As an orthodontist, I feel blessed that I can help change peoples’ smiles and facial appearances. But there is something much deeper that I cannot change: their smile on the inside. I have learned that a patient’s emotions and the pressures they are under—emotions and pressures that often come from a critical or judgmental society, family, or religious bodies—have very real impacts on their physical health.
The pressures of 2020 have exacerbated not just emotional stress, but its physical manifestations. Problems of the muscles of the head and neck, temporomandibular joint (jaw joint), and hearing disorders occur as a direct or indirect consequence of stress. Astudy from Tel Aviv University (TAU) reported in the Journal of Clinical Medicine found that during the first COVID lockdowns in Israel and Poland, there was a significant rise in the symptoms of jaw and facial pain, jaw-clenching, and teeth-grinding — well-known manifestations of anxiety and emotional distress.
Of course, my patients’ worries are not just about 2020. One woman stuck in an unhappy marriage came to our practice with relentless headaches and pain in her jaw joints and face. She was seeking a cure, but in truth more than a dental appliance; she needs peace in her life. A teenager with a facial anomaly asked me, “Can you make me look beautiful and look like others?” and told me she was willing to tolerate as much pain and discomfort as needed to look “pretty” to other people.
These sources of stress often come when someone feels they must make compromises in their lives or risk condemnation. They can affect individuals’ overall emotional and physical well-being, as well as their life span. Chronic stress comes with unique consequences far beyond the psychological. It is linked to a variety of diseases, such as heart disease, cancer, arthritis, type 2 diabetes, sleep disorders, other autoimmune disorders, digestive problems, and skin conditions , to name a few. Stress can suppress the effectiveness of the immune system, which can make one susceptible to infections and is also linked to development of cancer.
People can ignore the effects of stress on teeth and structures surrounding the teeth, until it’s too late. Under stress, people often neglect maintaining good oral hygiene. Further, changes in hormones caused by stress can lead to decreased blood flow and blood elements necessary for maintaining resistance to disease-causing microbes in the mouth. These factors lead to development of periodontal disease (disease of the gums and bone supporting the teeth), which, if not managed promptly, can lead to pain, bleeding gums, halitosis (bad breath), and loss of bone and gums surrounding the teeth. Ultimately, it could cause loosening of teeth and unsightly appearance of smile.
Chronic stressful situations can lead to the development of habits such as clenching or grinding of teeth, known as Bruxism. If not treated, it leads to damage of the teeth, gums and jaws. The number of patients seeking treatment because of jaw joint disorders, also known as temporomandibular joint disorder and oral parafunctions, is increasing daily in our practice.
During my interactions with my patients, I know they are only sharing a small portion of what is really going on and the real challenges they are facing. Too often I cannot reach the real cause of pain. Yet I know that my patient will continue to suffer until it is addressed.
We cannot eliminate all the triggers that the past year has brought—indeed, a PubMed search for research related to COVID-19 and mental health comes back with whooping 14412 results. But we can try to eliminate needless triggers caused by anger, condemnation, and ostracization.
So many people are compromising who they are due to fear of being condemned or shamed, because they have come to view themselves as deeply flawed, unlovable, unworthy with no hope of change because they are outside the society’s norms. In some situations, when one is condemned by religious organizations, their last hope—God—is no longer accessible to them and they are left with a feeling that they have nothing left.
I think about a seven-year-old who saw his CBCT (3D radiographic imaging) of his facial structures while I was reviewing the findings with mom. He was amazed and asked, “Is this how I look on the inside?” My answer back to him was, “Yes we all look the same on the inside.” I then showed him my CBCT. I am not sure how my answer helped him, but he looked as though he discovered something very valuable.
His response reminded me that diversity and inclusiveness is associated with wellbeing. When we are inclusive we are not only allowing others reach their potential, but we are allowing ourselves to do so as well. Life is a one-way journey with no return ticket. We can all help others make the way easier.
I feel helpless when I cannot make my patients’ smiles shine with true joy. But I also know the good news: this kind of healing, a healing we all need, doesn’t require a doctor’s care. We all have the power to love and accept each other and ease each other’s stress.