What lies beneath?

My teeth have been bothering me quite a lot recently. This isn’t unusual, and I’m never sure whether it falls within the realms of the neurotic, the slightly disconnected from reality or (most likely) the sadly realistic. I can hardly believe I’m eating chocolate buttons as I write this – rather than creating dissonance, it seems to help suspend belief.

I am fortunate enough to still have most of my teeth, but their grip is a little tenuous. I’d always prided myself on my dentition, so it came as a shock to be told by my dentist, some years ago now, that I had chronic gum disease. Aghast, I asked him if I would lose my teeth, and he said, yes, but probably not for a few years. It was at that point that the recurrent tooth-related dreams started. Sometime later I changed dentist, and the new one was much clearer, saying that I did indeed have periodontitis, causing quite a lot of bone loss and they would refer me to a specialist. Never one to panic, I immediately saw a nasty vision of my teeth floating in a glass by my bedside, my face sunken just like an old picture I could remember of Red Riding Hood’s grandmother, shortly before her horrible demise.

All very melodramatic, but what does this have to do with mental health, one might ask? From my personal experience as a case series of one, I would say rather a lot; but it’s also something I am very aware of in my own patients with alcohol and drug problems. And it’s dispiriting, when other things are improving for them, to be left with a mouth of aesthetically challenging and smelly teeth, which may well raise the likelihood of various other diseases.

My own teeth are still present, with an ivory hue, but much work goes into maintaining this. Lots of nasty little brushes, electric toothbrushes, odd flavoured toothpaste – when spending a night away from home, I’d rather forget anything else, even my contact lenses (without which I can just about see the end of my nose). I’ve had some vile treatment that involved a whole day (conscious) in the dentist’s chair – I’ve no idea what she was doing, or what will be next, or indeed what it might cost. A nice set of flashing falsies might be best and cheapest, but fills me with despair. This may ease as everything about me becomes more false – my hair colour, my contact lenses, my glasses (yes, both), and I suspect it’s only a matter of time before my hearing needs help. It’s sort of bionic, but not in a nice way, and I feel even worse because I know that I’m very lucky to have all these things. In past times, I would be semi-blind with long grey hair, and probably locked in an attic (according to my husband), so I shouldn’t complain.

But I do think that the rapid deterioration in my teeth has been exacerbated by my mental health problems, not least because so many of the drugs leave me with a terribly dry mouth. I probably don’t care for my teeth particularly stringently when unwell, which will make things worse. There is likely to be a genetic aspect, as both my grandmothers bade farewell to their teeth before I was born, and my mother is similarly afflicted though has, quite remarkably, held on to most of hers. I think they are more firmly lodged than mine. Pregnancy does your gums no good, which probably hasn’t helped; although I’ve never smoked, which is often implicated (and is high in psychiatric patients).

But no-one ever warned me that my gums would be at risk – I can’t fault this, as not something I usually raise with patients either. But maybe we should, and at an early stage, before it gets too embarrassing – and pointless – to mention. My dental hygiene is now perfect to the point of obsessional, and I chew vast quantities of sugar free gum to keep the juices flowing. But far better to have started twenty years ago. The problem is that symptoms then were few and far between, with only occasional bleeding. I was actually quite smug about my teeth in those days.

And what about the converse? It hit me like a bolt from the blue – chronic inflammation was probably the cause of my mood disorder. There is increasing evidence that it may be one of many underlying factors. Not only that, but I was going to develop cardiovascular disease and, worse, dementia, and it was all down to my teeth! This was the point at which I started taking regular ibuprofen, in a bid to beat it; probably unwise, given potential medication interactions and not to be recommended – yet. I abandoned it after some slightly more rational consideration.

But teeth are more than their medical meanings. Without them, smiling and grimacing would be tricky. They make it possible to eat, essential to life. Or bite, even, and protect oneself. It is hardly any wonder, then, that they assume such importance, that the dread of losing them haunts many a dream. In my night-time wanderings they are loose, with holes between the roots, just ready to drop. The relief when I wake is extreme, and even then I worry at them, check their stability. Sometimes I can feel them all, lodged within my gums, and I think I feel them move. 

Ultimately I need to develop tooth acceptance. I should enjoy my teeth while they last, both function and appearance, and care for them as best I can. That way I won’t have to reproach myself. What will be will be, and there are far worse things than losing your teeth. Perhaps some of the other things caused by gum disease?