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Is depression associated with oral health outcomes in adults and elders? A systematic review and meta-analysis

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Abstract

Objectives

To systematically review the literature in order to investigate association between depression and oral diseases.

Material and methods

Electronic searches were performed in five databases. Studies testing associations between depression and oral diseases as either exposure or outcome were included. Oral disease variable included any tooth loss or edentulism, periodontal disease, and dental caries.

Results

A total of 2504 articles were identified in the electronic database search. Sixteen studies were included in this systematic review being 14 included in the meta-analyses. Eleven studies considered oral health as outcome, whereas three studies considered depression as an outcome variable. Depression was associated to dental caries, tooth loss, and edentulism. Pooled estimates showed that depression increased the odds of dental caries (OR 1.27; 95% CI 1.13–1.44), tooth loss (OR 1.31; 95% CI 1.24–1.37), and edentulism (OR 1.17; 95% CI 1.02–1.34), respectively. When the oral diseases were tested as independent variable and depression as outcome, associations with both edentulism (OR 1.28; 95% CI 1.06–1.55) and periodontal disease (HR 1.73; 95% CI 1.58–1.89) were found.

Conclusions

The results of our systematic review and meta-analyses show a positive association between depression and oral diseases, specifically dental caries, tooth loss, and edentulism, in adults and elders. More longitudinal studies are required to test causal and temporal relationship between depression and oral health status.

Clinical relevance

Mental and oral health are among the main disabilities worldwide. This article helps to understand more about the relationship between both conditions, highlighting the importance for both clinicians and policy makers of considering individual’s psychological status in management of oral health.

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References

  1. GBD 2015 Disease and Injury Incidence and Prevalence Collaborators (2016) Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 388:1545–1602

    Article  Google Scholar 

  2. Luppino FS, de Wit LM, Bouvy PF, Stijnen T, Cuijpers P, Penninx BW, Zitman FG (2010) Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry 67:220–229

    Article  PubMed  Google Scholar 

  3. Chen T, Wu Z, Shen Z, Zhang J, Shen X, Li S (2014) Sleep duration in Chinese adolescents: biological, environmental, and behavioral predictors. Sleep Med 15:1345–1353

    Article  PubMed  Google Scholar 

  4. O'Neil A, Fisher AJ, Kibbey KJ, Jacka FN, Kotowicz MA, Williams LJ, Stuart AL, Berk M, Lewandowski PA, Taylor CB, Pasco JA (2016) Depression is a risk factor for incident coronary heart disease in women: an 18-year longitudinal study. J Affect Disord 196:117–124

    Article  PubMed  Google Scholar 

  5. Hugo FN, Hilgert JB, de Sousa MD, Cury JÁ (2012) Depressive symptoms and untreated dental caries in older independently living south Brazilians. Caries Res 46:376–384

    Article  PubMed  Google Scholar 

  6. Okoro CA, Strine TW, Eke PI, Dhingra SS, Balluz LS (2012) The association between depression and anxiety and use of oral health services and tooth loss. Community Dent Oral Epidemiol 40:134–144

    Article  PubMed  Google Scholar 

  7. Roohafza H, Afghari P, Keshteli AH, Vali A, Shirani M, Adibi P, Afshar H (2015) The relationship between tooth loss and psychological factors. Community Dent Health 32:16–19

    PubMed  Google Scholar 

  8. Saman DM, Lemieux A, Arevalo O, Lutfiyya MN (2014) A population-based study of edentulism in the US: does depression and rural residency matter after controlling for potential confounders? BMC Public Health 14:65

    Article  PubMed  PubMed Central  Google Scholar 

  9. Urzua I, Mendoza C, Arteaga O, Rodríguez G, Cabello R, Faleiros S, Carvajal P, Muñoz A, Espinoza I, Aranda W, Gamonal J (2012) Dental caries prevalence and tooth loss in Chilean adult population: first national dental examination survey. Int J Dent 2012:810170

    Article  PubMed  PubMed Central  Google Scholar 

  10. Ren C, McGrath C, Yang Y (2016) Edentulism and associated factors among community-dwelling middle-aged and elderly adults in China. Gerodontology 34:195–207

    Article  PubMed  Google Scholar 

  11. Tyrovolas S, Koyanagi A, Panagiotakos DB, Haro JM, Kassebaum NJ, Chrepa V, Kotsakis GA (2016) Population prevalence of edentulism and its association with depression and self-rated health. Sci Rep 6:37083

    Article  PubMed  PubMed Central  Google Scholar 

  12. Righolt AJ, Jevdjevic M, Marcenes W, Listl S (2018) Global-, regional-, and country-level economic impacts of dental diseases in 2015. J Dent Res 97:501–507

    Article  PubMed  Google Scholar 

  13. Kassebaum NJ, Bernabé E, Dahiya M, Bhandari B, Murray CJ, Marcenes W (2014) Global burden of severe periodontitis in 1990-2010: a systematic review and meta-regression. J Dent Res 93:1045–1053

    Article  PubMed  PubMed Central  Google Scholar 

  14. Kassebaum NJ, Bernabé E, Dahiya M, Bhandari B, Murray CJ, Marcenes W (2014) Global burden of severe tooth loss: a systematic review and meta-analysis. J Dent Res 93:20S–28S

    Article  PubMed  PubMed Central  Google Scholar 

  15. Kassebaum NJ, Bernabé E, Dahiya M, Bhandari B, Murray CJ, Marcenes W (2015) Global burden of untreated caries: a systematic review and metaregression. J Dent Res 94:650–658

    Article  PubMed  Google Scholar 

  16. Kassebaum NJ, Smith AGC, Bernabé E, Fleming TD, Reynolds AE, Vos T, Murray CJL, Marcenes W, GBD 2015 Oral Health Collaborators (2017) Global, regional, and national prevalence, incidence, and disability-adjusted life years for oral conditions for 195 countries, 1990–2015: a systematic analysis for the global burden of diseases, injuries, and risk factors. J Dent Res 96(4):380–387

    Article  PubMed  Google Scholar 

  17. Anttila SS, Knuuttila ML, Sakki TK (2001) Relationship of depressive symptoms to edentulousness, dental health, and dental health behavior. Acta Odontol Scand 59:406–412

    Article  PubMed  Google Scholar 

  18. Anttila SS, Knuuttila ML, Ylöstalo P, Joukamaa M (2006) Symptoms of depression and anxiety in relation to dental health behavior and self-perceived dental treatment need. Euro J Oral Sci 114:109–114

    Article  Google Scholar 

  19. O'Neil A, Berk M, Venugopal K, Kim SW, Williams LJ, Jacka FN (2014) The association between poor dental health and depression: findings from a large-scale, population-based study (the NHANES study). Gen Hosp Psychiatry 36:266–270

    Article  PubMed  Google Scholar 

  20. Phillips AC, Carroll D, Evans P, Bosch JA, Clow A, Hucklebridge F, Der G (2006) Stressful life events are associated with low secretion rates of immunoglobulin A in saliva in the middle-aged and elderly. Brain Behav Immun 20:191–197

    Article  PubMed  Google Scholar 

  21. Anttila SS, Knuuttila ML, Sakki TK (1999) Depressive symptoms favor abundant growth of salivary lactobacilli. Psychosom Med 61:508–512

    Article  PubMed  Google Scholar 

  22. Delgado-Angulo EK, Sabbah W, Suominen AL, Vehkalahti MM, Knuuttila M, Partonen T, Nordblad A, Sheiham A, Watt RG, Tsakos G (2015) The association of depression and anxiety with dental caries and periodontal disease among Finnish adults. Community Dent Oral Epidemiol 43:540–549

    Article  PubMed  Google Scholar 

  23. Khambaty T, Stewart JC (2013) Associations of depressive and anxiety disorders with periodontal disease prevalence in young adults: analysis of 1999-2004 National Health and Nutrition Examination Survey (NHANES) data. Ann Behav Med 45:393–397

    Article  PubMed  Google Scholar 

  24. Persson GR, Persson RE, MacEntee CI, Wyatt CC, Hollender LG, Kiyak HA (2003) Periodontitis and perceived risk for periodontitis in elders with evidence of depression. J Clin Periodontol 30:691–696

    Article  PubMed  Google Scholar 

  25. Singh H, Maharaj RG, Naidu R (2015) Oral health among the elderly in 7 Latin American and Caribbean cities, 1999–2000: a cross-sectional study. BMC Oral Health 15:46

    Article  PubMed  PubMed Central  Google Scholar 

  26. Wiener RC, Wiener MA, McNeil DW (2015) Comorbid depression/anxiety and teeth removed: behavioral risk factor surveillance system 2010. Community Dent Oral Epidemiol 43:433–443

    Article  PubMed  PubMed Central  Google Scholar 

  27. Park SJ, Ko KD, Shin SI, Ha YJ, Kim GY, Kim HA (2014) Association of oral health behaviors and status with depression: results from the Korean National Health and nutrition examination survey, 2010. J Public Health Dent 74:127–138

    Article  PubMed  Google Scholar 

  28. Hybels CF, Bennett JM, Landerman LR, Liang J, Plassman BL, Wu B (2016) Trajectories of depressive symptoms and oral health outcomes in a community sample of older adults. Int J Geriatr Psychiatry 31:83–91

    Article  PubMed  Google Scholar 

  29. Hsu CC, Hsu YC, Chen HJ, Lin CC, Chang KH, Lee CY, Chong LW, Kao CH (2015) Association of periodontitis and subsequent depression: a nationwide population-based study. Medicine (Baltimore) 94:e2347

    Article  Google Scholar 

  30. Yamamoto T, Aida J, Kondo K, Fuchida S, Tani Y, Saito M, Sasaki Y (2017) Oral health and incident depressive symptoms: JAGES project longitudinal study in older Japanese. J Am Geriatr Soc 65(5):1079–1084

    Article  PubMed  Google Scholar 

  31. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group (2010) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 8:336–341

    Article  PubMed  Google Scholar 

  32. Ababneh KT, Al Shaar MB, Taani DQ (2010a) Depressive symptoms in relation to periodontal health in a Jordanian sample. Int J Dent Hyg 16-21:8

    Google Scholar 

  33. Ababneh KT, Taha AH, Abbadi MS, Karasneh JA, Khader YS (2010b) The association of aggressive and chronic periodontitis with systemic manifestations and dental anomalies in a Jordanian population: a case control study. Head Face Med 6:30

    Article  PubMed  PubMed Central  Google Scholar 

  34. Alkan A, Cakmak O, Yilmaz S, Cebi T, Gurgan C (2015) Relationship between psychological factors and oral health status and behaviours. Oral Health Prev Dent 13:331–339

    PubMed  Google Scholar 

  35. Almomani FM, Bani-issa W (2017) The incidence of depression among residents of assisted living: prevalence and related risk factors. Clin Interv Aging 12:1645–1653

    Article  PubMed  PubMed Central  Google Scholar 

  36. Bertoldi C, Venuta M, Guaraldi G, Lalla M, Guaitolini S, Generali L, Monzani D, Cortellini P, Zaffe D (2018) Are periodontal outcomes affected by personality patterns? A 18-month follow-up study. Acta Odontol Scand 76:48–57

    Article  PubMed  Google Scholar 

  37. Coles E, Chan K, Collins J, Humphris GM, Richards D, Williams B, Freeman R (2011) Decayed and missing teeth and oral-health-related factors: predicting depression in homeless people. J Psychosom Res 71:108–112

    Article  PubMed  Google Scholar 

  38. D’Avila OP, Wendland E, Hilgert JB, Padilha DMP, Hugo FN (2017) Association between root caries and depressive symptoms among elders in Carlos Barbosa, RS, Brazil. Braz Dent J 28:234–240

    Article  PubMed  Google Scholar 

  39. Dirik G, Kilicarslan M, Gencoz T, Karanci N (2006) Correlates of anxiety and depression in Turkish complete denture patients. Soc Behav Pers 34:1311–1322

    Article  Google Scholar 

  40. Ehrenthal JC, Graetz C, Plaumann A, Dorfer CE, Herzog W (2016) Number of teeth predict depressive symptoms in a longitudinal study on patients with periodontal disease. J Psychosom Res 89:16–19

    Article  PubMed  Google Scholar 

  41. Hayashi N, Tamagawa H, Tanaka M, Hanioka T, Maruyama S, Tatsuya Takeshita T, Morimoto K, Shizukuis S (2001) Association of tooth loss with psychosocial factors in male Japanese employees. J Occup Health 43:351–355

    Article  Google Scholar 

  42. Johannsen A, Rylander G, Söder B, Asberg M (2006) Dental plaque, gingival inflammation, and elevated levels of interleukin-6 and cortisol in gingival crevicular fluid from women with stress-related depression and exhaustion. J Periodontol 77:1403–1409

    Article  PubMed  Google Scholar 

  43. Kim YS, Kim HN, Lee JH, Kim SY, Jun EJ, Kim JB (2017) Association of stress, depression, and suicidal ideation with subjective oral health status and oral functions in Korean adults aged 35 years or more. BMC Oral Health 17:101

    Article  PubMed  PubMed Central  Google Scholar 

  44. Kjellström B, Gustafsson A, Nordendal E, Norhammar A, Nygren Å, Näsman P, Rydén L, Åsberg M, Parokrank steering committee (2017) Symptoms of depression and their relation to myocardial infarction and periodontitis. Eur J Cardiovasc Nurs 16:468–474

    Article  PubMed  Google Scholar 

  45. Koyanagi A, Oh H, Stubbs B, Haro JM, DeVylder JE (2017) Epidemiology of depression with psychotic experiences and its association with chronic physical conditions in 47 low- and middle-income countries. Psychol Med 47:531–542

    Article  PubMed  Google Scholar 

  46. Kumar A, Kardkal A, Debnath S, Lakshminarayan J (2015) Association of periodontal health indicators and major depressive disorder in hospital outpatients. J Indian Soc Periodontol 19:507–511

    Article  PubMed  PubMed Central  Google Scholar 

  47. Li Q, Xu C, Wu Y, Guo W, Zhang L, Liu Y, Yu C, Peng J (2011) Relationship between the chronic periodontitis and the depression anxiety psychological factor. Zhong Nan Da Xue Xue Bao Yi Xue Ban 36:88–92

    PubMed  Google Scholar 

  48. Marques-Vidal P, Milagre V (2006) Are oral health status and care associated with anxiety and depression? A study of Portuguese health science students. J Public Health Dent 66:64–66

    Article  PubMed  Google Scholar 

  49. Mendes DC, Silva TF, Barros LO, de Oliveira MV, Vieira LT, Haikal DS, Guimarães AL, De Paula AM (2013) Analysis of the normative conditions of oral health, depression and serotonin-transporter-linked promoter region polymorphisms in an elderly population. Geriatr Gerontol Int 13:98–106

    Article  PubMed  Google Scholar 

  50. Moghadam SA, Masjedi O, Fakour SR, Moghaddam AA (2016) The association between psychological disorders and periodontitis. Int J High Risk Behav Addict 5:e21684

    Google Scholar 

  51. Monteiro da Silva AM, Oakley DA, Newman HN, Nohl FS, Lloyd HM (1996) Psychosocial factors and adult onset rapidly progressive periodontitis. J Clin Periodontol 23:789–794

    Article  PubMed  Google Scholar 

  52. Ng SK, Keung Leung W (2006) A community study on the relationship between stress, coping, affective dispositions and periodontal attachment loss. Community Dent Oral Epidemiol 34:252–266

    Article  PubMed  Google Scholar 

  53. Rosania AE, Low KG, McCormick CM, Rosania DA (2009) Stress, depression, cortisol, and periodontal disease. J Periodontol 80:260–266

    Article  PubMed  Google Scholar 

  54. Shah RJ, Diwan FJ, Diwan MJ, Chauhan VJ, Agrawal HS, Patel GC (2015) A study of the emotional effects of tooth loss in an edentulous Gujarati population and its association with depression. J Indian Prosthodont Soc 15:237–243

    Article  PubMed  PubMed Central  Google Scholar 

  55. Solis AC, Lotufo RF, Pannuti CM, Brunheiro EC, Marques AH, Lotufo-Neto F (2004) Association of periodontal disease to anxiety and depression symptoms, and psychosocial stress factors. J Clin Periodontol 31:633–638

    Article  PubMed  Google Scholar 

  56. Sundararajan S, Muthukumar S, Rao SR (2015) Relationship between depression and chronic periodontitis. J Indian Soc Periodontol 19:294–296

    Article  PubMed  PubMed Central  Google Scholar 

  57. Takiguchi T, Yoshihara A, Takano N, Miyazaki H (2016) Oral health and depression in older Japanese people. Gerodontology 33:439–446

    Article  PubMed  Google Scholar 

  58. The Joanna Briggs Institute (2015) Joanna Briggs Institute Reviewers’ Manual: 2015 edition. Adelaide, Australia: Joanna Briggs Institute. https://joannabriggs.org. Accessed 08 Nov 2016

  59. Zhang J, Yu KF (1998) What’s the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes. JAMA 280:1690–1691

    Article  PubMed  Google Scholar 

  60. DerSimonian R, Laird N (2015) Meta-analysis in clinical trials. Contemp Clin Trials 45:139–145

    Article  PubMed  PubMed Central  Google Scholar 

  61. Sullivan LE, Fiellin DA, O'Connor PG (2005) The prevalence and impact of alcohol problems in major depression: a systematic review. Am J Med 118:330–341

    Article  PubMed  Google Scholar 

  62. Shiue I (2014) Modeling the effects of indoor passive smoking at home, work, or other households on adult cardiovascular and mental health: the Scottish Health Survey, 2008-2011. Int J Environ Res Public Health 11:3096–3107

    Article  PubMed  PubMed Central  Google Scholar 

  63. Zahedi H, Kelishadi R, Heshmat R, Motlagh ME, Ranjbar SH, Ardalan G, Payab M, Chinian M, Asayesh H, Larijani B, Qorbani M (2014) Association between junk food consumption and mental health in a national sample of Iranian children and adolescents: the CASPIAN-IV study. Nutrition 30:1391–1397

    Article  PubMed  Google Scholar 

  64. Zhai L, Zhang Y, Zhang D (2015) Sedentary behaviour and the risk of depression: a meta-analysis. Br J Sports Med 49:705–709

    Article  PubMed  Google Scholar 

  65. Kikutani T, Suzuki T, Hwang SH, Park SG (2018) The relationship between depression and periodontal diseases. Community Dent Health 35:23–29

    Google Scholar 

  66. Bergdahl M, Bergdahl J (2000) Low unstimulated salivary flow and subjective oral dryness: association with medication, anxiety, depression, and stress. J Dent Res 79:1652–1658

    Article  PubMed  Google Scholar 

  67. Chapple IL, Bouchard P, Cagetti MG, Campus G, Carra MC, Cocco F, Nibali L, Hujoel P, Laine ML, Lingstrom P, Manton DJ, Montero E, Pitts N, Rangé H, Schlueter N, Teughels W, Twetman S, Van Loveren C, Van der Weijden F, Vieira AR, Schulte AG (2017) Interaction of lifestyle, behaviour or systemic diseases with dental caries and periodontal diseases: consensus report of group 2 of the joint EFP/ORCA workshop on the boundaries between caries and periodontal diseases. J Clin Periodontol 44:S39–S51

    Article  PubMed  Google Scholar 

  68. Shimazaki Y, Fu B, Yonemoto K, Akifusa S, Shibata Y, Takeshita T, Ninomiya T, Kiyohara Y, Yamashita Y (2017) Stimulated salivary flow rate and oral health status. J Oral Sci 59:55–62

    Article  PubMed  Google Scholar 

  69. Graves D (2008) Cytokines that promote periodontal tissue destruction. J Periodontol 79:1585–1591

    Article  PubMed  Google Scholar 

  70. Araújo MM, Martins CC, Costa LC, Cota LO, Faria RL, Cunha FA, Costa FO (2016) Association between depression and periodontitis: a systematic review and meta-analysis. J Clin Periodontol 43:216–228

    Article  PubMed  Google Scholar 

  71. Kisely S, Sawyer E, Siskind D, Lalloo R (2016) The oral health of people with anxiety and depressive disorders - a systematic review and meta-analysis. J Affect Disord 200:119–132

    Article  PubMed  Google Scholar 

  72. Geurs N, Iacono V, Krayer J, Mealey B, Paquette D, Pearson B, Rosen P, Sabatini R, Schweinebraten M (2015) American Academy of Periodontology task force report on the update to the 1999 classification of periodontal diseases and conditions. J Periodontol 86:835–838. https://doi.org/10.1902/jop.2015.157001

    Article  Google Scholar 

  73. Genco RJ, Ho AW, Grossi SG, Dunford RG, Tedesco LA (1999) Relationship of stress, distress and inadequate coping behaviors to periodontal disease. J Periodontol 70:711–723

    Article  PubMed  Google Scholar 

  74. Yiengprugsawan V, Somkotra T, Seubsman SA, Sleigh AC (2013) Longitudinal associations between oral health impacts and quality of life among a national cohort of Thai adults. Health Qual Life Outcomes 11:172

    Article  PubMed  PubMed Central  Google Scholar 

  75. Button KS, Ioannidis JP, Mokrysz C, Nosek BA, Flint J, Robinson ES, Munafò MR (2013) Power failure: why small sample size undermines the reliability of neuroscience. Nat Rev Neurosci 14:365–376

    Article  PubMed  Google Scholar 

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  1. Graduate Program in Dentistry, Federal University of Pelotas, 457, Gonçalves Chaves St., Pelotas, RS, Brazil

    Mariana Gonzalez Cademartori, Márcia Torres Gastal, Gustavo Giacommelli Nascimento, Flavio Fernando Demarco & Marcos Britto Corrêa

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  1. Mariana Gonzalez Cademartori
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Cademartori, M.G., Gastal, M.T., Nascimento, G.G. et al. Is depression associated with oral health outcomes in adults and elders? A systematic review and meta-analysis. Clin Oral Invest 22, 2685–2702 (2018). https://doi.org/10.1007/s00784-018-2611-y

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