Relationship between the number of lost teeth and the occurrence of depressive symptoms in middle-aged adults: a cross-sectional study

BMC Oral Health (2024) 24:559 Głuszek–Osuch et al. BMC Oral Health https://doi.org/10.1186/s12903-024-04337-z Open Access RESEARCH Relationship between the number of lost teeth and the occurrence of depressive symptoms in middle‑aged adults: a cross‑sectional study Martyna Głuszek–Osuch1, Elżbieta Cieśla1 and Edyta Suliga1* Abstract Background Many recent studies suggest the existence of a relationship between oral health and the occurrence of depressive symptoms. The aim of this study was to assess the relationship between the number of lost teeth and the occurrence of depressive symptoms in middle-aged adults. Methods An analysis was performed on the data obtained from the PONS project (POlish-Norwegian Study), conducted in the Świętokrzyskie Province in Poland in 2010–2011. The research material included the cross-sectional data of 11,901 individuals aged 40–64 years (7967 women). Depressive symptoms, used as outcome variables, were assessed with a questionnaire. The participants provided the responses to questions concerning the occurrence of eight symptoms over the last 12 months. The answers were scored as 1 point or 0 points. The participants were divided into three tercile groups based on their total scores: no or mild (0–2 points), moderate (3–5 points), and severe depressive symptoms (6–8 points). The self-reported number of lost teeth was analysed according to the following categories: 0–4, 5–8, 9–27, and a complete lack of natural teeth. Multivariable logistic regression analysis for depressive symptoms was used in relation to the number of lost teeth. The following covariates were included in the adjusted model: age, sex, place of residence, education, marital status, BMI, diabetes status, stressful life events in the last year, use of antidepressants, smoking, and sugar and sweet consumption. Results The likelihood of both moderate (OR = 1.189; 95%CI: 1.028–1.376; p < .020) and severe (OR = 1.846; 95%CI: 1.488–2.290; p < .001) depressive symptoms showed the strongest relationship with a total lack of natural teeth. A loss of more than 8 natural teeth was also significantly associated (OR = 1.315; 95%CI: 1.075–1.609; p < .008) with the occurrence of severe depressive symptoms. Conclusions The loss of natural teeth was positively related to the occurrence of depressive symptoms in middleaged adults. Thus, there is an urgent need to intensify stomatological prophylaxis, education and treatment for middle-aged individuals. Keywords Depressive symptoms, Tooth loss, Middle-aged adults *Correspondence: Edyta Suliga 1 Institute of Health Sciences, Collegium Medicum, Jan Kochanowski University, Kielce, Poland Introduction Depression is one of the most common mental health disorders worldwide and can originate from genetic, biological, and environmental factors [1, 2]. Depressive symptoms, such as lowered mood (sadness, © The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Głuszek–Osuch et al. BMC Oral Health (2024) 24:559 despondency, reliving of negative events, anhedonia, and indifference); decreased psychomotor drive (psychomotor retardation or inhibition, loss of energy, and persistent fatigue); abnormal circadian rhythm; and somatic symptoms (hyposomnia, hypersomnia, dry mucous membranes in the mouth, and weight changes), may also occur in people who do not meet the clinical diagnostic criteria for depression and who experience subthreshold depression. Many recent studies suggest the existence of a relationship between oral health and the occurrence of depressive symptoms [3, 4]. One of the most severe oral conditions is tooth loss [5, 6]. Its direct causes are usually untreated caries and periodontal diseases [7–9]. The prevalence of tooth loss and the factors that directly determine it depend largely on economic development, access to dental care, social factors, and lifestyle, which is why they may differ between countries and regions [8–15]. Loss of teeth not only reduces the effectiveness of mastication but also contributes to a limitation, or even complete elimination, of hard products from the diet (e.g., nuts and some raw fruits and vegetables), significantly reducing the nutritional value of food [16]. Consequently, such changes may impact the nutritional status and health of individuals. Loss of teeth results in a gradual decrease in bone tissue and may lead to malocclusion and disorders of the temporomandibular joints. It also causes speech impediments, especially lisping, since without proper support in the form of teeth, the tongue cannot be positioned to correctly articulate some sounds [17]. Furthermore, visibly missing teeth constitute an aesthetic blemish, while poorly fitted dentures and incorrect articulation reduce self-confidence, make it difficult for individuals to be active in the job market, and cause individuals to withdraw from social life, which in turn may reduce mental well-being [17, 18]. These relationships have, to date, been analysed predominantly among elderly individuals, with very few publications addressing the topic among middle-aged adults. The aim of this study was to assess the relationship between the number of lost teeth and the occurrence of depressive symptoms among individuals aged 40–64 years. According to our hypothesis, the number of lost natural teeth shows a positive relationship with the occurrence of depressive symptoms among middle-aged adults. Materials and methods Study design An analysis was performed on the cross-sectional data obtained as part of the PONS project (POlish-Norwegian Study), which was conducted in the Świętokrzyskie Province in Poland in 2010–2011. The goal of the project was to observe the health and prevalence of chronic noncommunicable diseases among the residents of southeastern Page 2 of 9 Poland [19]. This was a facility-based survey. All participants of the project were volunteers. The study in its entirety (both the measurements and the interviews) wa (...truncated)