The Association Between Psychosocial Stress and Oral Health Related Behaviours: A Narrative Literature Review

Abstract

ABSTRACT Background Oral disorders are one of the most common diseases in the world. Oral health and the prevention of oral illnesses rely heavily on individual compliance with oral health-related behaviours. Psychosocial stress, which refers to how social aspects influence mental states, has been established as a significant risk factor for general and oral diseases. Stressed individuals may engage in oral health-compromising behaviours, but no reviews have investigated this fully. Aim This project aimed to review and summarise the existing literature on the association between psychosocial stress and selected oral health-related behaviours (oral hygiene, sugar consumption, tobacco use, alcohol consumption, irregular dental visits). Methods A narrative literature review of quantitative prospective studies published between 1990 and 2021 on the association between psychosocial stress and oral health-related behaviours was conducted. The literature search was conducted using Medline online database, which recovered 716 studies. Twenty-seven studies that satisfied the eligibility criteria were included for review. Stressors and the association reported by each study were extracted and summarised for critical review.

Results Overall, this review found only modest support for a consistent association between psychosocial stress and oral health-related behaviours. The strongest relationships were found with regards to an association between psychosocial stress and tobacco use and alcohol consumption. The most-reported stressors identified were academic stress, work stress, financial stress, family-related stressors, and perceived inequalities. The evidence regarding oral hygiene behaviour, sugar consumption, and irregular dental visits was inconclusive due to the limited evidence and inconsistency of the study findings. However, most of the studies found that academic stress increased plaque accumulation. Also, in female students, it increased sugar consumption. Academic stress and serious psychological distress were associated with fewer and less adherence to dental visits. On the other hand, the evidence regarding tobacco smoking and alcohol consumption was more consistent. Higher levels of psychosocial stress in general and specifically higher levels of stressors related to finance, work, relationship, family, and perceived inequalities were associated with persistent, current smoking, cigarette cravings, and smoking relapse. In contrast, lower levels were associated with smoking cessation and reduction. Alcohol consumption and cravings were also significantly associated with psychosocial stress. Conclusion People neglect or engage in these behaviours as a coping mechanism to avoid or mediate stressful events. Creating a supportive environment and addressing social determinants and psychosocial stressors is vital to promoting healthy oral behaviours and preventing oral diseases. This can be achieved by addressing the core causes of stress and promoting healthy stress coping mechanisms in the community.