Stress from living on the border near Gaza affects not only the psychological health of children and teens but also their dental health, according to a first-ever study conducted by the Maccabident Research Institute, the dental division of Maccabi, the second-largest health fund in Israel.
The study found that ongoing security tensions led to significant changes in the dental and skeletal development of children and teens. Physiological responses to prolonged stress are known to affect hormonal regulation in the body, as increased levels of cortisol, growth hormone and estrogen, which are secreted during stressful situations, accelerate skeletal maturation and early physical development.
The study was published in Nature’s prestigious journal Scientific Reports under the title “Impact of conflict-induced stress on dental and skeletal development in children and adolescents.” It was written by Dr. Thabet Asbi, who heads the institute, and Dr. Doron Haim, who is Maccabident’s vice president for medical affairs and its chief medical officer. Both also work at the periodontology department at the Rambam Health Care Campus in Haifa.
The research institute conducts studies using databases and clinical knowledge in dentistry, with the aim of identifying trends in the Israeli population and improving medical care.
In addition to its research activities, it serves as a platform for clinical testing of new medical technologies, collaborating with leading start-up companies in the fields of pharma and dentistry. Its aim is to make effective, safe solutions available to the market and to promote groundbreaking medical and technological start-ups in their early stages.
Exposure to a war in adolescents, children
“In this study, we investigated whether children and adolescents raised in a war-torn environment, marked by constant rocket fire and the pervasive sounds of war, exhibited accelerated physiological development,” Haim said. “Specifically, it explored whether chronic stress due to prolonged exposure to a war environment could lead to advanced dental and skeletal maturation.”
TO EXAMINE the effect of psychological stress typical of war zones on dental and skeletal development in children and adolescents, the study included 272 children and adolescents aged nine to 15 who visited Maccabident clinics for orthodontic examinations shortly after the events of October 7, 2023. Of the total number of subjects, 106 live within seven kilometers of the Gaza Strip – an area that has been characterized by security tensions for over two decades. The comparison group included 166 children from central Israel.
The study was based on an analysis of panoramic and cephalometric X-rays that were used to assess the stages of the youngsters’ dental and skeletal development.
They did not include in the study group youngsters with poor nutritional habits (such as high sugar or fat intake or irregular dietary habits), obesity, chronic health conditions, endocrine problems, or pathology related to dental development and eruptions.
The researchers did not find that the stress caused bruxism (tooth grinding), which is common among anxious adults, especially during sleep. Haim told The Jerusalem Post in an interview that baby teeth do not show grinding, as they are replaced in a few years by permanent teeth.
The stress on those in border cities and settlements was greater during the early eruption of teeth than on children in the center of the country. This refers to the process by which teeth emerge from the dental sac into the oral cavity.
“For this to occur, two mechanisms are necessary: alveolar bone resorption by osteoclasts – a process that is crucial for bone remodeling during orthodontic tooth movement, periodontal disease, and in response to mechanical pressure – and an eruptive force that moves the tooth into the oral cavity after three-quarters of the root is developed,” he explained. “These mechanisms are independent and physiological ways, but the exact mechanism of tooth eruption remains unknown.”
Normally, eruption timing of each permanent tooth occurs within a specific chronological age range and can be influenced by factors such as genetics, gender, nutrition, socioeconomic factors, systemic diseases, and hormonal factors, the institute’s head said. “Stress and anxiety can alter hormonal regulation that can affect the timing of tooth emergence.”
THE RESEARCHERS concluded that living in a continuous state of stress directly affects the development of the body and the jaws; they demonstrated that stress is not just a mental problem but also a significant physiological issue.
“Using our extensive database allows us to identify trends and establish medical hypotheses,” Haim said. “The study observed early growth, especially of tooth #7 in the lower jaw. Establishing this hypothesis could, in the future, serve as a means of identifying children who are under continuous stress. The study reinforces the understanding that there is a connection between oral health and general health, and the fact that the mouth allows us to identify physiological trends.”
In the study, the team confirmed that “children living under the stress of a conflict zone exhibited earlier skeletal maturation and accelerated eruption of permanent second molars and upper canines than their peers. The early eruption of second molars and canines, particularly the lower left second molar, may serve as a predictive marker for pubertal progression.”