Fort Worth, Texas,
10:37 AM

A Bright Smile Begins With A Healthy Mindset: The Overlooked Link Between Dental and Mental Health

Written by: Ashley Antle

A smile is a powerful thing. It can brighten someone’s day or even boost your mood. The act itself releases feel-good hormones in your brain.

But when you are plagued with mental illness or poor oral health—or a combination of both—it can be hard to turn a frown upside down, and that can have a profound impact on a child’s overall well-being.

“Our children don’t smile if they are hurting,” said Tonya Fuqua, DDS, director of child oral health at Cook Children’s. “If they have oral health disease and pain, or they are embarrassed by their smile, they don’t eat, or talk, or socialize, and they have trouble learning in school or being the best they can be as a kid. It’s the same with their mental health. If they are not in a good state of mind kids disconnect and aren’t the best kid they can be, and a domino effect happens.”

When people think about health, they rarely consider mental and oral health as part of the equation, but the two can be as taxing on the body as any other ailment. In Cook Children’s 2021 Community Health Needs Assessment (CHNA) survey of parents and guardians in the North Texas region, more than 180,000 children ages 0 to 17 went without needed dental care, and more than 63,000 without needed mental health care.

“People don’t realize the importance of oral and mental health to their overall health,” Dr. Fuqua said. “But dental disease is connected to heart health, and if you have cancer and are using certain medications, or you’re an asthmatic and using inhalers, that is going to impact your oral health. It’s the same with mental health. If you have to cope with one of these chronic illnesses, it’s going to impact your mental health, and poor mental health can stress other body systems and lead to other health issues.”

Oral and mental health also have a direct impact on each other. People with severe mental illness often neglect good oral hygiene practices and are 2.7 times more likely to lose their teeth, according to an article published in the Canadian Journal of Psychiatry. Add in an unhealthy coping strategy and your mouth and teeth are at even greater risk of disease.

“There is a clear connection between your emotions and how you handle stress,” said Kim Cox, a clinical therapist and manager of Cook Children’s Save a Smile program. “Sometimes kids handle stress in non-productive ways, like smoking and vaping, for example. That all affects your oral health as well.”

The risk is present in reverse, too. Poor oral health often leads to worsening mental health as people grapple with chronic pain and self-consciousness from an imperfect smile.

Add the stress of the pandemic on top of all of this and it’s easy to understand the recent decline in both mental and dental health among children. Cook Children’s has recorded a record number of suicide attempts in the past 12 months and, according to the CHNA parent survey, more than 170,000 children have had dental problems in the past 12 months. Parents identified the impact of COVID-19 as one of the top three barriers to their children getting the care they needed.

“There has been a marked increase in dental disease since the pandemic,” Dr. Fuqua said. “There is no surprise that when kids are stressed, disconnected or depressed, they eat. This leads to bad habits that can result in increased cavities. Also, when kids are off their routine, like during the pandemic, things go by the wayside, such as brushing and good oral health habits. Then, when kids get lots of cavities, they will not smile or even talk as much because they are embarrassed by the way their teeth look. This is a huge social inconvenience and causes kids to be even more distant and traumatized emotionally.”

Connecting the Dots

More often than not, mental illness and dental disease are treated in a silo. There is little recognition of their ties to and impact on other health issues and body systems, and little coordination between specialties in their treatment, according to Cox.

“If you have heart disease and go see a cardiologist, just because you are going to see a specialist for a specific issue doesn’t mean that part of your body is disconnected from other parts of your body and its function,” Cox said. “But for some reason, oral and mental health are seen that way. Dentists and therapists are seen as treating systems completely disconnected from a person’s overall physical health.”

Both share a similar stigma, too. Embarrassment leads many to suffer in silence.

“I call it the silent epidemic,” Dr. Fuqua said. “Nobody talks about mental health because there’s a stigma attached to it. Nobody wants to admit their child is going through a difficult time or kids don’t speak up about it. We see the same in dentistry. Many are embarrassed to admit they have issues with their teeth.”

A lack of insurance keeps many from getting the dental and mental health care they need, according to the CHNA parent survey. Insurance companies don’t cover services for mental and oral health as robustly as they do for other issues, making treatment unaffordable for many families. Dental insurance, for example, usually provides a capped maximum payout for treatment per year, but many dental procedures and treatments cost well above the typical yearly maximum.

The first step to breaking these shared barriers is for physicians and parents to talk about oral and mental health as much as they talk about diabetes, obesity, asthma, nutrition, childhood vaccinations and viruses.

“We need all of us—dentists, pediatricians and parents—talking about mental and oral health and looking at kids as a whole,” Dr. Fuqua said. “We need to always be in tune and watching for signs and symptoms. Doctors can take a quick look at a child’s teeth at their well-child check and ask them if they are seeing a dentist. Parents can talk to their kids about how their mind and mouth are feeling, and help them understand that their mental and oral health and hygiene are as important as any other part of their body.”

After all, a healthy mouth and mind help make a healthy body, not to mention a big, beautiful and bright smile.


Save A Smile and The Joy Campaign 
For more information about affordable access to dental care and Cook Children’s efforts to improve the oral health of children through its Save a Smile program and the Children’s Oral Health Coalition, click here. If your child is struggling with depression, anxiety or any other mental health issue, you can find helpful information, including tips for talking to your child about mental health, through Cook Children’s JOY campaign at