The often overlooked link between dental health and mental health
The relationship between oral and mental health is cyclical, with both continually impacting the other.
Editor’s Note: May is Mental Health Awareness Month and National Masturbation Month. This is also the month that we celebrate Mother’s Day. At BYP, we will be exploring these topics alongside the theme of Imagination and the Arts, and we are interested in publishing works that address these topics and the things surrounding them.
I am constantly worried that my teeth will rot out of my head. That statement is only somewhat hyperbolic. I’m not happy with my teeth, but as a poor, uninsured Black millennial, I don’t currently have the resources to get the smile that I really want, despite having more than one job.
I never talk about this, because struggling with dental hygiene is a source of shame for me, as it is for many others. This shame is no easy thing to carry, especially when I am already carrying so much. I stayed silent about it for a long time, and when I finally shared my feelings with a few trusted friends, I learned that I am not alone.
Far too many Black Americans, and non-Black people of color, go without the dental care they need. 42% of Black American adults have untreated dental disease, compared to only 22% of whites. Untreated tooth decay in primary teeth is twice as high among Black children as compared to their white counterparts.
Economic disparities contribute to this gap, especially because of food insecurity. It’s not surprising that lack of insurance is a major factor as well. According to the National Association of Dental Plans, approximately 114 million Americans currently have no dental insurance, which makes them 67% more likely to have heart disease, 50% more likely to have osteoporosis, and 29% more likely to have diabetes than the insured.
Even for those who have Medicaid, the available programs fail to provide adequate care, with the average program allotting less than 2% of its budget for dental coverage. There also isn’t much incentive for dentists to accept Medicaid as an option at their practice, as most will end up losing money on Medicaid-using patients.
As with many health-related issues in the US, dental care is so expensive and inaccessible for so many people that some are seeking it out across the border because our healthcare system as a whole is a hell hole that is only concerned with profits for the rich. Ironically, many of those crossing into Mexico to receive affordable treatment voted for Trump and his Border Wall, because white supremacist nationalism and xenophobia are always awash with cognitive dissonance.
Going without basic dental care can increase the chances of suffering from other health problems caused by untreated oral infections, like heart disease, diabetes, and stroke, conditions that already disproportionately impact communities of color due to socioeconomic disadvantages. Untreated tooth decay in children can also stunt their development, impacting how they eat and speak, and even how they learn, as well as their self-esteem and self-image growing up.
This is about a lot more than off-white smiles with gaps in the teeth like mine. There is a connection between lack of dental care and the rest of our body, as well as our mind, especially for those of us locked in a constant battle with white supremacy and its violences. Oral health connecting with mental health is a significant factor in this.
The relationship between oral and mental health is cyclical, with both continually impacting the other. The Penn Dental Family Practice lists many examples of how mental illnesses can lead to and/or exacerbate poor dental health, and how oral hygiene contributes to the state of our mental health:
- Depression is associated with higher abuse of alcohol, caffeine, and tobacco, which may cause tooth erosion and decay.
- Depression often causes self-neglect, which often results in poor oral hygiene and consequential tooth decay.
- Bipolar affective disorder often causes over-brushing that may damage gums and cause dental abrasion, mucosal lacerations, or gingival lacerations.
- Bipolar patients treated with lithium have a higher rate of xerostomia and stomatitis.
- Acids from vomiting makes patients with eating disorders more susceptible to tooth decay.
- Side effects of antipsychotic, antidepressant, and mood stabilizer drugs may include a higher susceptibility to oral bacterial infections.
- Poor dental health affects speech, which can cause significant social anxiety. Likewise, bad breath can exacerbate social anxiety.
- Patients of mental illness are 2.8 times more likely to have lost all their teeth; this affects physical appearance, self-esteem, and self-image.
- Similarly, patients of mental illness have higher statistical rates of tooth decay and missing teeth, which likewise affect physical appearance and self-image.
There is also an intense fear of and discomfort with dentists and dental treatment among people with anxiety, depression, and PTSD, many of whom cite feeling stigmatized during the times when they have sought out treatment. For Black people, those fears are magnified by the shortage of Black dentists and the rightful distrust of white or otherwise non-Black medical professionals. A multitude of things keep us from accessing the oral care we need.
I’ve known for a long time that my mental health can have an impact on my body in varying ways and to varying degrees, and now I have one more thing to add to the list of worries. Learning all of this won’t do anything to help my teeth or my brain. I currently don’t have the option for regular dentist visits or mental health care. The best I can do is work towards making them more of a priority moving forward and taking better care of myself in the meantime, as much as I can, that is.
What this information has helped me to better understand is the extent of the psychological warfare we are fighting against white supremacy and the capitalism it worships. These systems manufacture scarcity and inequality, forcing low-income people out of access to necessary treatments, and we are the ones who have to carry the shame.
For me, it helps to know that at least I am not alone in carrying that shame. It helps to remind myself that the entire damn system is corrupt, more rotten than the untreated tooth decay in so many Black children’s smiles. It’s insidiousness knows no bounds and we have to destroy it all, and I know that our work to dismantle white supremacy and capitalism is and always will be right and just.