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

Abstract

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