Study suggests people with depression and anxiety have lower use of oral health services and greater tooth loss


A previous systematic review has shown that ‘‘People with severe mental illnesses like schizophrenia or bipolar disorder are over three times more likely to lose their teeth’.   Another large cross-sectional study from the USA has now been published that looks at the associations among depression, anxiety, use of oral health services, and tooth loss.

This study analysed data form 80,486 non-institutionalized adults in 16 states who participated in the 2008 Behavioural Risk Factor Surveillance System.  They used binomial and multinomial logistic regression analyses to estimate predicted marginals, adjusted prevalence ratios, adjusted odds ratios (AOR) and their 95% confidence intervals (CI).

They found:-

Adults with current depression had a significantly higher prevalence of non-use of oral health services in the past year than those without this disorder (P<0.001), after adjustment for age, sex, race/ethnicity, education, marital status, employment status, adverse health behaviours, chronic conditions, body mass index, assistive technology use and perceived social support.

Logistic regression showed that adults with depression and anxiety were more likely to have tooth loss. Adults with current depression, lifetime diagnosed depression and lifetime diagnosed anxiety were significantly more likely to have had at least one tooth removed than those without each of these disorders (P<0.001 for all), after fully adjusting for evaluated confounders (including use of oral health services).

The adjusted odds for numbers of teeth removed versus not having teeth removed were increased for adults with current depression versus those without.

  • 1-5 teeth removed          1.35;  (95% CI, 1.14-1.59)
  • 6-31 teeth removed       1.83;  (95% CI, 1.51-2.22)
  • all teeth removed            1.44;  (95% CI, 1.11-1.86)

The adjusted odds of being in the 1-5 teeth removed and 6-31 teeth removed categories versus no teeth removed  were also increased for adults with lifetime diagnosed depression or anxiety versus those without each of these disorders.

They concluded that:-

The use of oral health services and tooth loss was associated with depression and anxiety after controlling for multiple confounders.

Okoro CA, Strine TW, Eke PI, Dhingra SS, Balluz LS. The association between depression and anxiety and use of oral health services and tooth loss. Community Dent Oral Epidemiol. 2011 Aug 25. doi: 10.1111/j.1600- 0528.2011.00637.x. [Epub ahead of print] PubMed PMID: 21883356.

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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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