way, poor mental health can lead to poor physical health and the onset of illness and disease. This is no less true for our oral health.

Balanced physical and mental health is key to living a fulfilled life, free from as much preventable suffering as possible. A significant portion of the population has experienced at least one traumatic event in their lives. According to the National Centre for PTSD, approximately 60 percent of men and 50 percent of women will experience trauma at least once.[4] While some people can experience trauma and return to functional health after the event, some are unable to process that trauma fully. In this case, the trauma lives on in the body and mind and creates physical and mental health complications.

Living with trauma and PTSD can cause us to neglect daily activities that seem simple for others. Due to the nature of trauma, those affected may find it difficult to adhere to good personal hygiene and to be consistent with a professionally recommended care routine following dental issues.

This, in part, relates to a disconnect between the mind and body. Mental and behavioural health issues caused by trauma, such as PTSD, depression, anxiety, and avoidance can be obstacles to successfully maintaining our physical health.

 

Understanding Trauma

Trauma can cause a person affected to develop post-traumatic stress disorder (PTSD), a debilitating condition in which a person experiences[5]:

  • Vivid recollections of the traumatic event
  • Nightmares
  • Insomnia
  • Depression
  • Neglect of personal hygiene
  • Anxiety and panic
  • Aches and pains
  • Headaches
  • Paranoia
  • Social withdrawal
  • Dissociation
  • Avoidant behaviours (substance misuse and abuse, eating disorders, self-harm)

Trauma can happen to any of us – it does not discriminate. It has a significant impact on those affected. For children, experiencing trauma in the early developmental years can cause major changes in a person’s understanding of and relationship to their internal and external world.[6]

Trauma Symptoms that Lead to Poor Dental Health

Substance Abuse

As a result of trauma, a person is likely to have low self-esteem, a lack of consistent motivation, and a tendency to abuse alcohol, nicotine, and other drugs.[7] The frequent use of drugs, especially nicotine, and the neglect of personal care as a trauma symptom drastically increases a person’s chances of developing oral health issues, namely tooth decay.[8]

Depression and Anxiety

The likelihood of anxiety and depression is also significantly higher in traumatised individuals than the general population.[9] These conditions can make it even more difficult to adhere to a good oral health routine.

Personal Neglect

Some of the many difficulties associated with trauma and PTSD are feelings of hopelessness, despair, and apathy towards personal maintenance. Trauma can be so debilitating and all-consuming that it can be hard for those affected to carry out even basic daily activities, such as showering, cooking, or practising good dental hygiene.

Bruxism

Bruxism is the habitual clenching and grinding of one’s teeth. This behaviour is often carried out unconsciously and can happen during both sleep and wakefulness.[10] Over time, bruxism can wear away at our dental health. It can also cause pain in the mandibular area (upper jaw bone) headaches, and can sometimes affect speech and swallowing.[11]

Bruxism is not a mental disorder itself but it can appear as a symptom of PTSD. It is often seen in people experiencing panic, depression, anxiety, sleep disorders, and those with increased sensitivity to stress. Studies have found that manic and depressive symptoms are more prevalent among people with bruxism than those without.[12]

 

Three Models of Life Course Research

Tooth loss and other dental issues in adult life can be considered through the lens of three models, as outlined by University Michigan researcher Haena Lee in the journal Community Dentistry and Oral Epidemiology – the sensitivity period model, the accumulation model, and the social mobility model.[13]

The sensitivity period model considers the ‘sensitive period’ of a person’s life – the time of life during which events have the strongest impact on a person’s development. The accumulation model considers the accumulation of adverse throughout the lifespan and how that impacts overall health. The social mobility model looks at one’s socioeconomic status (SES) over the lifespan.

The sensitivity period model suggests a strong connection between childhood trauma and tooth loss. UoM researcher Haena Lee believes that tooth loss resulting from childhood trauma occurs through ‘sociobehavioural pathways’[14] created by the trauma.

For example, childhood trauma increases the likelihood that an affected person will engage in unhealthy behaviours such as abuse of alcohol, nicotine, and other drugs. Excessive drug use is known to lead to tooth decay.[15]

Further, childhood trauma can negatively impact a person’s memory and ability to learn and process new information. As a result, a person is more likely to struggle with educational attainment. This can make it difficult to find and maintain a job that provides dental insurance.

 

The Impact of Adverse Childhood Experiences on Oral Health

Adverse childhood experiences (ACEs) is a term used to define exposure to ‘abuse or household dysfunction before the age of 18 years.[16] Examples of ACEs include:

  • Sexual abuse
  • Physical, emotional, verbal abuse
  • Neglect
  • Exposure to domestic violence
  • Exposure to mental illness, substance abuse, or incarceration

Research has consistently shown that exposure to one or multiple ACEs negatively impacts the functionality of the immune system, nervous system, and endocrine system in those affected.[17] ACEs also impact normal brain development.[18]

In the long-term, ACE exposure can create a tendency toward unhealthy behaviours, such as poor diet, smoking and drug abuse, and neglect of personal hygiene.

Childhood abuse, particularly sexual abuse, has been found to increase the likelihood that a person will experience dental phobia.[19] This makes those affected less likely to attend dental appointments, to the detriment of their oral health.

More studies show people who have been through ACEs are more likely to follow a poor diet. Unhealthy diets are also a common risk factor for oral health issues. [20]

‘Children are also likely to be reliant upon their parents or carers for their diet and maintenance of their oral health’[21], explain an article in BMC Oral Health. In cases where children grow up in dysfunctional households and have suffered an ACE, their dental outcomes may be negatively affected.

 

On Preventing and Treating Oral Health Issues in Adults with ACEs

There is clear evidence that childhood trauma leads to oral health issues in adulthood. Moving forward, it is important that appropriate support is put in place for those who are at a disadvantage when it comes to receiving sufficient oral healthcare, such as those who have experienced ACEs, people who have PTSD, and those with a lower SES.

 

If you have a client, or know of someone who is struggling to heal from psychological trauma, reach out to us at Khiron Clinics. We believe that we can improve therapeutic outcomes and avoid misdiagnosis by providing an effective residential program and out-patient therapies addressing underlying psychological trauma. Allow us to help you find the path to realistic, long-lasting recovery. For information, call us today. UK: 020 3811 2575 (24 hours). USA: (866) 801 6184 (24 hours).

 

[1] Lee, Haena. “A Life Course Approach To Total Tooth Loss: Testing The Sensitive Period, Accumulation, And Social Mobility Models In The Health And Retirement Study”. Community Dentistry And Oral Epidemiology, vol 47, no. 4, 2019, pp. 333-339. Wiley, doi:10.1111/cdoe.12463. Accessed 2 Jan 2021.

[2] De Bellis, Michael D, and Abigail Zisk. “The biological effects of childhood trauma.” Child and adolescent psychiatric clinics of North America vol. 23,2 (2014): 185-222, vii. doi:10.1016/j.chc.2014.01.002

[3] Center for Substance Abuse Treatment (US). Trauma-Informed Care in Behavioral Health Services. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2014. (Treatment Improvement Protocol (TIP) Series, No. 57.) Chapter 3, Understanding the Impact of Trauma. Available from: https://www.ncbi.nlm.nih.gov/books/NBK207191/

[4] “VA.Gov | Veterans Affairs”. Ptsd.Va.Gov, https://www.ptsd.va.gov/understand/common/common_adults.asp#:~:text=PTSD%3A%20National%20Center%20for%20PTSD,-How%20Common%20is&text=During%20this%20type%20of%20event,one%20trauma%20in%20their%20lives. Accessed 2 Jan 2020.

[5] Sareen, Jitender. “Posttraumatic Stress Disorder In Adults: Impact, Comorbidity, Risk Factors, And Treatment”. The Canadian Journal Of Psychiatry, vol 59, no. 9, 2014, pp. 460-467. SAGE Publications, doi:10.1177/070674371405900902. Accessed 2 Jan 2021.

[6] De Bellis, Michael D., and Abigail Zisk. “The Biological Effects Of Childhood Trauma”. Child And Adolescent Psychiatric Clinics Of North America, vol 23, no. 2, 2014, pp. 185-222. Elsevier BV, doi:10.1016/j.chc.2014.01.002. Accessed 2 Jan 2021.

[7] Sinha, Rajita. “Chronic Stress, Drug Use, And Vulnerability To Addiction”. Annals Of The New York Academy Of Sciences, vol 1141, no. 1, 2008, pp. 105-130. Wiley, doi:10.1196/annals.1441.030. Accessed 2 Jan 2021.

[8] Malhotra, Ranjan et al. “Nicotine And Periodontal Tissues”. Journal Of Indian Society Of Periodontology, vol 14, no. 1, 2010, p. 72. Medknow, doi:10.4103/0972-124x.65442. Accessed 2 Jan 2021.

[9] Sareen, Jitender. “Posttraumatic Stress Disorder In Adults: Impact, Comorbidity, Risk Factors, And Treatment”. The Canadian Journal Of Psychiatry, vol 59, no. 9, 2014, pp. 460-467. SAGE Publications, doi:10.1177/070674371405900902. Accessed 2 Jan 2021.

[10] Lobbezoo, F. et al. “Bruxism Defined And Graded: An International Consensus”. Journal Of Oral Rehabilitation, vol 40, no. 1, 2012, pp. 2-4. Wiley, doi:10.1111/joor.12011. Accessed 2 Jan 2021.

[11] Tan, Eng-King et al. “Bruxism In Huntington’s Disease”. Movement Disorders, vol 15, no. 1, 2000, pp. 171-173. Wiley, doi:10.1002/1531-8257(200001)15:1<171::aid-mds1031>3.0.co;2-y. Accessed 2 Jan 2021.

[12] Manfredini, Daniele et al. “Mood Disorders In Subjects With Bruxing Behavior”. Journal Of Dentistry, vol 33, no. 6, 2005, pp. 485-490. Elsevier BV, doi:10.1016/j.jdent.2004.11.010. Accessed 2 Jan 2021.

[13] Lee, Haena. “A Life Course Approach To Total Tooth Loss: Testing The Sensitive Period, Accumulation, And Social Mobility Models In The Health And Retirement Study”. Community Dentistry And Oral Epidemiology, vol 47, no. 4, 2019, pp. 333-339. Wiley, doi:10.1111/cdoe.12463. Accessed 2 Jan 2021.

[14] “Childhood Trauma Tied To Tooth Loss Later In Life”. University Of Michigan News, 2019, https://news.umich.edu/childhood-trauma-tied-to-tooth-loss-later-in-life/. Accessed 2 Jan 2021.

[15] Shekarchizadeh, Hajar et al. “Oral Health of Drug Abusers: A Review of Health Effects and Care.” Iranian journal of public health vol. 42,9 (2013): 929-40.

[16] Ford, Kat et al. “Understanding The Association Between Self-Reported Poor Oral Health And Exposure To Adverse Childhood Experiences: A Retrospective Study”. BMC Oral Health, vol 20, no. 1, 2020. Springer Science And Business Media LLC, doi:10.1186/s12903-020-1028-6. Accessed 2 Jan 2021.

[17] Su, Shaoyong et al. “The Role Of Adverse Childhood Experiences In Cardiovascular Disease Risk: A Review With Emphasis On Plausible Mechanisms”. Current Cardiology Reports, vol 17, no. 10, 2015. Springer Science And Business Media LLC, doi:10.1007/s11886-015-0645-1. Accessed 2 Jan 2021.

[18] McLaughlin, Katie A. et al. “Childhood Adversity And Neural Development: Deprivation And Threat As Distinct Dimensions Of Early Experience”. Neuroscience & Biobehavioral Reviews, vol 47, 2014, pp. 578-591. Elsevier BV, doi:10.1016/j.neubiorev.2014.10.012. Accessed 2 Jan 2021.

[19] Dougall, Alison, and Janice Fiske. “Surviving Child Sexual Abuse: The Relevance To Dental Practice”. Dental Update, vol 36, no. 5, 2009, pp. 294-304. Mark Allen Group, doi:10.12968/denu.2009.36.5.294. Accessed 2 Jan 2021.

[20] Bhatia SK, Maguire SA, Chadwick BL, Hunter ML, Harris JC, Tempest V, et al. Characteristics of child dental neglect: a systematic review. J Dent. 2014;42:229–39.

[21] Ford, Kat et al. “Understanding The Association Between Self-Reported Poor Oral Health And Exposure To Adverse Childhood Experiences: A Retrospective Study”. BMC Oral Health, vol 20, no. 1, 2020. Springer Science And Business Media LLC, doi:10.1186/s12903-020-1028-6. Accessed 2 Jan 2021.

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