Andrew Lipovsky/NBC
Amanda MacMillan
June 14, 2017 08:29 PM

This article originally appeared on Health.com.

Demi Moore dropped a bombshell on The Tonight Show this week, revealing—with photographic evidence—that she’d lost two of her front teeth. The culprit behind her toothless smile, she says? Stress.

“I sheared off my front tooth,” the Rough Night actress told host Jimmy Fallon on Monday night. “I’d love to say it was skateboarding or something really kind of cool, but I think it’s something that’s important to share because I think it’s literally, probably after heart disease, one of the biggest killers in in America, which is stress.”

Wait, what!? Is that actually possible? Sure, Moore is dealing with some pretty nerve-racking stuff lately, like defending herself against a lawsuit after a house guest drowned in her pool in 2015. But let’s be real: We all have things to stress out about. Could our pearly whites be at risk, too?

We dug a little deeper, and we also spoke with dentist Marc Lowenberg, a partner in Lowenberg, Lituchy, and Kantor Cosmetic Dentistry in New York City. Dr. Lowenberg has not treated Moore, but he does know firsthand how the effects of stress can wreak havoc on teeth and oral health. Here’s what you should know.

Andrew Lipovsky/NBC

Moore has had tooth troubles before

First, there’s more to Moore’s story than her initial quote let on. In her conversation with Fallon, the actress clarified that she “literally knocked it out”—referring to one of the two teeth she lost—“almost like it fell out and my warranty was up.”

Yesterday, Moore confirmed in a statement to Page Six that she did lose two teeth, but that “they happened a year apart.” The actress also spoke about losing a front tooth on The Ellen DeGeneres Show back in 2010, using very similar language to describe the experience.

“I had a bad bite and knocked my own front tooth out, which basically fell out into my hand, and I just thought my warranty was up,” she said at the time. She told DeGeneres she was “holding my teeth, maybe a little too tense,” and made a clenching motion to demonstrate.

On Monday night, Moore praised “modern dentistry” for repairing her tooth in time for her Tonight Show appearance, and Fallon played a funny Snapchat video of Moore in her dentist’s chair. “People have a hard time at the dentist, and I’d like to share that it can be a lot of fun,” she told him. On Ellen in 2010, she also shared a gap-toothed photo of herself at the dentist.

Stress can be a contributor, but not the sole cause

So could stress really be the root of these dental dilemmas? While only Moore and her dentist can say for sure what’s going on in her mouth, Dr. Lowenberg says stress can certainly play a role in tooth and gum issues.

Most commonly, stress can make people more likely to grind their teeth, a condition known as bruxism. Grinding—when you’re awake or asleep—can wear away tooth enamel, causing teeth to crack or break, and it can damage the jaw joint, as well.

“Stress is very obvious in most people’s teeth,” he says. “You can actually see how they grind their teeth and how they’re worn down, and many people who live with stress have to have a guard made to protect their teeth.”

But bruxism doesn’t usually cause teeth to fall out entirely, says Dr. Lowenberg, except in rare cases when teeth split straight down the middle. “If you fracture the tooth itself in a way where it splits in half, there’s no way to save it,” he says. “Otherwise, if you just break off a piece of the tooth structure, then it can usually be repaired.”

Stress has also been shown to contribute to inflammation throughout the body, which may be a risk factor for gum disease. In a 2006 study in the Journal of Periodontology, women who had stress-related depression and exhaustion had increased levels of plaque around their teeth, inflammation of their gums, and inflammatory proteins in their saliva—“suggesting that depression might affect immune function,” the authors wrote, “which could lead to impaired periodontal health.”

According to the American Academy of Periodontology, gum disease (also called gingivitis or, in its most severe form, periodontitis) can be painless, and it is a major cause of tooth loss in adults. Gum disease can also be made worse by smoking, poor nutrition, obesity, certain medications, and, yes, clenching or grinding teeth—all factors that could be indirectly related to stress.

But even if they’re under lots of stress, healthy middle-age people shouldn’t worry about their teeth falling out, says Dr. Lowenberg. “Your teeth are very strong and the bone that supports them is very strong, and you really have to be incredibly abusive for many years to end up losing them,” he says. And if Moore did lose her teeth because of grinding-related fractures, he adds, her scenario is still the “absolute extreme.”

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How to keep your smile safe

Moore was definitely right about one thing: Stress and anxiety can be major health hazards, and there’s no question that they can have strange effects on the body from head to toe. That’s why finding healthy ways to cope with day-to-day stressors is so important.

Meanwhile, Dr. Lowenberg emphasizes the importance of simple, common-sense oral hygiene. “If you have an awareness of dental health—if you brush your teeth and floss your teeth and go to the dentist twice a year—that’s the best way of assuring yourself that your teeth will stay healthy,” he says.

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