Association of Dental Status and Dry Mouth with Mental Health in Elderly Patients
Abstract
Objectives: Psychological disorders are prevalent medical conditions that can negatively affect oral health. Due to the increase in the elderly population, and higher risk of psychological conditions in this age group, this study assessed the association of mental health evaluated by the 28-Item General Health Questionnaire (GHQ-28) and oral health in the elderly patients.
Materials and Methods: Overall, 150 elderly patients aged 60 years and higher presenting to the dental clinic of School of Dentistry, Tehran University of Medical Sciences in 2019 participated in this cross-sectional study. Oral and dental examinations were conducted to assess the dental caries status using the decayed, missing, and filled teeth (DMFT) index, number of existing teeth, and self-reported dry mouth. Sociodemographic status, oral hygiene behaviors, and medical history of the participants were also recorded. The GHQ-28 was used to assess their mental health. Data were analyzed by SPSS version 25 using the correlation tests (alpha=0.05).
Results: Of all the participants, 64 (42.7%) were females, and the age range was 60 to 90 years (mean age: 67.56±6.42 years). The mean total GHQ score was 4±3.8. The DMFT score and number of teeth had significant associations with severe depression and social dysfunction (P<0.05). Dry mouth was directly associated with the total GHQ score and anxiety (P<0.05).
Conclusion: Elderly people with severe depression suffered from poor oral health. Comprehensive oral and dental examination and paying close attention to mental health aspects should be considered in regular dental check-ups and oral health promotion programs for the elderly.
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5. Noorbala AA, Faghihzadeh S, Kamali K, Bagheri Yazdi SA, Hajebi A, Mousavi MT, et al. Mental health survey of the Iranian adult population in 2015. Arch Iran Med. 2017 Mar;20(3):128-34.
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11. Anttila S, Knuuttila M, Ylöstalo P, Joukamaa M. Symptoms of depression and anxiety in relation to dental health behavior and self-perceived dental treatment need. Eur J Oral Sci. 2006 Apr;114(2):109-14.
12. Teoh CXW, Thng M, Lau S, Taing MW, Chaw SY, Siskind D, et al. Dry mouth effects from drugs used for depression, anxiety, schizophrenia and bipolar mood disorder in adults: systematic review. BJPsych Open. 2023 Mar;9(2):e53.
13. Stepović M, Stajić D, Rajković Z, Maričić M, Sekulić M. Barriers affecting the oral health of people diagnosed with depression: A systematic review. Zdr Varst. 2020 Oct;59(4):273-80.
14. Kisely S, Sawyer E, Siskind D, Lalloo R. The oral health of people with anxiety and depressive disorders - a systematic review and meta-analysis. J Affect Disord. 2016 Aug;200:119-32.
15. Kisely S, Baghaie H, Lalloo R, Johnson NW. Association between poor oral health and eating disorders: systematic review and meta-analysis. Br J Psychiatry. 2015 Oct;207(4):299-305.
16. Kisely S, Baghaie H, Lalloo R, Siskind D, Johnson NW. A systematic review and meta-analysis of the association between poor oral health and severe mental illness. Psychosom Med. 2015 Jan;77(1):83-92.
17. Kisely S, Quek LH, Pais J, Lalloo R, Johnson NW, Lawrence D. Advanced dental disease in people with severe mental illness: systematic review and meta-analysis. Br J Psychiatry. 2011 Sep;199(3):187-93.
18. Goldberg DP, Hillier VF. A scaled version of the General Health Questionnaire. Psychol Med. 1979 Feb;9(1):139-45.
19. Malakouti SK, Fatollahi P, Mirabzadeh A, Zandi T. Reliability, validity and factor structure of the GHQ-28 used among elderly Iranians. Int Psychogeriatr. 2007 Aug;19(4):623-34.
20. Noorbala AA, Bagheri Yazdi SA, Yasamy MT, Mohammad K. Mental health survey of the adult population in Iran. Br J Psychiatry. 2004 Jan;184:70-3.
21. Nazifi M, Mokarami H, Akbaritabar A, Faraji Kujerdi M, Tabrizi R, Rahi A. Reliability, validity and factor structure of the Persian translation of General Health Questionnaire (GHQ-28) in hospitals of Kerman University of Medical Sciences. J Fasa Univ Med Sci. 2013 Dec;3(4):336-42.
22. Lewis S, Jagger RG, Treasure E. The oral health of psychiatric in-patients in South Wales. Spec Care Dentist. 2001 Sep-Oct;21(5):182-6.
23. Zana A. Attitude to death and changes of death image in Hungarian society. Study of the differences in generational value-judgments and of the possibilities of measurement. Is death still a taboo?. Orvosi Hetilap. 2009 Jun;150(25):1183-7.
24. Neimeyer RA, Fortner BV. Death anxiety in the elderly. Encyclopedia of aging. 1995;2:252-3.
25. Geraets AF, Heinz A. The association of adolescents' mental health with oral health behavior: The Luxembourg Health Behavior in School-Aged Children study. Front Dent Med. 2022 Oct;3:979192.
26. Okoro CA, Strine TW, Eke PI, Dhingra SS, Balluz LS. The association between depression and anxiety and use of oral health services and tooth loss. Community Dent Oral Epidemiol. 2012 Apr;40(2):134-44.
27. Anttila S, Knuuttila M, Ylöstalo P, Joukamaa M. Symptoms of depression and anxiety in relation to dental health behavior and self-perceived dental treatment need. Eur J Oral Sci. 2006 Apr;114(2):109-14.
28. Tiwari T, Kelly A, Randall CL, Tranby E, Franstve-Hawley J. Association Between Mental Health and Oral Health Status and Care Utilization. Front Oral Health. 2022 Feb 7;2:732882.
29. Afonso-Souza G, Nadanovsky P, Chor D, Faerstein E, Werneck GL, Lopes CS. Association between routine visits for dental checkup and self-perceived oral health in an adult population in Rio de Janeiro: the Pró-Saúde Study. Community Dent Oral Epidemiol. 2007 Oct;35(5):393-400.
30. Adam H, Preston AJ. The oral health of individuals with dementia in nursing homes. Gerodontology. 2006 Jun;23(2):99-105.
31. Kisely S, Baghaie H, Lalloo R, Siskind D, Johnson NW. A systematic review and meta-analysis of the association between poor oral health and severe mental illness. Psychosom Med. 2015 Jan;77(1):83-92.
32. McFarland ML, Inglehart MR. Depression, self-efficacy, and oral health: an exploration. Ohdmbsc. 2010 Dec;9(4):214-2.
33. Skośkiewicz-Malinowska K, Malicka B, Ziętek M, Kaczmarek U. Oral health condition and occurrence of depression in the elderly. Medicine (Baltimore). 2018 Oct;97(41):e12490.
34. D'Avila OP, Wendland E, Hilgert JB, Padilha DMP, Hugo FN. Association between Root Caries and Depressive Symptoms among Elders in Carlos Barbosa, RS, Brazil. Braz Dent J. 2017 Jan-Apr;28(2):234-40.
35. Cademartori MG, Gastal MT, Nascimento GG, Demarco FF, Corrêa MB. Is depression associated with oral health outcomes in adults and elders? A systematic review and meta-analysis. Clin Oral Investig. 2018 Nov;22(8):2685-702.
36. Datta D, Kumar SG, Narayanan A, Selvamary LA, Sujatha A. Depression and oral health. Int J Curr Res. 2018;10:66561-4.
37. Anil S, Vellappally S, Hashem M, Preethanath RS, Patil S, Samaranayake LP. Xerostomia in geriatric patients: a burgeoning global concern. J Investig Clin Dent. 2016 Feb;7(1):5-12.
38. Sutarjo FN, Rinthani MF, Brahmanikanya GL, Parmadiati AE, Radhitia D, Mahdani FY. Common precipitating factors of xerostomia in elderly. J Health Allied Sci NU. 2024 Jan;14(01):011-6.
39. Page MM. Psychotropic drugs and dentistry. Aust Prescr. 2007 Aug;30(4):98.
40. Dagnew ZA, Abraham IA, Beraki GG, Tesfamariam EH, Mittler S, Tesfamichael YZ. Nurses' attitude towards oral care and their practicing level for hospitalized patients in Orotta National Referral Hospital, Asmara-Eritrea: a cross-sectional study. BMC Nurs. 2020 Jul;19:63.
2. World Health Organization (WHO). World mental health report: transforming mental health for all. Geneva: World Health Organization, 2022. Available at: https://www.who.int/publications/i/item/9789240049338, accessed on: 07.06.2.23
3. Hall CA, Reynolds-Iii CF. Late-life depression in the primary care setting: challenges, collaborative care, and prevention. Maturitas. 2014 Oct;79(2):147-52.
4. Köhler S, Thomas AJ, Barnett NA, O'Brien JT. The pattern and course of cognitive impairment in late-life depression. Psychol Med. 2010 Apr;40(4):591-602.
5. Noorbala AA, Faghihzadeh S, Kamali K, Bagheri Yazdi SA, Hajebi A, Mousavi MT, et al. Mental health survey of the Iranian adult population in 2015. Arch Iran Med. 2017 Mar;20(3):128-34.
6. Noorbala AA, Bagheri Yazdi SA, Faghihzadeh S, Kamali K, Faghihzadeh E, Hajebi A, et al. Trends of mental health status in Iranian population aged 15 and above between 1999 and 2015. Arch Iran Med. 2017 Nov;20(11 Suppl. 1):S2-6.
7. Bahrami M, Jalali A, Ayati A, Shafiee A, Alaedini F, Saadat S, et al. Epidemiology of mental health disorders in the citizens of Tehran: a report from Tehran Cohort Study. BMC Psychiatry. 2023 Apr;23(1):267.
8. Fakhari A, Herizchi S, Sadeghi-Bazargani H, Amiri S, Noorazar SG, Mirzajanzade M, et al. Prevalence of psychiatric disorders in the aging population in the northeastern of Iran. Middle East Curr Psychiatr. 2023 Mar;30(1):25.
9. Choi J, Price J, Ryder S, Siskind D, Solmi M, Kisely S. Prevalence of dental disorders among people with mental illness: An umbrella review. Aust N Z J Psychiatry. 2022 Aug;56(8):949-63.
10. Hugo FN, Hilgert JB, Bozzetti MC, Bandeira DR, Gonçalves TR, Pawlowski J, et al. Chronic stress, depression, and cortisol levels as risk indicators of elevated plaque and gingivitis levels in individuals aged 50 years and older. J Periodontol. 2006 Jun;77(6):1008-14.
11. Anttila S, Knuuttila M, Ylöstalo P, Joukamaa M. Symptoms of depression and anxiety in relation to dental health behavior and self-perceived dental treatment need. Eur J Oral Sci. 2006 Apr;114(2):109-14.
12. Teoh CXW, Thng M, Lau S, Taing MW, Chaw SY, Siskind D, et al. Dry mouth effects from drugs used for depression, anxiety, schizophrenia and bipolar mood disorder in adults: systematic review. BJPsych Open. 2023 Mar;9(2):e53.
13. Stepović M, Stajić D, Rajković Z, Maričić M, Sekulić M. Barriers affecting the oral health of people diagnosed with depression: A systematic review. Zdr Varst. 2020 Oct;59(4):273-80.
14. Kisely S, Sawyer E, Siskind D, Lalloo R. The oral health of people with anxiety and depressive disorders - a systematic review and meta-analysis. J Affect Disord. 2016 Aug;200:119-32.
15. Kisely S, Baghaie H, Lalloo R, Johnson NW. Association between poor oral health and eating disorders: systematic review and meta-analysis. Br J Psychiatry. 2015 Oct;207(4):299-305.
16. Kisely S, Baghaie H, Lalloo R, Siskind D, Johnson NW. A systematic review and meta-analysis of the association between poor oral health and severe mental illness. Psychosom Med. 2015 Jan;77(1):83-92.
17. Kisely S, Quek LH, Pais J, Lalloo R, Johnson NW, Lawrence D. Advanced dental disease in people with severe mental illness: systematic review and meta-analysis. Br J Psychiatry. 2011 Sep;199(3):187-93.
18. Goldberg DP, Hillier VF. A scaled version of the General Health Questionnaire. Psychol Med. 1979 Feb;9(1):139-45.
19. Malakouti SK, Fatollahi P, Mirabzadeh A, Zandi T. Reliability, validity and factor structure of the GHQ-28 used among elderly Iranians. Int Psychogeriatr. 2007 Aug;19(4):623-34.
20. Noorbala AA, Bagheri Yazdi SA, Yasamy MT, Mohammad K. Mental health survey of the adult population in Iran. Br J Psychiatry. 2004 Jan;184:70-3.
21. Nazifi M, Mokarami H, Akbaritabar A, Faraji Kujerdi M, Tabrizi R, Rahi A. Reliability, validity and factor structure of the Persian translation of General Health Questionnaire (GHQ-28) in hospitals of Kerman University of Medical Sciences. J Fasa Univ Med Sci. 2013 Dec;3(4):336-42.
22. Lewis S, Jagger RG, Treasure E. The oral health of psychiatric in-patients in South Wales. Spec Care Dentist. 2001 Sep-Oct;21(5):182-6.
23. Zana A. Attitude to death and changes of death image in Hungarian society. Study of the differences in generational value-judgments and of the possibilities of measurement. Is death still a taboo?. Orvosi Hetilap. 2009 Jun;150(25):1183-7.
24. Neimeyer RA, Fortner BV. Death anxiety in the elderly. Encyclopedia of aging. 1995;2:252-3.
25. Geraets AF, Heinz A. The association of adolescents' mental health with oral health behavior: The Luxembourg Health Behavior in School-Aged Children study. Front Dent Med. 2022 Oct;3:979192.
26. Okoro CA, Strine TW, Eke PI, Dhingra SS, Balluz LS. The association between depression and anxiety and use of oral health services and tooth loss. Community Dent Oral Epidemiol. 2012 Apr;40(2):134-44.
27. Anttila S, Knuuttila M, Ylöstalo P, Joukamaa M. Symptoms of depression and anxiety in relation to dental health behavior and self-perceived dental treatment need. Eur J Oral Sci. 2006 Apr;114(2):109-14.
28. Tiwari T, Kelly A, Randall CL, Tranby E, Franstve-Hawley J. Association Between Mental Health and Oral Health Status and Care Utilization. Front Oral Health. 2022 Feb 7;2:732882.
29. Afonso-Souza G, Nadanovsky P, Chor D, Faerstein E, Werneck GL, Lopes CS. Association between routine visits for dental checkup and self-perceived oral health in an adult population in Rio de Janeiro: the Pró-Saúde Study. Community Dent Oral Epidemiol. 2007 Oct;35(5):393-400.
30. Adam H, Preston AJ. The oral health of individuals with dementia in nursing homes. Gerodontology. 2006 Jun;23(2):99-105.
31. Kisely S, Baghaie H, Lalloo R, Siskind D, Johnson NW. A systematic review and meta-analysis of the association between poor oral health and severe mental illness. Psychosom Med. 2015 Jan;77(1):83-92.
32. McFarland ML, Inglehart MR. Depression, self-efficacy, and oral health: an exploration. Ohdmbsc. 2010 Dec;9(4):214-2.
33. Skośkiewicz-Malinowska K, Malicka B, Ziętek M, Kaczmarek U. Oral health condition and occurrence of depression in the elderly. Medicine (Baltimore). 2018 Oct;97(41):e12490.
34. D'Avila OP, Wendland E, Hilgert JB, Padilha DMP, Hugo FN. Association between Root Caries and Depressive Symptoms among Elders in Carlos Barbosa, RS, Brazil. Braz Dent J. 2017 Jan-Apr;28(2):234-40.
35. Cademartori MG, Gastal MT, Nascimento GG, Demarco FF, Corrêa MB. Is depression associated with oral health outcomes in adults and elders? A systematic review and meta-analysis. Clin Oral Investig. 2018 Nov;22(8):2685-702.
36. Datta D, Kumar SG, Narayanan A, Selvamary LA, Sujatha A. Depression and oral health. Int J Curr Res. 2018;10:66561-4.
37. Anil S, Vellappally S, Hashem M, Preethanath RS, Patil S, Samaranayake LP. Xerostomia in geriatric patients: a burgeoning global concern. J Investig Clin Dent. 2016 Feb;7(1):5-12.
38. Sutarjo FN, Rinthani MF, Brahmanikanya GL, Parmadiati AE, Radhitia D, Mahdani FY. Common precipitating factors of xerostomia in elderly. J Health Allied Sci NU. 2024 Jan;14(01):011-6.
39. Page MM. Psychotropic drugs and dentistry. Aust Prescr. 2007 Aug;30(4):98.
40. Dagnew ZA, Abraham IA, Beraki GG, Tesfamariam EH, Mittler S, Tesfamichael YZ. Nurses' attitude towards oral care and their practicing level for hospitalized patients in Orotta National Referral Hospital, Asmara-Eritrea: a cross-sectional study. BMC Nurs. 2020 Jul;19:63.
| Issue | Vol 23 (Continuously Published Article-Based) | |
| Section | Original Article | |
| Keywords | ||
| Aged Mental Health Oral Health | ||
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How to Cite
1.
Moghaddam F, Tonkaboni A, Karami MA, Sargeran K. Association of Dental Status and Dry Mouth with Mental Health in Elderly Patients. Front Dent. 2026;23.
