How Depression Can Affect Dental Hygiene

In June, Elina Howard posted a TikTok of her brushing her teeth, writing in the caption that she “knew [her depression] was getting bad again when even the simplest tasks felt like too much.” 

A stay-at-home mom to three kids, Howard, 30, lives in Greenville, S.C., and has often talked about her experiences with mental health on social media. Howard says that she’s lucky to have support from her husband, but she’s struggled to brush her teeth regularly on-and-off for years while dealing with anxiety and depression. For her, teeth-brushing tends to be “one of the first things to go.”

“I’m like, ‘I know I haven’t brushed my teeth in a couple of days, but I also haven’t eaten a meal today—and I know I need to do that, so I’m going to eat a meal instead of brushing my teeth,’” Howard tells TIME. “Because I can’t do both.” 

How mental health affects dental health 

Research over the years has established a link between mental and oral health, with several studies finding that people who suffer from depression and anxiety are more likely to experience tooth loss.

Mental Health can affect oral Health in a few ways, according to experts. Some antidepressants or anti-anxiety medications can have the side effect of dry mouth, which can increase the risk of cavities, says Zainab Mackie, a dentist based in Grosse Pointe, Mich. People struggling with their mental Health may also clench or grind their teeth, which can cause teeth to chip or break. And people who suffer from depression or anxiety sometimes just don’t have the energy or motivation to take care of their teeth each day.

Dental Health professionals recommend brushing your teeth twice a day, flossing at least once a day, and visiting a dentist every six months for an oral exam and professional cleaning. But for someone in the throes of depression, that can feel challenging. 

“When people are depressed, whether it’s a major depressive episode or whether it’s just a minor low mood, everything becomes difficult to do,” says Kojo Sarfo, a psychotherapist based in Los Angeles. “The things that we call ‘routine tasks’ or ‘activities of daily living’—like brushing your teeth, putting your shoes on, taking a shower—these things become that much harder to do.”

Read More: How Much Do You Actually Need to Shower?

And it isn’t uncommon, says Suhail Mohiuddin, a dentist based in Chicago and co-founder of the practice Dentologie. He estimates that nearly 15-20% of patients at his practice have had a mental-Health strain that impacted their oral Health at some point in their lives.

Grace Mills, 25, has struggled with brushing her teeth regularly ever since she was little, and that has continued when her mental Health has suffered, like when her mom passed away and when she was in a toxic relationship.

“Brushing my teeth is the last thing that I want to do right now,” Mills recalls thinking.

Now that Mills is in a healthier relationship and goes to therapy, she says she feels more motivated to start taking better care of herself. But she still finds it hard to brush her teeth consistently—while she’s better at brushing them in the morning, she finds it harder to do it at night when she’s tired from the day. She posts videos of her brushing her teeth on TikTok to hold herself accountable, and she says she hopes the videos help destigmatize the effects of mental-health struggles.

Barriers to dental care 

Mackie and Mohiuddin say that not brushing your teeth regularly can lead to issues like cavities and gum disease. And the longer the issue persists, the more it can snowball. 

Some people may be afraid to go to the dentist and will delay or avoid making an appointment, either because they worry about how much it will cost (the longer someone puts off dental care, the more expensive it can be, Mohiuddin says) or because they’re concerned that their dentist may judge them over the state of their teeth. Studies show that about 36% of people in the U.S. are afraid of dental treatment.

“Now they’re in this position of, ‘Oh my God, now I have a bunch of cavities or a bunch of issues, and I have a lot of stress and anxiety [about] going to the dentist,’” says Mohiuddin.

It’s been years since Howard saw a dentist, even though she knows that she needs to see one.  Howard says the guilt and shame she feels about her dental health has held her back.

“It’s something that I’m embarrassed about, because I’m like, ‘What is the dentist going to say when they look at my teeth?’” Howard says. 

Mills, who lives in New Jersey, also hasn’t seen a dentist in years, except for one emergency visit when she had to get a tooth pulled. Mills currently works as a pet sitter and has been in between jobs and moved a lot, so it’s been hard for her to find and afford dental care.

Mackie and Mohiuddin both stress that dentists are not there to judge—they just want to take care of their patients.

“We’re their quarterback where we’re guiding them through this process,” Mohiuddin says. “If you really struggle for a certain period of time and you don’t take care of your teeth, it is not something that you can’t recover from.”

How to take care of your teeth if you’re struggling

People can take several small steps to make brushing easier. Mackie suggests rinsing your mouth with a fluoridated mouthwash and using wipes to rub the plaque off your teeth. She adds that chewing gum with xylitol, which can starve the bacteria in your mouth, can help prevent cavities from forming. Mohiuddin says that using mini disposable toothbrushes that come pre-pasted and keeping them in easily accessible places—like in the car or in the kitchen—can also help make brushing more convenient.

Sarfo says people struggling with brushing their teeth should “remove the shame” they’re feeling. He encourages people to say affirmations—I am worthy, I am loved, I am respected—and reminds them that many people worldwide struggle with their mental health.

“Whether you brush your teeth or not, whether you shower or not, whether you’re around people or not, you’re still a human being who’s worthy of love, attention, and respect,” Sarfo says.