Stress is a common concern for most of us, in today’s complex world.  Some stress can be beneficial.   The pressure it exerts can be an incentive to accomplish necessary goals or keep us safe in threatening situation.  Unfortunately, when stress reaches chronic, harmful levels, it’s impact on body systems are numerous and destructive.  We know that stress has been linked to all the leading causes of death, such as cardiovascular disease, cancer, accidents and suicide.  What we may not know is that almost 90 percent of all visits to primary health care providers are due to stress related problems and nearly one half of all adults suffer adverse effects from stress.  It is estimated that millions of Americans miss work every day due to stress-related complaints and workplace violence has been directly attributed to stress. [1] Knowing these facts, stress reduction or management is essential to maintaining health both physically and psychologically.  Effective ways of managing the daily stressors may not always be easy, but it is important to find healthy ways of dealing with stress to reduce its impacts on our overall health.

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The relationship between stress and illness is complex and the susceptibility to stress varies from person to person.  As we learn more about the interchange between oral and systemic health, stress as a modifiable risk factor is something we all need to be aware of.  Overall, it has been found that individuals with greater perceived stress also report poorer oral health. [2]  Oral health concerns associated with stress include an increase in mouth sores, clenching and grinding that may damage teeth or lead to Temporomandibular joint disorder (TMD).  Stress has also been associated with poor oral hygiene which can lead to caries and or periodontal issues including gingivitis, mild to severe. [3]  We also know that stress is one of the main reasons for dry mouth, which can impact both oral and systemic health.

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Physiology of Stress:

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What’s really happening when we’re under stress?  Stress is both a biological and physiological response experienced on encountering a threat that we feel we do not have the resources to deal with.  There are three physiological systems that are directly involved in the stress response: the nervous system (comprised of the central nervous system (CNS) and the peripheral nervous system (PNS), the endocrine system, and the immune system.[4]  Each of these systems respond to stressors through specific yet interconnected pathways.  We know that the physiologic response is different for acute (short-term) and chronic (long-term) stressor.

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When exposed to a chronic stressor, such as an exam, divorce, death, moving or loss of a job, our body first judges the situation and decides whether or not it is stressful.  This decision is made based on sensory input and processing of things we see and hear in the situation as well as stored memories of what happened the last time we were in a similar situation.  If the situation is judged as being stressful, the bodies initial response starts in the hypothalamus, at the base of the brain, which is activated and sends signals to the pituitary gland and the adrenal medulla.

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Physiologically, long term stressors activate the Hypothalamic Pituitary Axis (HPA) which starts as the hypothalamus stimulates the pituitary gland.  In response to the stimulation, the pituitary gland secretes adrenocorticotropic hormone (ACTH) which stimulates the adrenal gland to produce the hormone corticosteroid.  Cortisol enables the body to maintain a steady supply of blood sugar which helps cope with the prolonged stressor, and helps the body to return to normal.  The adrenal cortex release of cortisol function is to release stored glucose from the liver for energy and control swelling after injury.  The immune system is suppressed while this happens which is the most likely reason for a decreased immune response during prolonged stress.

 

Sudden and severe stress (short term stressor) usually produces an increased heart rate, increase in breathing, decrease in digestive activity and the liver releases glucose for energy.  Short term responses to stress are produced by the fight or flight response via the Sympathomedullary Pathway (SAM) where the hypothalamus activates the adrenal medulla which is part of the Autonomic Nervous System (ANS).   The ANS is part of the peripheral nervous system that acts as a control system, maintaining homeostasis in the body.  These activities are generally performed without conscious control.  The adrenal medulla secretes the hormone adrenaline which gets the body ready for a fight or flight response.   Physiological reaction includes increased heart rate and arousal of the sympathetic nervous system and a reduced activity in the parasympathetic nervous system.  Adrenaline also creates changes in the body such as decreases in digestion and increases in sweating, pulse and blood pressure.  Once the threat is over, the parasympathetic branch takes control and brings the body back into a balanced state.[5]

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The effects of chronic and acute stress on human health are myriad and severe.  During periods of increased stress, immune cells are being bathed in molecules (cortisol) which suppress the immune system and inflammatory pathways, rendering the body more susceptible to disease.  High levels of stress tend to prolonged healing times, reduce ability to cope with vaccinations, and heighten vulnerability to viral infections.[6]   Long-term, constant cortisol exposure associated with chronic stress produce further symptoms, including impaired cognition, decreased thyroid function, and accumulation of abdominal fat.   The bottom line is that both episodes of acute stress and more prolonged stressful circumstances precipitate lower levels of general health, and exposure to such stress should be minimized. [7]

 

Importance of Stress reduction to reduce effects of long term stressors

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Living with high levels of stress puts overall well-being at risk.  Stress wreaks havoc on emotional equilibrium, physical health and the ability to function effectively.  Effective stress management can help break the destructive patterns of stress and bring balance to a hectic life. [8]  Stress management starts with identifying the sources of stress in your life and how you naturally respond or react in those situations.  Recognizing ways you currently manage and cope with stress helps identify healthy and unhealthy practices that impact your bodies response to stress.  When methods of coping with stress aren’t contributing to greater emotional and physical health, it’s time to find healthier ones. 

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Stress management will mean different things to different people, just as stressors affect us all differently.  There are many stress management techniques, but some, like counseling or biofeedback, require a long-term commitment and you might not feel the effects for weeks. [9]  Some simple, yet powerful, solutions that help reduce stress within minutes include diaphragmatic breathing, meditation, guided imagery, self-hypnosis, progressive muscle relaxation, emotional freedom technique (tapping), aromatherapy, exercise or engaging in enjoyable hobbies or pastimes.  

 

Stress is part of everyone’s life and too much stress can increase the likelihood of emotional or physical illness.  Find several stress reduction strategies that work for you and practice them regularly to help reduce the long term consequences of stress related illness.   

 

1. Antonovsky, A. (1987). The Jossey-Bass social and behavioral science series and the Jossey-Bass health series. Unraveling the mystery of health: How people manage stress and stay well. San Francisco: Jossey-Bass.

2. How stress can affect your oral health:  march 6, 2013, 123 Dentist Dental Health, patient education.  Accessed 9/2017  https://www.123dentist.com/how-stress-can-affect-your-oral-health/  

3. Current stress and poor oral health A. Vasiliou1 , K. Shankardass2,3,4*, R. Nisenbaum3,4 and C. Quiñonez1,4 Vasiliou et al. BMC Oral Health (2016) 16:88 DOI 10.1186/s12903-016-0284-y

4. Dealing with Stress.  Accessed online 9/2017  https://www.drweil.com/health-wellness/body-mind-spirit/stress-anxiety/dealing-with-stress/

5. Physiology of stress.  accessed online 9/2017 https://www.jblearning.com/samples/0763740411/Ch%202_Seaward_Managing%20Stress_5e.pdf

6. McLeod, S. A. (2010). What is the Stress Response? accessed online 9/2017 www.simplypsychology.org/stress-biology.html

7. The physiology of stress, cortisol and the hypothalamic pituitary adrenal axis.  accessed online 9/2017  http://dujs.dartmouth.edu/2011/02/the-physiology-of-stress-cortisol-and-the-hypothalamic-pituitary-adrenal-axis/#.WcAhBciGPIV

8. Stress management.  Accessed online 9/2017  https://www.helpguide.org/articles/stress/stress-management.htm     

9. Stress management techniques.  accessed online 9/2017 https://bebrainfit.com/stress-management-techniques/