Exploring the emotional roots of oral disease through Biodecoding and Psycho-Neuro-Odontology (PNO)

As dental professionals, we’re trained to decode what we can see: radiographs, biofilm patterns, tissue changes, and patient habits. Yet we’ve all encountered moments when the biology doesn’t quite match the story, like advanced periodontitis in a young, otherwise healthy patient, or recurrent ulcers that flare during stressful seasons rather than after certain foods. Since the 1970s, Lipowski and Reiser have urged us to consider disease as a dynamic interaction between mind, body, and environment.¹ Their biopsychosocial perspective laid the groundwork for what we now call psychosomatic medicine.

This view opens the door to a deeper question: could some oral manifestations carry traces of unspoken emotion or unmet needs? As Ávila (2010) explains, “Somatization emerges only when and where the mind is incapable of representing a state, feeling, or experience.”²

Although integrative approaches like Biodecoding and Psycho-Neuro-Odontology (PNO) are becoming more visible in dental conversations, they remain outside the realm of evidence-based clinical practice. A 2023 review by Ferreira et al. found that much of the available information comes from nonpeer-reviewed sources with limited methodological rigor.³ And still, acknowledging these frameworks clearly and ethically can help us pause, stay curious, and listen more deeply to our patients, because sometimes the lesion is only part of the story.

Biodecoding and PNO: When the mouth becomes the mirror

Biodecoding and PNO are emerging approaches that invite us to look at oral disease through a more integrative lens. While different in method, they share a central idea: the body, and especially the mouth, may express what the psyche has not yet found words for. In these models, symptoms are not viewed solely as biological disruptions but as adaptive responses to emotional stress, with each tooth and soft tissue structure carrying a potential imprint of lived experience or inherited family narratives.⁴

Both disciplines also highlight timing, suggesting that lesions often arise alongside emotionally charged moments or internal conflict. In this view, the oral cavity becomes not only anatomical but symbolic, a place where identity, expression, memory, and protection converge. They align on several fundamental principles that bridge the biological and the emotional.

First, they propose that every anatomical structure, from teeth to soft tissues, holds an emotional resonance shaped by personal and family history. Second, they see disease as a biological adaptation to unresolved tension. Third, they emphasize timing as clinically meaningful. And finally, they portray the mouth as more than mechanical; it is a stage where the emotional and biological meet.⁵

While Biodecoding and PNO approach the mouth from different directions, they share a common invitation: to consider that some oral symptoms may reflect emotional conflict as much as biological imbalance (table 1). Biodecoding often focuses on soft tissue conditions, gingivitis, aphthous ulcers, burning mouth, and sees them as symbolic expressions of instability, anger, grief, or suppression (figure 1). PNO offers a more structured clinical view that maps specific emotional themes to individual teeth and relates occlusion, posture, and jaw dynamics to emotional regulation, particularly in cases like bruxism or TMJ dysfunction.

Together, they encourage us to ask: Why this lesion? Why now? Why here? This shift, from treating symptoms to listening to their story, opens the door to deeper, more human-centered healing.

Biodecoding: The symbolic language of the body

Biodecoding, or Biological Decoding, emerged in the 1990s from a confluence of German New Medicine, symbolic biology, and transgenerational psychology across Europe and Latin America. It proposes that when emotional conflicts remain unresolved or unspoken, the body may express them somatically, through illness.

Rather than viewing these conditions solely as microbial or immune-­driven, Biodecoding invites us to reflect on their emotional context. The mouth becomes a stage for stories the conscious mind may not yet be ready to voice.

Psycho-Neuro-Odontology: A clinical-emotional bridge

PNO, developed by French dentist and psychotherapist Dr. Christian Beyer, bridges dentistry, neuroscience, and emotional awareness. It proposes that each tooth reflects a specific emotional theme, shaped by personal and transgenerational experience, and that emotional stress can directly impact oral health (figure 2).^6,7 PNO also uses tooth-emotion maps and tooth meridian charts, blending anatomical detail with emotional insight.

Understanding common oral conditions through a psychosomatic lens

At first glance, linking emotions to oral disease may seem unconventional. But a growing body of research in oral medicine, psychoneuroimmunology, and integrative health continues to explore this connection. While bacterial, immunological, and mechanical causes remain essential in diagnosing oral conditions, unresolved psychological stress is increasingly seen as a contributing factor, sometimes even a trigger.

Take oral lichen planus (OLP), for example. A recent meta-analysis showed a statistically significant correlation between OLP, depression, and anxiety. This suggests that emotional distress may not only coexist with OLP, but could influence its onset, severity, or persistence.^8,9 In 1989, Lamey and Lamb applied the Hospital Anxiety and Depression Scale (HADS) to patients with burning mouth syndrome, finding nearly 40% experienced anxiety and 13% depression, even without visible mucosal changes.¹⁰ These findings remind us that sometimes what the lesion reveals is not just inflammation but a deeper emotional load. Listening to that can be just as healing as treating it.¹⁰

A compassionate, integrative approach

As dental professionals, we’re not trained to treat emotions directly, but we often witness their imprint. When the clinical findings don’t match the patient’s habits or hygiene, that’s often a cue to look deeper.

This doesn’t mean abandoning science; it means adding humanity. It can be as simple as asking, “Did anything stressful happen around the time this started?” It means noticing recurring lesions, persistent bleeding sites, or flare-ups that align with emotionally charged events. Sometimes, it means referring to an integrative provider. Other times, it just means saying, “I see you as a whole.”

This shift invites empathy into the operatory. Because emotions don’t always stay silent; sometimes they find their voice in the mouth.

Why it matters for dental hygienists

Dental hygienists are often the first to notice what others might miss: a recurrent lesion, a quadrant that always bleeds, a subtle shift in posture, or a patient who suddenly becomes quiet. We build long-term rapport, track patterns over time, and cultivate the kind of trust that allows people to open up.

That makes us powerful observers, not only of biofilm, but of behavior, stress, and silence. Sometimes the plaque tells part of the story … but not the whole one.

When we honor the emotional context of oral health, we:

• Ask open, compassionate questions that invite dialogue.
• Observe patterns that correspond with life events or stressors.
• Normalize the connection between chronic stress and inflammation.
• Collaborate, when appropriate, with integrative or mental health providers.

This is especially valuable for patients who have unexplained or recurrent lesions, carry trauma histories or live under chronic stress, struggle with psychosomatic patterns like IBS, autoimmune flares, or migraines.

Even small gestures, like validating that stress matters, can open the door to healing. In this light, we are not just preventive specialists; we become bridges between body and experience.

Where to begin as a clinician

We don’t need formal training in Biodecoding or Psycho-Neuro-Odontology to begin seeing our patients through a more integrative lens. We can start today with curiosity, compassion, and clinical mindfulness (figure 3). This approach doesn’t ask us to abandon science; it asks us to expand our lens.

Try beginning with:

Observation: What is happening? When did it start? Where does it recur?

Gentle inquiry: “Has anything changed in your life recently?” or “How have you been feeling, not just physically, but emotionally?”

Explore resources on psychosomatic medicine, trauma-informed care, or mind-body connections in dentistry.

Balance: Let both science and story inform your care. Evidence-based practice and emotional intelligence are not mutually exclusive.

Biodecoding and PNO remind us that oral pathology doesn’t exist in isolation. It exists in a person—with memories, stressors, joys, grief, and a nervous system that remembers more than we realize.

We won’t always be able to name what lies beneath. But we can choose to notice. We can treat what we see … and still honor what may be unspoken. 

Editor's note: This article appeared in the January/February 2026 print edition of RDH magazine. Dental hygienists in North America are eligible for a complimentary print subscription. Sign up here.

References

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9. Adamo D, Calabria E, Canfora F, et al. Anxiety and depression in keratotic oral lichen planus: a multicentric study from the SIPMO. Clin Oral Investig. 2023;27(6):3057-3069. doi:10.1007/s00784-023-04909-3
10. Lamey PJ, Lamb AB. The usefulness of the HAD scale in assessing anxiety and depression in patients with burning mouth syndrome. Oral Surg Oral Med Oral Pathol. 1989;67(4):390-392. doi:10.1016/0030-4220(89)90379-4