Depression and oral health

The study participants may not be representative of the real-world population

Depression is a common problem and a major cause of global disability. Oral diseases are also common health problems with a substantial economic burden.  Studies have suggested an association between oral and mental health with some suggesting a bi-directional relationship.

The aim of this review was to investigate the association between depression and oral health.


Searches were conducted in the PsychInfo, PubMed, Scielo, Scopus, and Web of Science Data bases with no language or date restrictions. Original cross-sectional and longitudinal prospective and retrospective observational studies depression and oral health conditions work considered. Two reviewers independently extracted data and assessed quality. Study quality was assessed using the observational studies critical appraisal checklist from the Joanna Briggs Institute. Odds ratio (OR) with 95% confidence interval (CI) was used to measure effect size. Fixed and random-effects models were used to pool the study data.


  • 16  cross-sectional studies were included with 14 contributing to the meta-analyses.
  • 11 studies considered oral health as outcome with 3 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) [2 studies]
    • Tooth loss     OR =  1.31 (95% CI; 1.24-1.37) [4 studies]
    • Edentulism   OR = 1.17  (95% CI; 1.02-1.34) [4 studies]
  • 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 authors concluded: –

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.


Previously we have looked a review (Dental Elf -13th Jun 2016) which focused more broadly on psychological disorders and oral health which highlighted the need to consider the oral health of people with psychiatric illness. The current review focuses more specifically on those patients suffering with depression. A broad search strategy was employed and only studies using validated diagnostic tools for depression were included. The only oral health outcomes considered were caries, periodontal disease and tooth loss. All the included studies were cross-sectional with the majority considered to be high quality. Although positive associations were shown for caries, tooth loss and edentulism, only a few studies contributed to the meta-analysis.

This review and previous research draws attention to the fact that patients with mental health problems have poorer oral health. This may be due to both the personal challenges of this group of patients, side effects of medication, and ability both to access care highlighting a need for both oral and mental health professionals to have greater awareness of the oral health needs of this group of patients.


Primary Paper

Cademartori MG, Gastal MT, Nascimento GG, Demarco FF, Corrêa MB. Is depression associated with oral health outcomes in adults and elders? A systematic review and meta-analysis. Clin Oral Investig. 2018 Nov;22(8):2685-2702. doi:10.1007/s00784-018-2611-y. Epub 2018 Sep 6. Review. PubMed PMID: 30191327.

Other references

 Dental Elf -13th Jun 2016

Psychological disorders associated with poor oral health






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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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