Relationship between depression and oral health cum dental outreach service

Abstract

Background: Based on existing literature, it has been suggested that individuals suffering from depression might have an increased caries risk due to hyposalivation caused by antidepressants and stress. The prevalence of depression has been on the rise in Hong Kong. However, there is a lack of research focusing on the oral health of individuals with depression in this city. The project aimed to provide dental health services to depressive individuals and improve their oral health awareness, as well as investigate the oral health condition of this population. Methods: People with depression were recruited from three centers. Self-completed questionnaires were distributed to evaluate their oral health related practices and knowledge. The severity of depression was assessed using the Patient Health Questionnaire-9 (PHQ-9). Participants underwent clinical examinations for the assessment of their oral health conditions, and received dental treatments according to the clinical findings. Oral health education was then provided based on their caries risk, as determined by Caries Management by Risk Assessment (CAMBRA). Results: 74 participants, aged 42 to 83, were recruited while about half of them had PHQ-9 scores suggesting major depressive symptoms. Around two-thirds of participants (68.9%) had visited a dentist within the past two years, but only around one-third of participants had regular check-ups. All of the participants (100%) had tooth decay experience (DMFT) and gingival bleeding. Over half of the participants (56.8%) had untreated decay and almost all (94.6%) had missing teeth. A statistically significant relationship was found between the severity of depression and the number of missing teeth (p = 0.015), as well as resting salivary flow rates (p = 0.001). Majority of participants (86.1%) had periodontal pockets 4mm or above. No statistically significant relationship was found between depression levels and other oral health habits and conditions. Conclusion: Tooth decay experience and gingival bleeding were found in all participants. Individuals with moderate to severe depression had a higher number of missing teeth and lower resting salivary flow rates compared to individuals with none to mild depression. Oral examination, dental treatments and oral health education were well-received and appreciated by the study participants.