Oral Health Challenges Worldwide: Causes, Treatments, and Inequities in Managing Bruxism, Gingivitis, and Impacted Teeth

Sokuntheary Prak

Humera Rohail 

Viviana Filangeri

August 1, 2025

Oral health is a significant component of overall well-being, yet millions of individuals around the world continue to suffer from preventable and treatable dental conditions due to unequal access to care. Conditions such as bruxism, gingivitis, and impacted teeth can lead to pain and discomfort if left untreated. However, these three conditions are common and often manageable for patients in countries where care is easily accessible. Underserved populations often face significant barriers, including financial limitations, geographical inaccessibility, and a lack of dental education. This article will discuss what bruxism, gingivitis, and impacted teeth are, potential treatment options, and the global disparities that hinder equal access to these essential dental services (WHO).

Bruxism is a dental condition in which an individual grinds and/or clenches their teeth and jaw. This can happen while a person is awake or asleep, however, it occurs more commonly while a person is awake (NIH). Various factors can cause bruxism; some of these include stress, nervousness, alcohol consumption, caffeine consumption, and smoking (NIH). Common symptoms of this condition can affect  the teeth, jaw, and/or head and face. These include  cracked or loose teeth, worn tooth enamel, and tooth pain or sensitivity. In the jaw, soreness, tightness, and tiredness of jaw muscles. In the head and face, headaches and tooth pain (NIH). It is evident that bruxism can affect  more than one location in the cephalic region of the body. Many cases of bruxism are mild and may not even require treatment; however, severe cases can persist (NIH). In more severe cases of bruxism, tooth damage, gum recession, and Temporomandibular Joint Disorder (TMD) can occur (Ohlmann et al. 611).  

Bruxism can occur when someone experiences negative, yet common emotions such as anxiety, stress, or depression. A birth cohort study performed by the Journal of Dentistry examined the correlation between common mental disorders and bruxism in adults. According to this study, participants with common mental disorder symptoms reported both sleep and awake bruxism compared to those without common mental disorder symptoms. In more severe cases, psychosocial stress experienced during childhood or adulthood was found to increase the likelihood of bruxism, supporting the biopsychosocial model in which mental, physical, and social factors interact to influence overall oral health (de Azevedo Kinalski et al. 27-32).  Another common phenomenon seen in many dental offices worldwide is bruxism in students. Students may experience an overwhelming amount of stress and anxiety during the school year, leading them to be tense in the jaw and susceptible to conscious or non-conscious teeth grinding (Dental Choice).  

There are treatment options available for this disorder in more severe circumstances. Some of these options include mouthguards, stress-reduction techniques, muscle-relaxing medications, and/or Botox injections. Dentists may also offer advice on prevention to those whose cases are still milder. Preventative techniques include practicing mindfulness to reduce daily stress, getting regular dental checkups, and avoiding smoking and heavy alcohol consumption (Cleveland Clinic). 

Treatment and prevention for bruxism look different in developed and non-developed regions of the world. Students in more developed countries have greater access to dental appliances, such as a night guard, to help mitigate the wear down of their teeth. In Canada, many insurance companies cover mouth guard appliances; however, some do not. Even in this developed country, not everyone can afford the dental appliances that help mitigate the effects of bruxism. In low-income countries, many of these areas lack  access to basic dental care, including  hygiene visits. The most common preventive advice given about teeth grinding is to practice mindfulness to reduce daily stress. Where it is accessible, some may turn to cognitive behavioural therapy to adopt  better lifestyle practices. However, in low-income countries, mental health resources are more scarce, and people in these regions do not have access to a therapist (Saraceno and Saxena 40-44). It is seen that common mental disorders and psychosocial stressors can cause bruxism in some individuals. In underserved communities, economic strain, trauma, and limited access to mental health and oral health resources are more prevalent. Recent research from 2020 has shown that there is a relationship between poverty, depression, and anxiety (Ridley et al. 1126). 

Bruxism, while often overlooked, can be a complex condition in more severe cases. Although effective treatments and preventive strategies do exist, access to these resources remains unequal in low-income communities worldwide. In wealthier countries, patients may benefit from customized mouth guards and mental health support, while individuals in marginalized communities frequently go without basic care. This disparity highlights the critical need for more equitable access to oral and mental health services. 

Gingivitis is a common form of gum disease, also referred to as periodontal disease. Gingivitis causes redness, swelling, and bleeding of the gingiva, a part of the gum around the base of the teeth (Rathee et al.). Symptoms of gingivitis include sensitivity to hot or cold foods, discomfort or pain when chewing, and bad breath that persist even after brushing. If left untreated, gingivitis can progress to more severe forms of periodontal disease, potentially leading to bone loss, gum recession, and tooth loss (Mayo Clinic Staff). In fact, this disease poses a significant threat to dental health and is the most common cause of tooth loss. More than 42% of all adults aged 30 or older have some form of gum disease (NIH). Gingivitis is driven by a buildup of plaque, a sticky film of bacteria, on and around the teeth. Plaque can form without adequate brushing and flossing, and when it remains  on teeth, it can cause irritation to the gums.

Stress is a contributing factor to gum disease. Studies have shown that stress can contribute to the progression of gingivitis. Chronic stress weakens the immune system, making individuals more susceptible to infections. Additionally, stress can influence oral hygiene habits, affecting one's brushing and flossing habits (Dental Choice). For instance, individuals who are prone to stress can neglect their oral care routine, often skipping brushing or flossing their teeth. Stress can also lead to dry mouth, a condition resulting from a disruption to the natural flow of saliva in the mouth. Saliva acts as a natural defence mechanism, constantly washing away food debris and bacteria. When the flow of saliva is disrupted, the mouth is more susceptible to the buildup of plaque and the development of gingivitis. The relationship between stress and its impact on an individual’s gum health is significant. 

The treatment and prevention of gingivitis aim to control the infection through scaling and root planing, and as well as improved oral hygiene. Scaling and root planning is a procedure that cleans beneath the gums, removing tartar and bacteria (Mayo Clinic). This allows a smooth surface for the roots of teeth, ultimately preventing bacteria from sticking. In addition to professional care, such as dental cleanings, daily oral hygiene practices can help control gingivitis. Consistent brushing and flossing can help reduce the buildup of plaque. This includes brushing at least twice daily, flossing at least once a day, and brushing after every meal or snack (Cleveland Clinic). Stress coping strategies are equally important. Learning and using stress management techniques, including meditation and deep breathing, can help reduce stress levels (Dental Choice). Maintaining a healthy lifestyle and limiting smoking or excessive alcohol can limit unhealthy coping mechanisms. Taking proactive steps to care for one’s gums will help prevent the formation of gingivitis. 

Impacted teeth are teeth that fail to fully emerge through the gumline, typically due to overcrowding, lack of space, or abnormal positioning in the Jaw (Mayo Clinic). This condition is most commonly seen with the third molars, also known as wisdom teeth, although other teeth, such as canines, can also become impacted (Mayo Clinic). An impacted tooth may be completely trapped beneath the gums (fully impacted) or partially erupted, which leaves it exposed to bacteria and debris (Mayo Clinic). These teeth often grow at off angles and can press against neighbouring teeth or bone, causing discomfort or damage (Mayo Clinic).

If left untreated, impacted teeth can lead to a range of oral health issues. They may cause pain, swelling, gum infections, and difficulty opening the mouth (Mayo Clinic). Over time, an impacted tooth can damage the roots of adjacent teeth or contribute to misalignment of the dental arch (American Association of Oral and Maxillofacial Surgeons, AAOMS). In some cases, cysts or tumours may form around the impacted tooth, which can erode bone and require more extensive surgical treatment (AAOMS). Even if no symptoms are present initially, impacted teeth can cause long-term complications and are often recommended for removal after evaluation by a dental professional (AAOMS). 

Access to treatment for impacted teeth is not equal across all populations and is significantly influenced by socioeconomic status. Individuals from low-income households are more likely to delay or forgo treatment due to the high costs of oral surgery and lack of insurance coverage (Nasseh and Vujicic). This increases their risk for serious infections, chronic pain, and tooth damage, which can negatively impact eating, speaking, and self-confidence (Lin, Mei et al.). According to data from the Centers for Disease Control and Prevention, disparities in oral health access persist worldwide, especially in underserved communities where fewer dental providers are available. Without proper access to treatment, many individuals continue to suffer long-term effects of untreated impacted teeth simply because they cannot afford the care (Lin, Mei et al.). This highlights a significant gap in oral health outcomes, where financial limitations, not medical necessity, determine whether a person receives timely intervention (Nasseh and Vujicic). 

Works Cited

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