Introduction: Why the Mouth and Mind Matter Together?
What if the state of your mouth could influence how you think, feel, and function every day and, in turn, your mental health could affect the health of your teeth and gums? Imagine someone who’s struggling with chronic anxiety. The stress and tension from anxiety may cause them to grind their teeth at night (bruxism), which can lead to jaw pain, worn-down teeth, and headaches. Those dental problems can then worsen their stress, disrupt sleep, and even affect their confidence when smiling or speaking. In this way, mental health and oral health create a cycleeach influencing the other.
Research shows that oral health and mental well-being are closely connected, each shaping the other. Recognizing this connection can change the way we care for both, highlighting the importance of nurturing our mind and our mouth as essential, interconnected components of overall health. This two-way relationship, each can significantly influence the other through biological, behavioral, and social pathways. Understanding this connection is essential for public health professionals seeking to implement person centered care, improve population health, reduce disparities, and design integrated prevention strategies.
According to WHO, nearly 1 in 7 people worldwide approximately 1.1 billion individuals, live with a mental health disorder [1]. Mental health conditions can severely disrupt daily life and cause long-term suffering if left untreated, often compounded by stigma, discrimination, and limited access to care [1]. At the same time, the WHO report shows that oral diseases affect an estimated 3.5 billion people globally, making them among the most prevalent noncommunicable diseases worldwide [2]
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Despite their shared risk factors and overlapping impacts on quality of life, mental health and oral health are often addressed in isolation. From a public health perspective, this separation represents a missed opportunity to improve outcomes through integrated, equitable approaches to care. A recent article published in the Journal of the American Dental Association (JADA) highlighted the relationship between oral health and mental health, particularly depression. The authors emphasized: “Systemic correlations and identifying indications for poor oral health, especially among subgroups of the general population, are vital for guiding public health strategies and appropriate allocation of funding and support to achieve health equity.” [3].
Despite the clear connections between mental and oral health [4-6], mental health education in dental programs remains extremely limited. Of the 25 CODA (committee of Dental Accreditation) standards, only one touch on mental health [7]:
• “2-25: Graduates must be competent in assessing and managing the treatment of patients with special needs.”
This indicates that, while some attention is given to behavioral principles and special needs, formal training addressing mental health issues in dental education is minimal, leaving graduates underprepared to recognize and manage the mental health aspects of patient care.
Understanding Mental Health Disorders
According to WHO “A mental disorder is characterized by a clinically significant disturbance in cognition, emotional regulation, or behavior, typically associated with distress or impairment in important areas of functioning” [1]. According to the International Classification of Diseases, 11th Revision (ICD-11), mental disorders include a broad range of conditions such as anxiety disorders, depression, bipolar disorder, schizophrenia, post-traumatic stress disorder (PTSD), eating disorders, neurodevelopmental disorders, and disruptive behavior disorders [8].
While effective prevention and treatment options exist, most people with mental disorders do not have access to effective care, particularly in low- and middle-income countries. Social determinants such as poverty, violence, disability, and inequality further increase vulnerability, highlighting the need for population-level interventions [9].
Like what you’re learning? Consider enrolling in the Herman Ostrow School of Dentistry of USC’s online, competency-based certificate or master’s program in Community Oral Health.
How Mental Health Conditions Affect Oral Health:
Below are some common mental health disorders and their connections with oral health condition.
Anxiety Disorders
In 2021, 359 million people, including 72 million children and adolescents, were living with anxiety disorders. These conditions are characterized by excessive fear, worry, and behavioral disturbances severe enough to impair functioning [1].
Oral health implications include:
• Dental anxiety and avoidance of dental care
• Bruxism (teeth grinding) and temporomandibular joint (TMJ) disorders
• Xerostomia (dry mouth), often related to anxiolytic medications
• Increased risk of periodontal disease due to stress-related inflammation
Depression
Approximately 280 million people worldwide experience depression. Depression involves persistent low mood, loss of interest or pleasure, fatigue, impaired concentration, and changes in sleep or appetite. Literature has confirmed that depression is closely associated with fewer dental visits, poorer oral hygiene, and more caries, periodontal disease, and tooth loss [4-5]. A recent publication showed that depression was the fifth and sixth most prevalent comorbid condition for a primary and secondary diagnosis of Periapical abscess [3].
Oral health implications include:
• Neglected oral hygiene due to reduced motivation
• Increased risk of dental caries and periodontal disease
• Higher likelihood of tooth loss
• Reduced oral health–related quality of life (OHRQo).
Bipolar Disorder
In 2021, 37 million people were living with bipolar disorder, characterized by alternating depressive and manic episodes [1].
Oral health considerations include:
• Irregular oral hygiene routines during mood episodes
• Medication side effects such as xerostomia
• Increased risk-taking behaviors that may negatively affect oral health
Post-Traumatic Stress Disorder (PTSD)
PTSD develops following exposure to extremely threatening or horrific events and is characterized by intrusive memories, avoidance behaviors, and persistent perceptions of heightened threat [1].
Oral health implications include:
• Heightened dental anxiety
• Difficulty tolerating dental procedures
• Increased prevalence of bruxism and chronic orofacial pain
Schizophrenia
Schizophrenia affects approximately 23 million people worldwide and is associated with significant impairments in perception, cognition, and behavior. Individuals with schizophrenia have a life expectancy nearly nine years shorter than the general population [1].
Oral health implications include:
• High prevalence of untreated dental disease
• Poor access to dental care
• Medication-induced xerostomia and increased caries risk
• Challenges with self-care and appointment adherence
Eating Disorders
In 2021, 16 million people, including 3.4 million children and adolescents, experienced eating disorders such as anorexia nervosa and bulimia nervosa [1].
Oral health implications include:
• Enamel erosion from repeated exposure to gastric acid
• Increased risk of dental caries
• Xerostomia and oral mucosal lesions
• Dental sensitivity and esthetic concerns
How Poor Oral Health Affects Mental Well-Being
Oral health is more than the absence of disease. It enables essential functions such as eating, speaking, and social interaction and supports self-confidence, well-being, and participation in society [10].
Poor oral health can contribute to:
• Chronic pain and discomfort
• Sleep disturbances
• Social withdrawal due to embarrassment or halitosis
• Reduced self-esteem and confidence
• Increased anxiety and depressive symptoms
From a public health perspective, oral diseases disproportionately affect vulnerable and disadvantaged populations, reinforcing existing social and health disparities across the life course.
Biological Links: Inflammation and Shared Risk Factors
Emerging research highlights chronic inflammation as a shared biological pathway linking mental and oral health. Periodontal disease and several mental health disorders involve inflammatory processes that may contribute to disease onset and progression.
A nationally representative U.S. cohort study found that symptoms of mental health problem, particularly internalizing conditions such as anxiety and depression were associated with a higher prevalence of adverse oral health outcomes, including bleeding gums, tooth extraction, and periodontal disease. These associations persisted even after adjusting for socioeconomic, demographic, and behavioral risk factors [9].
These findings support the need for integrated prevention strategies that address shared risk factors such as stress, tobacco use, poor nutrition, and limited access to care.
Medications and Oral Health: An Overlooked Public Health Issue
Many commonly prescribed psychotropic medications, including antidepressants, antipsychotics, and anxiolytics are associated with xerostomia, which increases the risk of dental caries, candidiasis, and oral discomfort. Polypharmacy further compounds oral health risks, particularly among individuals with severe mental illness.
Public health strategies should promote:
• Medication review and monitoring
• Patient education on oral side effects
• Collaboration between medical, dental, and mental health providers
Toward Integrated Mental and Oral Health Care
Improving population health requires recognizing the interconnected nature of mental and oral health. Key public health strategies include:
• Integrating mental health screening into dental and primary care settings
• Applying trauma-informed care (TIC) approaches to reduce dental anxiety
• Educating communities about the oral–mental health connection
• Strengthening interprofessional collaboration
• Reducing stigma and improving access to preventive and therapeutic services
• Including mental health in dental education
• Interprofessional practices between mental health professionals and oral health professionals [11].
Key Points
This article briefly discusses the relationship between mental health and oral health, highlighting the importance of integrating these two aspects of healthcare. Key points include:
• Mental disorders and oral health issues are both significant public health concerns globally [1,2].
• Studies have found associations between depression and poor oral health among adults in the United States [3].
• Mental and oral health are interconnected and addressing them together is crucial for comprehensive healthcare and prevention [4].
• There is an established link between mental health status and oral health utilization and outcomes [5].
• Mental health and oral health should be considered together in national health surveys and research [6].
• Dental education programs are encouraged to incorporate mental health education and training [7].
• Policies addressing social determinants of mental health can also impact oral health at the population level [9].
• Incorporate interprofessional education and practices in dental and mental health programs [11].
Conclusion
Mental health and oral health are deeply intertwined, influencing one another through biological, behavioral, and social mechanisms. Addressing one without the other limits the effectiveness of public health interventions. By adopting integrated, person-centered, and health equity approaches, public health professionals can improve quality of life, reduce disparities, and support individuals and communities in achieving their full health potential.
Earn an Online Postgraduate Degree in Community Oral Health
Do you like learning about a variety of issues while focused on the unique needs of community health dental programs? Consider enrolling in the Herman Ostrow School of Dentistry of USC’s online, competency-based certificate or master’s program in Community Oral Health.
References
1. World Health Organization. (2025). Mental disorders. https://www.who.int/news-room/fact-sheets/detail/mental-disorders
2. World Health Organization. Oral health. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/oral-health
3. Llaneza, A. J., Zetino, Y., Llaneza, D. H., & Seward, J. (2026). Investigating the relationship between depression and oral health among adults in the United States, 2017–2020. Journal of the American Dental Association, 157(2), 153–162. https://doi.org/10.1016/j.adaj.2025.09.008
4. Z K, Siluvai S, Kanakavelan K, Agnes L, Kp I, G K. Mental and Oral Health: A Dual Frontier in Healthcare Integration and Prevention. Cureus. 2024 Dec 23;16(12):e76264. doi: 10.7759/cureus.76264. PMID: 39845207; PMCID: PMC11753583
5. Tiwari T, Kelly A, Randall CL, Tranby E, Franstve-Hawley J. Association Between Mental Health and Oral Health Status and Care Utilization. Front Oral Health. 2022 Feb 7;2:732882. doi: 10.3389/froh.2021.732882. PMID: 35199101; PMCID: PMC8859414
6. Kulagina, A., & Chaffee, B. W. (2023). Mental health and oral health in a nationally representative cohort. Journal of Dental Research, 102(9), 1007–1014. https://doi.org/10.1177/002203452311.
7. Commission on Dental Accreditation. (2025). Accreditation Standards for Dental Education Programs: Predoctoral Dental Education Standards. American Dental Association. Retrieved from https://coda.ada.org/-/media/project/ada-organization/ada/coda/files/predoc_standards.pd
8. World Health Organization. (2019). International classification of diseases for mortality and morbidity statistics (11th Revision). https://www.who.int/standards/classifications/classification-of-diseases
9. Llop-Gironés, A., Salamero, M., Borrell, C., & Vives, A. (2021). Policies addressing social determinants of mental health at the population level: A scoping review. BMC Public Health, 21, 2142. https://doi.org/10.1186/s12889-021-12145-1
10. FDI World Dental Federation. (2016). FDI’s definition of oral health. International Dental Journal, 66(6), 322–324. https://doi.org/10.1111/idj.12294
11. Integrating dentistry into interprofessional healthcare: A scoping review on advancing collaborative practice and patient outcomes. Healthcare, 13(21), 2780. https://doi.org/10.3390/healthcare13212780
