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Anxiety, Depression, Stress, and Oral Health

Course Number: 573


Anxiety and depression are common in the United States. In general, 1 out of every 6 adults will have depression, which may be situational and/or clinical, at some time in their lifetime.11 Many people who experience depression also have other mental health conditions, particularly anxiety disorders, with up to 60% of individuals diagnosed with depression also meeting the criteria for an anxiety disorder.12,13

Individuals with psychiatric disorders experience increased risk of systemic diseases, including diabetes mellitus, cardiovascular disease, autoimmune diseases, cancer, and chronic obstructive pulmonary disorder.5,14-18 Chronic psychosocial stress and depression have also been shown to adversely effect therapy and outcomes of these conditions.18 Stress and depression have also been linked to higher overall rates of morbidity and mortality within the population across a range of systemic conditions. The mechanisms for these links may be manifold.16-18 Chronic stress, which has been associated with anxiety disorders and depression, increases systemic inflammatory burden and is associated with damage to the brain region that controls mood, including the hippocampus and prefrontal cortex, making these conditions difficult to treat19-24

The interrelationship of anxiety and depression and periodontal disease is generally explained through the effects of these psychosocial conditions on the host immune response through a chronic stress mechanism.25 A recent meta-analysis identified a significant association between anxiety disorders and/or depression and periodontitis.26 The underlying reasons for this may be multifactorial, including increased xerostomia due to medications and/or an upregulation of sympathetic nervous system stimulation, a reduction in motivation for self-care behaviors, such as oral hygiene, in individuals with anxiety and depressive disorders, and/or a common inflammatory burden that may affect the host immune response.5,26 Assessment of patients’ psychological well-being is critical to understanding their current disease state and their potential response to therapy.