Owais Kareem  ( Department of Psychiatry and Behavioural Sciences, Nishtar Medical University, Multan, Pakistan )
Bushra Ijaz  ( Department of Community Medicine, Multan Medical and Dental College, Multan, Pakistan. )
Shaheen Anjum  ( Department of Maxillofacial Surgery, Nishtar Institute of Dentistry, Multan, Pakistan. )
Sadia Hadayat  ( Department of Psychiatry and Behavioural Sciences, Nishtar Medical University, Multan, Pakistan )
Iqra Tariq  ( Department of Psychiatry and Behavioural Sciences, Multan Medical and Dental College, Multan, Pakistan )
Maria Younis  ( Department of Special Education, Government of the Punjab, Pakistan )

Objective: To determine the association of depression with dental caries and periodontal disease.

Methods: The cross-sectional descriptive study was conducted at the Nishtar Institute of Dentistry, Multan, Pakistan, from May 7, 2018 to January 7, 2019, and comprised samples from subjects with dental caries and periodontal disease. Hospital Anxiety and Depression Scale was applied to screen the participants for the presence or absence of depression. Data was analysed using SPSS 21.

Results: Of the 296 participants, 125(42.2%) were males and 171(57.7%) were females. The overall mean age was 38.74±12.87 years. Depression was found in 195(65.8%) patients. Significant association of depression in patients of dental caries and periodontal disease was found with female gender, age <50 years, illiteracy, marital status, pre-existing hypertension, coronary artery disease, illicit substance addiction and psychotropic medication use (p<0.05).

Conclusion: There was high frequency of depression among patients of dental caries and periodontal disease.

Keywords: Depression, Dental caries, Periodontal disease, Medical illness, Multan, Pakistan. (JPMA 71: 1345; 2021)

DOI: https://doi.org/10.47391/JPMA.432

 

Introduction

 

Depression is one of the most common psychiatric disorders with a lifetime prevalence of 8-12% in the general population.¹ The World Health Organisation (WHO) ranks depression fourth among the leading causes of the global disease burden, while it is expected to rank second by 2030.² Although depression is prevalent worldwide, it is more common among those suffering from medical illnesses than in the general population.³ About a third of people attending medical clinics have a co-morbid depressive disorder.⁴ Depression is also a common cause for apparent worsening of medical illnesses and its adequate recognition and treatment has shown to improve outcome of medical illnesses.⁵

Further, poor oral health has often been identified in patients of depression.⁶ Recent evidence supports the association of depression with dental caries and periodontal disease, suggesting that a bidirectional link is possible between the two conditions.⁷

Among the common dental diseases, dental caries and periodontal disease are the two oral pathologies that remain prevalent in community.⁸

Dental caries, which is also known as dental cavities or tooth decay, is an infectious disease that may result in pain and tooth damage, and may lead to tooth-loss.⁹ Periodontal disease is mainly the result of some infection, leading to inflammation of the gum and bone that surround and support the teeth.¹⁰

As far as the association of depression with medical illnesses are concerned, the underlying mechanisms for such associations have been extensively studied, but the association between mental health and oral health is relatively a neglected area.¹¹ No study on the subject was conducted in Pakistan. The current study was planned to fill the gap by determining the association of depression with dental caries and periodontal disease, and to identify factors that can affect such an association.

 

Patients and Methods

 

The cross-sectional descriptive study was conducted at the Nishtar Institute of Dentistry, Multan, Pakistan, from May 7, 2018 to January 7, 2019. After approval from the institutional ethics committee, the sample size was determined by considering 95% confidence interval(CI), 5% margin of error and 26% anticipated prevalence of depression using a sample estimation formula [n = z2pq / d2].⁷ The sample was raised using non-probability purposive sampling technique.

Those included was male and female patients aged 18-65 years having dental caries or periodontal disease. Those excluded were patients diagnosed simultaneously with dental caries and periodontal disease or suffering from a dental disease other than dental caries or periodontal disease.

After taking informed consent, Detailed socio-demographic data was collected on a predesigned proforma. For depression screening, the validated Urdu version of the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D), a 7-item section, was administered. Each item in the scale is scored 0-3. A score of 8 or above indicates the presence of depression without categorising depression into mild, moderate, severe or stupor types.¹²

Data was analysed using SPSS 21. Descriptive statistics were expressed as frequencies and percentages. Pearson chi-squared test was used to determine the association of depression with dental caries and periodontal disease. P<0.05 was considered statistically significant.

 

Results

 

Of the 296 participants, 125(42.2%) were males and 171(57.7%) were females. The overall mean age was 38.74±12.87 years. Dental caries was found in 211(71.3%) patients, while 85(28.7%) had periodontal disease. Depression was found in 195(65.8%) patients (Table-1).

 

 

The presence of depression was classified along various socio-demographic characteristics (Table-2).

 

 

Significant association of depression in patients of dental caries and periodontal disease was found with female gender, age <50 years, illiteracy, marital status, pre-existing hypertension, coronary artery disease, illicit substance addiction and psychotropic medication use (Table-3).

 

 

Discussion

 

The findings of the current study are in line with literature.^11,13-18

The study further corroborated the findings of an earlier study explaining the possible aetiology of depression in dental conditions.6 As highlighted earlier, the result underlines the neglected oral health of people with psychiatric disorders.18 The current results were also consistent with the findings supporting the association of depression with dental caries.⁷ Increased prevalence of depression in patients of dental diseases who had hypertension and coronary artery disease were also in line with literature.^19-21

The finding regarding illicit substance addiction was in line with a study which highlighted an increased rate of illicit substance addiction among depressed individuals.²² As a consequences of illicit substance abuse, certain behavioural changes, such as poor oral hygiene and increased intake of sweetened beverages, are observed which can result in dental plaque and recurrent oral infections, leading to dental caries and periodontal disease.²⁴

Additionally, the current study's finding regarding psychotropic medicines corroborated literature, confirming that psychotropic medicines induce dry mouth, or xerostomia, through reduced salivary flow which may result in an increased risk of dental caries and periodontal disease.²³

The overall prevalence of depression in patients of dental caries and periodontal disease reported in the current study was 65.8% which was much higher compared to the 26% reported in Finland.²³ This high rate might reflect the already high prevalence of depression in the general population of Pakistan, which has been reported to range from 22% to 60%.^24,25 The rate detected in the current study, however, falls within the prevalence rates of depression in patients with medical illnesses, which is 17-53%,³ suggesting a high prevalence of depression in the presence of dental diseases.

The current study has limitations as it used a cross-sectional design limited to a single centre. Further multicentre, randomised controlled trials (RCTs) are recommended to confirm the findings.

In the light of the findings of the current study, however, a multidisciplinary management approach is recommended while catering to the needs of patients suffering from depression and dental diseases. It should include a close liaison involving dental, psychiatry and medical departments. Clinicians and mental health professionals should include oral health as part of a comprehensive assessment of people presenting with depression. Furthermore, a dentist should identify symptoms of depression in patients by careful observation and screening of depression by a valid scale combined with a detailed medical and social assessment. If required, a timely referral to a mental health professional and a medical specialist should be made.

 

Conclusion

 

There was high prevalence of depression among patients of two common dental diseases. Factors, such as female gender, younger age, low educational status, illicit substance addiction, medical illnesses and psychotropic medications usage, associated depression with dental caries and periodontal disease.

 

Disclaimer: None.

Conflict of Interest: None.

Source of Funding: None.

 

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