There are many theories about my life that I believe to be true. One of my longest held beliefs is that if I had bought stocks in Bonjela 10 years ago, I would be a much wealthier woman today. Why? Because for as long as I can remember, I have bulk bought the oral care gel to stash away in every handbag I own like a favourite nude lipstick. That might sound excessive but my relentless and infuriating susceptibility to mouth ulcers means that mass purchasing has become an annoyingly necessary habit.
A constant case of mouth ulcers can point towards a wider health issue, meaning my propensity for developing painful mouth spots has long been a point of conversation. Could it be linked to low iron levels and subsequent anaemia? Is it due to a lack of vitamin A or C? Does it just come down to a shoddy immune system? All these questions have been explored and no conclusive answers found. But I had been ignoring one thing which was likely a big contributing factor: my penchant for mouth biting.
I can’t pinpoint exactly when I started mindlessly biting my mouth, although I know I have been doing it for a long time. As something of an unconscious habit, I never gave it much thought until I saw an infographic about common anxiety symptoms. I started taking note of when I would bite at my lower lip or the inside of my cheek and, to no one's surprise, it was almost always during times of stress. Though people often bite their mouth due to eating while distracted, tooth deflection or issues with their jaw, studies suggest that habitual mouth biting is frequently linked to anxiety.
According to the TLC Foundation, morsicatio buccarum (also known as chronic cheek biting) is a compulsive behaviour similar to dermatillomania, where sufferers pull out their hair or pick at their skin. Classified as a body-focused repetitive behaviour (BFRB), the habit is said to be more common among those dealing with stress or anxiety, with the process often "initiated or influenced by emotional states". Though it affects only 750 out of every 1 million people, cheek biting is said to be more common in women, which aligns with data that shows women are twice as likely as men to have an anxiety disorder.
Jackie, 28, can attest to the connection between mouth biting and stress. "It’s a lot worse in times of anxious thought or especially when I’m concentrating on my work. I experience ulcers all the time and then I tend to bite those and make everything worse. The insides of my cheeks often feel quite rough because I bite the skin there too," she explains. Jackie says she finds it hard to control, with her habit happening mindlessly. "I mouth bite all the time. I catch myself doing it when I’m watching TV in the evening, or shopping, or out with friends. Perhaps because I find it difficult to switch off and there’s always something I’m thinking about."
The unconscious nature of the habit is something that psychologist and Counselling Directory member Philip Karahassan says is often part of our response to stress. "We all have our own way of dealing with our issues and we all look for ways to deal with these feelings, both with actively taking control and also passive or unconscious actions such as dermatillomania or cheek biting. These unconscious actions can become so ingrained into us that it becomes our normal or default way of dealing with stress and pressure without us even realising it." This can even manifest in people mouth biting while asleep.
The trancelike state of mouth biting is something I can personally vouch for, often catching myself chewing while I ruminate on problems or concentrate on a task. Similarly, Jackie says her biting is entirely unconscious. "I’m not aware I’m doing it most of the time, unless I go too far and draw blood, then I’ll try and stop and pop a little Bonjela on the sores." For some people however, once they realise they are biting their mouths, it can become a conscious action by way of wanting to 'smooth' the marks left behind. According to the TLC Foundation, this repetitive behaviour can cause feelings of guilt, shame and hopelessness and even drive sufferers to limit their social activities out of concern that others will notice what they're doing.
Beyond the emotional impact, the condition often causes physical damage too. Many dentists see the effects of chronic cheek biting on patients' oral health. "It’s often something that patients do when they’re stressed and – since the beginning of the pandemic – stress levels are of course heightened," says cosmetic dentist Dr Hanna Kinsella. In her experience, the consequence of repetitive biting is often damage to the mouth tissue. "We often see lesions on the tissue in the way of mouth sores and ulcers. Chronic cheek biting can result in painful, red sores and tears in the mucosa (the mouth’s inner lining)."
In chronic cases, this can lead to the formation of a linea alba on the inside of the mouth. "Biting soft tissue inside the cheek or around the mouth causes trauma to the layers of the skin," explains cosmetic dentist Dr Aneka Khaira. The skin creates a keratinised layer in response, which appears as a visible white line along the cheek lining in the mouth. In such cases, Dr Khaira suggests wearing a splint similar to a teeth whitening tray, which can act as a barrier. Where lesions are already present, she recommends soothing with pain relief such as paracetamol or ibuprofen, warm saltwater rinses and over-the-counter topical ointments to help sore spots heal quickly.
As important as it is to treat the symptoms, Karahassan emphasises the need to tackle the root emotional cause of mouth biting in order to stop. "Understanding the motives behind your actions will help you to understand why you bite your cheeks and make the change to stop doing it in the future," he explains. If you have no idea where to start with this journey, Karahassan suggests first trying to become conscious of when you are mouth biting. From there it is about identifying the triggers (the setting you are in, the people you are around) and linking those to an emotional response like stress or anxiety. Then it is about finding a different coping method for those emotions.
While it may sound difficult, Dr Kinsella echoes the importance of breaking the cycle. She suggests breathing exercises and meditation, alongside keeping a journal. "Breathing exercises and meditation can offer an effective treatment to stop you from cheek biting. Try keeping a journal and documenting when the cheek biting occurs and try to replace the behaviour with a healthier one such as chewing gum," she explains. BFRBs can feel impossible to tackle but taking steps to avoid mouth damage and improve mental wellbeing couldn’t be more important. Whether this means taking the steps to find a therapist or discussing aids with your dentist, talking to a professional is always the best course of action.