Periodontal disease has been associated with brain disorders such as Alzheimer’s disease and dementia. Little is known regarding any association with periodontal disease and emotional brain disorders such as depression and anxiety. In a meta-analysis published in 2021 in the Journal of Clinical Periodontology the authors aimed to “evaluate the relationship of periodontal disease with depression and anxiety via a systematic review and meta-analysis.”1
A total of 23 studied evaluating periodontal disease and depression and 12 studies evaluating periodontal disease and anxiety were included in the meta-analysis. The authors report no significant publication bias with any of the studies used for this meta-analysis.
The results of the meta-analysis showed a positive correlation between depression/anxiety and periodontal disease. Previously published literature has postulated that the relationship between depression/anxiety and periodontal disease is bi-directional. The pathophysiological mechanisms discussed in previous literature include behavioral perspectives and changes in hypothalamic-pituitary-adrenal axis activity.
Behavioral perspectives highlight negative attitudes and health risk behaviors such as smoking, alcohol consumption, and oral hygiene practices. The idea is that depression inhibits good oral hygiene due to a lack of caring and emotional stability. Adding to the assault is an increased incidence of smoking ang alcohol consumption associated with depression. All these behaviors are associated with periodontal disease onset and progression.
Changes in the hypothalamic-pituitary-adrenal axis activity can cause immune dysregulation and increase production of pro-inflammatory cytokines such as IL-6, TNF-α, and C-reactive protein. Immune dysregulation is a mechanism identified in the onset and progression of periodontal disease. This can be caused by physiological stress changing cortisol levels and increasing inflammation.
The authors site multiple limitations including high statistical heterogenicity, varying diagnostic criteria, differing cut-off points when measuring depression and anxiety. The authors suggest the findings be interpreted with caution. However, the authors also highlight the high incidence and prevalence of emotional disorders and periodontal disease in the general population as having “clinical and public health implications.”
The authors conclude by stating, “this systematic review provides aggregated information that depression/anxiety is positively associated with periodontal disease. However, there is a great heterogeneity among the studies. More high-quality prospective studies are required to confirm that relationship. Furthermore, well-conducted studies are needed to explore the underlying mechanisms and clarify the causal relationship between depression/anxiety and periodontal disease.”
Have you considered a possible link between mental disorders and periodontal disease? Does this meta-analysis give you new perspective on discussing the possible link between mental disorders and periodontal disease? Have you noticed an increased incidence/prevalence of periodontal disease in your patients that suffer with mental disorders?
- Zheng DX, Kang XN, Wang YX, et al. Periodontal disease and emotional disorders: A meta-analysis. J Clin Periodontol. 2021;48(2):180-204. doi:10.1111/jcpe.13395