By Susan Richards
As we set the clocks back this month (not you Hawaii and Arizona), we become all too aware of the shorter days and lack of sunlight associated with the impending winter season. For those who live in regions that experience all four seasons, it can be satisfying to enjoy the turning of the leaves, the first snowfall, or the budding blossoms of spring. However, approximately 6% of the U.S. population – almost 20 million people – dread the shorter days and cooler weather associated with the winter season. It's been discovered that patients affected by seasonal affective disorder (appropriately referred to as SAD) also have implications for their oral health.
Signs of SAD
According to the National Institute of Mental Health, depression is a common mood disorder that can cause severe symptoms affecting all aspects of life. Symptoms that persist for more than two weeks can indicate a clinical diagnosis of depression. In addition, different forms may be unique to the patient, such as postpartum, bipolar disorder, and SAD.
For those afflicted with a Major Depressive Disorder with Seasonal Pattern, the change in season is more than just the "winter blues." The reduction of natural sunlight can result in a diagnosed form of depression that can interfere with daily functioning and quality. SAD patients may present with a variety of more severe symptoms, including:
• Sleeping too much
• Feeling tired and sluggish
• A lack of interest in activities usually enjoyed
• Difficulty concentrating
• Weight gain due to changes in appetite (high carbs)
• A feeling of hopelessness or worthlessness
• In extreme cases, suicidal thoughts
Although there is a lot unknown about the disorder, the Mayo Clinic notes several potential factors such as circadian rhythms, serotonin levels, and melatonin levels. The decrease in sunlight can disrupt the biological clock and reduce serotonin, the brain chemical that affects moods. In addition, sleep patterns can be upended when melatonin levels drop.
More women than men seem to be affected by SAD, and more young people than old – symptoms typically emerge between ages 18 and 30. Additional risk factors include having depression or bipolar disorder or a family history of SAD or other forms of depressions. It also doesn't help to be located farther from the equator, which is why Oregon and Maine have some of the highest depression rates in the country, and 15% of Canadians report experiencing the winter blues. Inversely, only about 1% of Floridians suffer from SAD.
While less common, SAD symptoms specific to spring and summer can manifest with insomnia, loss of appetite and weight, as well as anxiety or agitation.
Seasons and Smiles
It should come as no surprise to those in the dental profession that SAD and other iterations of depression can have a tangible impact on oral health. The apathy many sufferers experience can result in a change of habits and a decrease in oral hygiene. As a result, dental hygienists may notice their best patients present with more plaque buildup or bleeding gums in the fall and winter than is typical.
Patients being treated for SAD with medication such as anti-depressants can experience xerostomia (dry mouth), leading to increased caries risk and other problems. Another downside of SAD is the increased levels of cortisol when a patient is under stress. Not only does cortisol cause bone loss – including those in the oral cavity – but it can also change the oral bacteria, furthering the risk of other health conditions. Multiple studies have shown that severe periodontal disease can ultimately impact other systems and increase the risk of kidney disease, coronary artery disease, and more.
The good news is that there are treatment options available that preclude hibernating until spring like a bear. Researchers have shown that light therapy is a good preventative treatment for SAD sufferers. Using measured exposure to a lightbox can replenish the sunshine that is lacking in the winter months.
Cognitive-behavioral therapy geared specifically for seasonally sad patients (CBT-SAD) has been effective in reducing the recurrence and remission between winters. Other limited studies promote the benefits of supplements, melatonin, and vitamin D.
Oral Health is Whole Health
While it may be difficult to discern a dental patient's mood disorder as SAD, given the stress levels we see due to the coronavirus pandemic, it's to everyone's benefit to be aware as fall turns into winter. Don't be afraid to probe if there are clear signs that something is not right with a typically happy and healthy patient. Deteriorating oral health due to seasonal depression can result in a vicious cycle of low self-esteem when they become stressed about their appearance.
We may not be able to promise SAD patients that "the sun will come out tomorrow," but there are options and treatments that will shine a light on the problem.
Author: Susan Richards is a staff writer at DOCS Education. With over 20 years of experience in local journalism and business marketing, Susan's career includes award-winning feature writing and creating content with context for a wide variety of industries.