ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Association Between Depression and Periodontitis Neither Confirmed Nor Denied
Clinical Question Are adult patients with depression at a higher risk for periodontitis than adult patients without depression?
Clinical Bottom Line An association between depression and periodontitis could not be fully declared. This is supported by a systematic review of eight cross-sectional reviews, six case-control studies, and one cohort study as well as meta-analysis of seven cross-sectional studies which indicated that there was not a significant association when it came to depression and periodontitis. Further research should be performed in order to confirm or deny the association.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 26743451de Araújo/2016The 15 studies selected adults who had depression and periodontitis from age 15 to age 82 in sample sizes from 45 to 1,979.Meta-Analysis
Key resultsFrom a systematic review of fifteen separate studies, six studies concluded that there was an association between depression and periodontitis while nine studies concluded that there was not an association between depression and periodontitis. According to a methodological quality assessment, most of the studies were credible and possessed little risk of bias. The Odds-Ratio calculation was 1.03 and 95% Confidence Interval calculation was 0.75-1.41 and led to a conclusion of no significant association when it came to depression and periodontitis for a meta-analysis of seven cross-sectional reviews.
Evidence Search Medline: ((periodontal disease [Mesh] OR periodontitis [Mesh] OR chronic periodontitis [Mesh] OR aggressive periodontitis [Mesh]) AND (anxiety [Mesh] OR Anxious [Mesh] OR depression [Mesh] OR depressive disorder [Mesh])); Web of Science: ((periodontal disease OR periodontitis OR chronic periodontitis OR aggressive periodontitis) AND (anxiety OR Anxious OR depression OR depressive disorder)); and Cochrane Library: ((periodontal diseases [Mesh] OR periodontitis [Mesh] OR chronic periodontitis [Mesh] OR aggressive periodontitis [Mesh]) AND (anxiety [Mesh] OR Anxious OR depression [Mesh] OR depressive disorder [Mesh])).
Comments on
The Evidence
Validity: There was bias due to the non-blinding of the examiners for periodontitis and depression and bias in the manner in which the samples were chosen (convenience samples from dental schools, hospitals, insurance companies, advertisement recruitment, and neighborhood). There was, however, one study that utilized a representative sample from US NHANES. It should be noted that there was variation in the requirements for periodontitis and different methods were utilized to quantify depression, sample size, and patient age. There may have been bias due to translation or language barriers, as some studies were not performed in the United States. On the other hand, the studies were successful in taking into account the confounding variables that included age, gender, smoking, and level of education. Periodontitis was defined by clinical examination while depression was determined by the use of instruments. Perspective: Case-control and cohort studies rank higher than cross-sectional studies on the evidence hierarchy but that does not mean that cross-sectional studies should be disregarded.
Applicability Both periodontitis and depression are known diseases that stem from a complex of problems and issues that often affect the body systemically. These diseases can be linked to both a genetic and environmental cause. In particular, depression is a crushing disease that often has profound impact on the populations that are affected such as the elderly. Periodontitis is also a disease that can lead to devastating effects on the periodontium through marked inflammation and subsequent loss of teeth. The reasoning behind the connections between depression and periodontitis is that depression may compromise an individual’s immune response that could potentiate or exacerbate any periodontal pathology. In conclusion, these two diseases respectively prove to be a relevant public health concern individually, but a connection between the two would provide insight into how mental health affects oral health.
Specialty/Discipline (General Dentistry) (Periodontics)
Keywords Depression, Periodontitis
ID# 3043
Date of submission: 03/15/2016spacer
E-mail Nguyent18@livemail.uthscsa.edu
Author Truc-Vien Nguyen
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Georgiana Gross, MPH
Faculty mentor/Co-author e-mail grossg@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
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Comments on the CAT
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