Recently, I went in for a routine tooth-cleaning, or what I like to call “my biannual dental shaming.” I had already postponed the appointment twice, so when the dentist’s office called because they’d had a cancellation and they wondered if I’d like to come in, it seemed there was no avoiding it.

It’s not that I have anything against dentists.

I just fear the possible judgment. When the kindly hygienist asked how often I flossed, I mumbled, “I should do it more.” How could I possibly explain that until my new mood stabilizing medication started working, I had very little interest in taking care of myself physically, because no one wants to take care of a someone they don’t like. I would brush, sure. But anything else was just wacky overkill.

This sort of thinking is incredibly common in people who suffer from depression.

Depression, unsurprisingly, leads to self-neglect. If you have it, you already know this. All your functions are literally depressed, as if a giant boulder is pressing down on you. Everything in your world becomes flattened to some degree. You have decreased energy. You experience a loss of self-worth.

Surprise, surprise, your self-care goes right out the window. You may be willing to drag yourself out of bed and fake it while you take your kids to school, or take your cat to the vet, or show up to your job. You might be able to plaster a veneer of normalcy over your loathsome self, because the only thing worse than being depressed is the mortification of being found out. You despise yourself, but you don’t want to disappoint other people or let them down.

At some point, however, you deflate. You can’t keep up the act anymore. It’s exhausting. Nights are the worst, because fatigue makes it even harder for you to challenge the bad thoughts.

You can’t bear to be alone with yourself, and you certainly don’t want to spend any time looking in the mirror or washing this body that has now become a misery-shell. Why would you even think about flossing? Maybe you can spend a few seconds running a toothbrush around the inside of your mouth, so you won’t repulse people (even more) with bad breath. But the bare minimum is all you can manage.

Research has shown a strong correlation between oral health and depression. According to one article: “Recent studies have highlighted the association between depression and oral health behaviors and oral health status. Poor periodontal health has been identified with depression based on both biologic and behavioral mechanisms. Biological mechanisms include the association between depression and the inhibition of immune function, as well as the discovery of the association between anti-depressant medication and the growth of specific bacteria. Psychological distress has been associated with lower toothbrushing frequency and frequent consumption of sugary products[.]” Patients with mental illness are at an elevated risk for tooth decay, gum disease, and a host of other ailments.

Translation? Depressed people tend to fuck up their oral health because their teeth and gums are on the laundry list of things their illness causes them to deprioritize. Also, sometimes we eat our feelings, and those feelings taste like a big bowl of Lucky Charms, scarfed down in a darkened kitchen at midnight.

Thus, when that reminder pops up on your calendar telling you it’s time for your twice-yearly cleaning, your anxiety skyrockets. I mean, no one likes having their teeth scraped with pointy instruments and then polished with fruit-flavored sand. But if you’re in a depressive episode, there’s also this continuous refrain of, “Now they’re going to find out what a terrible person I am” thudding around in your brain. That’s right. Not, “Boy, I’m in for a lecture,” but “I’m a terrible person.” And it makes complete sense to you, because you can’t regulate emotionally, and your reasoning is impaired.

Anyway, back to me. The hygienist lady was really nice. She didn’t bat an eye when she asked the routine questions about which meds I’m on. She had some gentle suggestions, like switching to an electric toothbrush with a built-in timer so there’s no need to think about how long to brush. She didn’t make me feel bad or judged. Possibly, I am not the first depressed person to sit in that chair.

I survived. If you’re in the same boat, you will, too. So, keep your appointment. Be kind to yourself, because this is an actual thing and not just you. And try to floss, because you deserve to be healthy, even if your brain is telling you otherwise.

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