When Oral Disease Affects the Mind: Understanding Emotional Distress in Oral Medicine Patients

When Oral Disease Affects the Mind: Understanding Emotional Distress in Oral Medicine Patients

Anxiety, Depression, and Stress Are Common—But Often Overlooked—in Oral Cancer and Pre-Cancer Care

Visiting an oral medicine clinic is rarely just about teeth and gums. For many patients, especially those facing cancer or potentially malignant oral conditions, the experience can be emotionally overwhelming. A recent study published in Medicina Oral, Patología Oral y Cirugía Bucal sheds light on how anxiety, depression, and stress affect patients in oral medicine settings—and why psychological support should be part of routine care.

Why Emotional Health Matters in Oral Medicine

Oral medicine clinics often manage serious and sometimes life-threatening conditions, such as oral squamous cell carcinoma (OSCC), other solid tumors, medication-related osteonecrosis of the jaw (MRONJ), and oral potentially malignant disorders (OPMD). Beyond physical symptoms, patients frequently struggle with fear of diagnosis, uncertainty about outcomes, and concerns about treatment side effects.

These emotional responses are not trivial. Anxiety, depression, and stress can reduce treatment adherence, worsen perceived symptoms, and negatively affect overall quality of life. Yet, emotional well-being is still not systematically assessed in many oral healthcare settings.

What Did the Researchers Do?

The research team conducted a cross-sectional study involving 100 adult patients treated at an oral medicine unit in Italy. Participants were divided equally into four groups:

• Patients with oral squamous cell carcinoma (OSCC)

• Patients with other solid tumors (ONCO)

• Cancer patients with MRONJ

• Patients with oral potentially malignant disorders (OPMD)

To assess emotional states, the researchers used two widely validated psychological tools:

• Beck Depression Inventory (BDI) to measure depressive symptoms

• Depression Anxiety Stress Scales-21 (DASS-21) to assess depression, anxiety, and stress

All questionnaires were completed after diagnosis, with psychological support available if needed.

Key Findings: Different Conditions, Different Emotional Burdens

The study revealed that emotional distress was common across all patient groups, but its pattern varied depending on diagnosis.

• Patients with oral squamous cell carcinoma (OSCC) showed the highest levels of depression, with average scores indicating moderate depressive symptoms. Feelings of worthlessness, sleep disturbances, and fatigue were particularly prominent.

• Patients with OPMD, despite not having a confirmed cancer diagnosis, experienced significantly higher anxiety levels than cancer patients. The uncertainty and fear of malignant transformation appeared to play a major role.

• Patients in the ONCO and MRONJ groups generally showed mild depressive symptoms, but emotional distress was still present and clinically relevant.

Overall, more than half of all participants experienced some degree of depression, anxiety, or stress.

Why These Results Matter

The findings highlight an important message: emotional distress is not limited to cancer diagnosis alone. Patients waiting for biopsies or monitoring potentially malignant lesions may experience anxiety levels as high—or even higher—than those already undergoing cancer treatment.

For oral cancer patients, emotional burden is often compounded by aggressive therapies, facial changes, impaired speech or eating, and social isolation. Without proper psychological support, these factors can significantly affect recovery and long-term outcomes.

Toward More Human-Centered Oral Healthcare

The authors emphasize the need for a multidisciplinary approach in oral medicine. Integrating psychologists into oral healthcare teams, offering individualized emotional support, and adopting patient-centered communication strategies could greatly improve patient experience and treatment adherence.

Innovative tools—such as educational materials, counseling, or even graphic narratives—may help reduce anxiety, especially for patients facing diagnostic uncertainty.

Conclusion

This study reinforces a simple but powerful idea: oral health care should treat the mind as well as the mouth. Recognizing and addressing emotional distress in oral medicine patients is not optional—it is essential for effective, compassionate, and holistic care.

Original Article Reference

Bazzano M, Mauceri R, Marcon G, Coppini M, Montemaggiore D, Campisi G. Emotional states in patients with cancer or with suspected oral potentially malignant disorders: a cross-sectional study in an oral medicine setting. Med Oral Patol Oral Cir Bucal. 2025;30(3):e446–e455.

DOI: 10.4317/medoral.26989