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The link between oral health and depression

June 21, 2021
Following the release of a study linking oral and mental health, DentistryIQ reached out for additional input. Find out what Dr. Samuel Low has to say about this important finding.

DentistryIQ exclusive

Research over time has found a connection between oral health and a range of health problems including Alzheimer’s disease, cardiovascular disease, stroke, and more. Newly released research from the Journal of Psychiatric Research now suggests there’s a connection between patients who have gingivitis and those living with depression.

The study was conducted in the UK from 2000-2016 and included more than 13,000 patients from 256 general practices. The results “demonstrated an association between chronic gingivitis and subsequent depression.”

DentistryIQ.com reached out to Samuel B. Low, DDS, MS, MEd, to discuss the findings that may affect how you talk about oral health with your patients.

Q: Are these findings a surprise, or not really?

Before the recent data shared by the Journal of Psychiatric Research, the Indian Society of Periodontology, a nonprofit association of periodontists of India, conducted a study that revealed a direct correlation between the severity of periodontal disease and the severity of depression in patients. As we continue to access and build on a growing body of evidence to support similar theories and have long been aware that periodontal disease has been associated with a number of physical health conditions, therefore these findings are likely not surprising to many in the health arena.

Q: What kind of evolution and understanding have you seen regarding oral-systemic link?

For years, cardiovascular diseases and diabetes were two of the primary systemic diseases associated with oral health. In time, additional data pointed to the direct link between oral health and pregnancy outcomes and pneumonia. And with COVID-19, we note direct relationships with periodontal disease and the magnitude of hospitalization and death due to common comorbidities. Fast forward to today, and we are discussing depression, a mental health condition that impacts more than 40 million adults in the U.S. alone.

Q: When did depression enter the oral/systemic realm and how did experts connect it?

As mentioned, the connection between periodontal disease and depression was proposed in earlier studies. Many of these studies touted negligent oral health care can affect the periodontal status by affecting the immune system.

Depression/anxiety is known to marginalize the immune system and create an enhanced susceptibility to both infection and chronic inflammatory disease. The dots began to connect those depressed patients often ignored oral hygiene maintenance, along with professional regular dental care given their reduced motivation and interest. Many of these patients adopted unhealthy habits such as smoking and alcohol dependence to cope with the mental illness, two habits known to increase risk for chronic periodontitis.

Q: How do you recommend applying the findings? Do any first steps come to mind?

Many dental professionals are already consuming papers and studies outside of dentistry alone, understanding that oral health is not isolated from the overall health of the body. To take this a step further, dentists may consider incorporating mental-health-related questions as part of patient forms, and even begin fostering relationships with local mental health experts to have credible and readily available referrals available when needed.

When it comes to prevention of poor oral health and the potential physical and mental health issues that come with it, implementing dental lasers into your practice can be an excellent way to get ahead of the issues. Lasers utilize light energy to reduce bacteria, decrease inflammation and enhance oral health. They also provide a less painful and faster treatment option for patients, potentially decreasing the stress and anxiety one might have around dental procedures.

Q: Given the emphasis on mental health in a COVID/post-COVID world, how do these findings relate?

The COVID-19 pandemic elevated awareness around mental health conditions and the link to oral health. For example, heightened anxiety and stress created an uptick in teeth grinding (bruxism), which can cause teeth to become loose, weakened, chipped, or broken. The same anxiety and depression also kept many patients from returning to their dentist for preventive care, even after the lockdowns had been lifted. There is a “ripple effect” when it comes to lack of preventative care, as it can cause serious dental problems. Amid the pandemic, studies postulated that the severity of COVID-19 symptoms could be linked to those who also exhibited poor oral health status.

The flood of this research and fast consumption of it among the general public, suggests that in a post-COVID world patients' eyes are more open to the serious implications of neglecting their oral health, and the impact poor oral health can have on their overall mental and physical well-being.

About Dr. Low
Samuel B. Low, DDS, MS, MEd,
was named Vice President, Dental and Clinical Affairs, and Chief Dental Officer of BIOLASE in October of 2016. Dr. Low is Professor Emeritus, University of Florida, College of Dentistry and Associate faculty member of the Pankey Institute, with 30 years of private practice experience in periodontics, lasers and implant placement. He is also a Diplomate of the American Board of Periodontology and past president of the American Academy of Periodontology.