How can oral stress be managed?

Managing Oral Stress

The management of oral stress requires a multidimensional approach focusing on reducing excessive musculoskeletal tension in speech and non-speech muscles, addressing psychological factors, and implementing appropriate symptomatic treatments. 1

Types of Oral Stress

Oral stress can manifest in several ways:

1. Speech-related tension: Excessive muscle tension affecting articulation and speech
2. Oral mucosa discomfort: Including dry mouth (sicca syndrome) and oral dysesthesia
3. Dental-related stress: Anxiety related to dental procedures or academic/professional stress in dental settings

Management Strategies

Reducing Musculoskeletal Tension

• Tension reduction techniques:

  • Reduce excessive tension in head, neck, shoulders, face, and mouth muscles 1
  • Where functional facial weakness or spasm exists, consider collaborative treatment with physiotherapy 1
  • Introduce mindfulness skills during oromotor tasks to maintain focus on easy, smooth movements 1

• Speech modification strategies:

  • Slow speech down or elongate sounds rather than building tension 1
  • Use nonsense words or syllable repetitions to demonstrate potential for normal function 1
  • Introduce dual tasking while speaking as a form of distraction 1
  • Consider non-speech articulation such as singing 1

Addressing Dry Mouth (Sicca Syndrome)

For patients with dry mouth, treatment should be based on the severity:

• Mild dry mouth:

  • Dietary modifications and improved hydration 1
  • Limit caffeine intake 1
  • Use topical measures: water sips, saliva substitutes, moisture-preserving mouth rinses 1
  • Salivary stimulants: sugarless chewing gum, lozenges, or candy 1

• Moderate to severe dry mouth:

  • Systemic sialagogues (cevimeline or pilocarpine) 1
  • Prednisone 20-40 mg daily for 2-4 weeks, then taper 1
  • Consider rheumatology and dental referrals 1

Oral Dysesthesia Management

For burning mouth sensation or oral pain:

• Dietary modifications: Avoid crunchy, spicy, acidic, or hot food/drinks 1
• Topical treatments:
  • High-potency topical steroids (gel or dental paste preferred) 1
  • Viscous lidocaine for pain relief 1
• Systemic medications:
  • Gabapentin for moderate to severe symptoms 1
  • Consider SSRIs or low-dose amitriptyline for persistent symptoms 1

Psychological Interventions

• Counseling approaches:

  • Address cognitive features related to locus of control, abnormal illness beliefs, and hypervigilance to bodily functions 1
  • Education about the physiology of anxiety and the anxiety arousal curve 1
  • Cognitive Behavioral Therapy to identify and challenge negative beliefs and cognitions 1
  • Recommend positive self-statements during oral activities 1

• Stress management:

  • For dental professionals and students experiencing oral stress, stress management courses should be encouraged 2
  • Regular exercise and healthy lifestyle habits can improve self-efficacy and reduce stress 3

Oral Hygiene During Periods of Stress

• Maintain oral hygiene routine even during high-stress periods, as research shows psychosocial stress can lead to neglect of oral hygiene and increased plaque accumulation 4
• Focus on thoroughness rather than just frequency of brushing 4
• Regular dental visits are associated with better oral hygiene practices even during stressful periods 3

Special Considerations

For Dental Students and Professionals

• Higher self-efficacy is associated with better oral hygiene practices despite stress 3
• Female dental students and those who exercise regularly tend to maintain better oral hygiene practices during stress 3
• Dental anxiety is higher in females and those with no previous dental visits 5

For Patients with Oral Manifestations of Systemic Conditions

• In patients with Stevens-Johnson syndrome/toxic epidermal necrolysis affecting the oral cavity:
  • Apply white soft paraffin ointment to the lips every 2 hours 1
  • Use mucoprotectant mouthwash three times daily 1
  • Clean the mouth daily with warm saline mouthwashes 1
  • Consider topical corticosteroids four times daily 1

Monitoring and Follow-up

• Daily oral review is necessary during acute oral stress conditions 1
• Regular dental check-ups to monitor oral health status, especially during periods of high stress 5
• Evaluate effectiveness of interventions and adjust treatment plan as needed

By implementing these strategies, oral stress can be effectively managed, improving both oral health and quality of life for affected individuals.