New Study Shows a Link Between Oral Health, Fibromyalgia, and Migraines

By Ayesha Khan, MD, MBA

Fibromyalgia and migraines, traditionally understood through neurological and musculoskeletal perspectives, may also be influenced by oral health—a connection that is gaining increasing attention. Oral health plays a significant role in systemic diseases, as conditions like periodontal disease, dental infections, and occlusal issues rarely exist in isolation. Instead, they can trigger widespread effects throughout the body. This link is driven by key pathways such as inflammation, microbial translocation, immune system interactions, and neural connections, highlighting the interconnected nature of oral and overall health.

With their expertise in identifying and managing these issues, dental professionals are pivotal in mitigating exacerbating factors, improving patient outcomes, and contributing to holistic, multidisciplinary care strategies.

Linking Oral Health and Fibromyalgia

Fibromyalgia, characterized by widespread musculoskeletal pain, fatigue, and cognitive dysfunction, has a high predisposition to involve oral health in its symptomatology. According to a study reported in the Journal of Dental Anesthesia and Pain Medicine, up to 94% of fibromyalgia patients experience temporomandibular disorders (TMD), a condition with overlapping pathologies of pain, inflammation, and central sensitization. The mechanical stress stemming from TMD dysfunctions, combined with the heightened pain perception in fibromyalgia patients, can exacerbate their overall condition.

Furthermore, poor oral health can worsen systemic inflammation in fibromyalgia. One study indicated that patients with fibromyalgia exhibited higher periodontal inflammation levels than controls, as measured by increased release of pro-inflammatory markers like C-reactive protein (CRP) and interleukin-6 (IL-6) into circulation. Migraines and fibromyalgia similarly exhibit chronic inflammatory profiles, raising the potential for oral inflammation to serve as a contributing factor to these conditions.

Salivary dysfunction is another significant issue. Fibromyalgia medications such as antidepressants or muscle relaxants often induce xerostomia, which increases the risk of caries and oral infections like candidiasis. This cycle further compromises a patient’s oral health and quality of life. Recent research from the University of Sydney observed that individuals with fibromyalgia reporting poor oral health had a 60% increased likelihood of experiencing widespread body pain and a 49% greater tendency to suffer migraines.

From oral muscle tenderness to dry mouth (xerostomia), dental practitioners often encounter the first signs of this syndrome, which may manifest as increased sensitivity to routine dental exams and treatments.

Understanding the Role of Oral Microbiota in Pain and Migraines

The oral cavity is a diverse microbial ecosystem housing bacteria that can influence systemic health via the gut-brain axis. Key findings suggest that specific oral bacteria may contribute to nervous system dysfunction, amplifying conditions such as fibromyalgia and migraines. Chronic poor oral hygiene fosters the proliferation of pathogenic microbiota, leading to low-grade systemic inflammation.

A pivotal study published in Frontiers in Pain Research identified oral microbial markers that are strongly linked to central sensitization disorders like migraine and fibromyalgia. These markers included species from the Parvimonas, Fusobacterium, and Solobacterium genera, which correlated with poor oral health and elevated pain intensity in affected patients. Furthermore, microbial byproducts such as lipopolysaccharides (LPS) have been implicated in exacerbating neuroinflammation by crossing the blood-brain barrier, potentially triggering migraines or amplifying migraine susceptibility.

Migraines, already understood to involve neurovascular dysregulation, may be worsened by oral bacterial activity. For example, nitric oxide (NO) production mediated by oral microbiota has been associated with vascular changes that predispose specific individuals to migraine attacks.

Patients with TMD often experience increased strain and tension in the masticatory muscles, which can trigger migraines or exacerbate their frequency and intensity. A review in the Journal of Oral Rehabilitation found that TMD-related myofascial pain is present in a substantial subset of migraine patients. Addressing TMD dysfunction through occlusal adjustments, splint therapy, or myofunctional exercises may provide relief for these patients.

Additionally, oral infections such as periapical abscesses or chronic periodontal conditions can contribute to systemic inflammation known to affect migraine severity. The trigeminal nerve also serves as a direct pain pathway between the cranial nerve roots and the oral cavity, suggesting that untreated dental issues may directly trigger or enhance migraine episodes.

Another emerging area of research is the impact of bruxism on migraines. Bruxism, the repetitive grinding or clenching of teeth, creates muscular strain and tension, which can radiate to the head. With bite guards or other management techniques, dental professionals can alleviate this contributing factor.

Clinical Implications for Dental Practice

Dentists who are well-versed in the systemic ramifications of oral health are essential contributors to comprehensive patient care for individuals with fibromyalgia and migraines. Below are actionable clinical strategies based on the current evidence base:

1. Enhanced Oral Health Screenings
   Dental practitioners should routinely evaluate patients for signs of chronic pain disorders, including TMD, xerostomia, and atypical facial pain. Identifying conditions such as temporomandibular joint noises or headaches originating in masticatory muscles can serve as red flags for possible systemic health issues.
2. Collaboration within Multidisciplinary Teams
   Successful management of fibromyalgia and migraines often relies on multidisciplinary approaches. Beyond providing palliative oral treatments, dentists can coordinate with rheumatologists, neurologists, and pain specialists to ensure a holistic care plan that incorporates oral health as a critical component of treatment.
3. Educating Patients on the Oral-Systemic Pain Link
   Since only a small fraction of patients recognize the correlation between oral health and systemic pain disorders, dental professionals are uniquely positioned to provide education. Teaching effective oral hygiene practices and encouraging regular dental visits could mitigate dental conditions and systemic inflammation contributing to chronic pain.
4. Xerostomia Management and Secondary Caries Prevention
   Fibromyalgia patients frequently experience dryness due to medications or autonomic dysfunction. Early intervention with salivary substitutes, sialagogues, or topical fluoride applications can prevent subsequent complications such as caries or candidiasis.
5. Consideration of Diet in Oral Microbiota Modulation
   Diet plays a pivotal role in shaping the oral microbiome. Dentists should counsel patients on reducing dietary sugars and increasing food intake that promotes healthy microbiota. Minimizing inflammatory oral microbial species could have downstream effects on central pain modulation pathways.
6. Pain Management Strategies for Dental Treatment
   Due to heightened pain sensitivity in fibromyalgia patients, offering topical anesthetics during cleaning or pre-treatment anxiety medications can improve patient experiences and reduce triggers for excessive pain sensitization.

The Future of Care

Evidence continues to mount, supporting the integral role of oral microbiota in influencing not just local oral conditions but systemic diseases characterized by chronic pain. For dental health professionals, this knowledge underscores the necessity of advancing preventive and therapeutic strategies within clinical practice. Incorporating screening tools, oral microbiome studies, and patient education into daily operations may promote dental health and address the systemic challenges of managing fibromyalgia and migraines.

References:

1. Jeon, Y. (2020). Fibromyalgia: practical considerations for oral health care providers. Journal of dental anesthesia and pain medicine, 20(5), 263.
2. Erdrich, S., Gelissen, I. C., Vuyisich, M., Toma, R., & Harnett, J. E. (2025). An association between poor oral health, oral microbiota, and pain identified in New Zealand women with central sensitisation disorders: a prospective clinical study. Frontiers in Pain Research, 6, 1577193.
3. Ranzolin, A., Duarte, A. L. B. P., Bredemeier, M., da Costa Neto, C. A., Ascoli, B. M., Wollenhaupt-Aguiar, B., ... & Xavier, R. M. (2016). Evaluation of cytokines, oxidative stress markers, and brain-derived neurotrophic factor in patients with fibromyalgia–A controlled cross-sectional study. Cytokine, 84, 25-28.
4. Kapos, F. P., Exposto, F. G., Oyarzo, J. F., & Durham, J. (2020). Temporomandibular disorders: a review of current concepts in aetiology, diagnosis and management. Oral Surgery, 13(4), 321-334.

Author: Ayesha Khan, MD, MBA, is a registered physician, former research fellow, and enthusiastic blogger. With a wide range of articles published in renowned newspapers and scientific journals, she covers topics such as nutrition, wellness, supplements, medical research, and alternative medicine. Currently serving as the Vice President of Social Communications and Strategy at Renaissance, Ayesha brings her expertise and strategic mindset to drive impactful initiatives. Follow her blog for insightful content on healthcare advancements and empower yourself with knowledge.