Oral Health Status in Patients with Depression and Anxiety: A Descriptive Cross-Sectional Study
DOI:
https://doi.org/10.52206/jsmc.2026.16.1.1115Abstract
Background: Depression and anxiety are among the most prevalent mental health disorders worldwide and are increasingly recognized as conditions that adversely influence physical health, including oral health. Through behavioral changes, medication side effects, and lifestyle factors, these disorders may predispose individuals to poor oral hygiene, dental caries, and periodontal disease.
Objective: To assess the oral health status of patients suffering from depression and anxiety.
Methodology: A descriptive cross-sectional study was conducted among 116 patients attending the Psychiatry Department of Saidu Group of Teaching Hospital, Swat. Participants diagnosed with depression or anxiety were enrolled using non-probability consecutive sampling. Depression and anxiety severity were assessed using the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scales, respectively. Oral health was evaluated using the Decayed, Missing, and Filled Teeth (DMFT) index, Gingival Index, and Periodontal Index. Statistical analysis included Pearson correlation, one-way ANOVA, and Student’s t-test.
Results: The mean age of participants was 32.76 ± 9.47 years, with females comprising 57.76% of the sample. Strong positive correlations were observed between DMFT scores and depression (r = 0.97, p < 0.001) as well as anxiety (r = 0.97, p < 0.001). Gingival index and pocket depth were also significantly correlated with both depression and anxiety (p < 0.001). Oral health parameters deteriorated significantly with increasing severity of depression, whereas no significant differences were observed between moderate and severe anxiety groups.
Conclusion: Depression and anxiety are strongly associated with poor oral health outcomes. Integrating oral health assessment and preventive dental care into mental health services may improve overall health outcomes in this vulnerable population.
Keywords: Anxiety, Cross-sectional study, Depression, DMFT, Gingival Index, Oral Health, Periodontal Index.
References
Mekonen T, Chan GC, Connor JP, Hides L, Leung J. Estimating the global treatment rates for depression: a systematic review and meta-analysis. J Affect Disord. 2021;295:1234-42. https://doi.org/10.1016/j.jad.2021.09.038
Khan MN, Akhtar P, Ijaz S, Waqas A. Prevalence of depressive symptoms among university students in Pakistan: a systematic review and meta-analysis. Front Public Health. 2021;8:603357. https://doi.org/10.3389/fpubh.2020.603357
Choi KW, Kim Y-K, Jeon HJ. Comorbid anxiety and depression: clinical and conceptual consideration and transdiagnostic treatment. Anxiety Disord. 2020;1191:219-35. https://doi.org/10.1007/978-981-32-9705-0_14
Mallya PS, Mallya S. Microbiology and clinical implications of dental caries-a review. J Evol Med Dent Sci. 2020;9(48):3670-5. https://doi.org/10.14260/jemds/2020/805
Kwon T, Lamster IB, Levin L. Current concepts in the management of periodontitis. Int Dent J. 2021;71(6):462-76. https://doi.org/10.1111/idj.12630
Takedachi M, Shimabukuro Y, Sawada K, Koshimizu M, Shinada K, Asai H, et al. Evaluation of periodontitis-related tooth loss according to the new 2018 classification of periodontitis. Sci Rep. 2022;12(1):11893. https://doi.org/10.1038/s41598-022-15462-6
Tiwari T, Kelly A, Randall CL, Tranby E, Franstve-Hawley J. Association between mental health and oral health status and care utilization. Front Oral Health. 2022;2:732882. https://doi.org/10.3389/froh.2021.732882
Kisely S, Baghaie H, Lalloo R, Siskind D, Johnson NW. A systematic review and meta-analysis of the association between poor oral health and severe mental illness. Psychosom Med. 2015;77(1):83-92. https://doi.org/10.1097/PSY.0000000000000135
Choi JH, Kim MJ, Kho HS. Oral health?related quality of life and associated factors in patients with xerostomia. Int J Dent Hyg. 2021;19(3):313-22. https://doi.org/10.1111/idh.12528
Skallevold HE, Rokaya N, Wongsirichat N, Rokaya D. Importance of oral health in mental health disorders: An updated review. J Oral Biol Craniofac Res. 2023;13(5):544-52. https://doi.org/10.1016/j.jobcr.2023.06.003
Lopes AG, Ju X, Jamieson L, Mialhe FL. Oral health?related quality of life among Brazilian adults with mental disorders. Eur J Oral Sci. 2021;129(3):e12774. https://doi.org/10.1111/eos.12774
Khadka S, Khan S, King A, Goldberg LR, Crocombe L, Bettiol S. Poor oral hygiene, oral microorganisms and aspiration pneumonia risk in older people in residential aged care: a systematic review. Age Ageing. 2021;50(1):81-7. https://doi.org/10.1093/ageing/afaa102
Como DH, Stein Duker LI, Polido JC, Cermak SA. Oral health and Autism Spectrum Disorders: A unique collaboration between dentistry and occupational therapy. Int J Environ Res Public Health. 2021;18(1):135-42. https://doi.org/10.3390/ijerph18010135
Mohammadi TM, Sabouri A, Sabouri S, Najafipour H. Anxiety, depression, and oral health: A population-based study in Southeast of Iran. Dent Res J. 2019;16(3):139-44. https://doi.org/10.4103/1735-3327.255748
Kisely S, Sawyer E, Siskind D, Lalloo R. The oral health of people with anxiety and depressive disorders–a systematic review and meta-analysis. J Affect Disord. 2016;200:119-32. https://doi.org/10.1016/j.jad.2016.04.040
Johnson AM, Kenny A, Ramjan L, Raeburn T, George A. Oral health knowledge, attitudes, and practices of people living with mental illness: a mixed-methods systematic review. BMC Public Health. 2024;24(1):2263. https://doi.org/10.1186/s12889-024-19713-1
Additional Files
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 The authors retain the copyrights. Authors are permitted and encouraged to post their work online (e.g. in institutional repositories or on their website), as it can lead to productive exchanges, as well as greater citation of published work.

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Readers may “Share-copy and redistribute the material in any medium or format” and “Adapt-remix, transform, and build upon the material”. The readers must give appropriate credit to the source of the material and indicate if changes were made to the material. Readers may not use the material for commercial purpose. The readers may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.



