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 from 80,486 non-institutionalised 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 abstract]