Which Comes First, Depression Or Tooth Loss?

Are you depressed and anxious because you are experiencing tooth loss, or are you experiencing tooth loss due to feelings of depression and anxiety? It is commonly held that your dental health is associated with your overall health, as well as your emotional well-being. Periodontal disease has been linked to conditions such as diabetes, heart disease, and lung infection. Research has shown that high levels of financial stress coupled with poor coping abilities double the likelihood of developing gum disease. People suffering depression have a poor outcome after periodontal treatment double that of patients with good mental health.  A new study indicates a connection between depression, anxiety, periodontal disease, and tooth loss.

The Study

Presented at the 43rd Annual Meeting of the American Association for Dental Research, the study was conducted via The Behavioral Risk Factor Surveillance System (BRFSS), a telephone survey conducted by state health departments in conjunction with the Centers for Disease Control and Prevention. An analysis of data from 451, 075 telephone respondents answering questions related to anxiety, depression, and tooth loss from 2010 was performed. Of the 292 eligible participants, over 13 percent reported experiencing anxiety, over 16 percent reported experiencing depression, and nearly 6 percent suffered total tooth loss.


Research indicates that an individual’s dental health is influenced by a variety of biopsychosocial factors such as dental anxiety, self-worth, energy, motivation, and oral facial pain associated with the state of depression. According to research there are several ways depression and anxiety can affect oral health:


  • Anxiety disorders can cause canker sores, dry mouth, mouth ulcers, burning mouth syndrome, red blotches and/or white lines in your mouth, and temporomandibular joint disorders (TMJ).
  • People suffering from anxiety may avoid the dentist altogether, and have proven to be at increased risk for bruxism (clenching and grinding), cavities, and gum disease.


  • Decreased energy and motivation, as a result of depression, can cause lack of interest in dental hygiene.
  • Negative views of self can cause dental, and overall, neglect.
  • Decreased serotonin levels can cause cravings for carbohydrates, establishing favorable conditions for the growth of oral bacteria leading to dental caries, gum disease, and tooth loss.
  • Depressed patients may find it overwhelming to attend the dentist.
  • Depressed patients may find it overwhelming to undergo periodontal treatment.
  • People suffering from depression are less likely to comply with treatment recommendations.
  • Patients with depression are more likely to continue to smoke, which can reduce the healing effects of periodontal therapy.
  • Depression may impair the immune system, allowing an overgrowth of pathogenic bacteria, and slowing the body’s ability to fight off infection.
  • Some antidepressants can reduce salivary production which is required to cleanse the mouth of decaying food particles, and limit bacterial growth.
  • Some antidepressants may increase bruxism which can lead to tooth loss.

Periodontal disease leading to tooth loss is a result of complex, chronic conditions. There are many factors involved on a biological level (periodontal disease can be genetic), psychological level (depressive states can affect oral hygiene practices), and social level (lack of a social support system leading to depression, lack of self-esteem, negative feelings of self, can all lead to dental and overall neglect). Patients with depressive symptoms also present with a higher incidence of attachment loss, and alveolar bone degeneration than non-depressive patients.

Although dentists are not trained to diagnose depression in patients, an open, honest relationship between dentist and patient can familiarize the dentist with the patient’s personality leading the dentist to notice any major changes. Familiarity with patients’ mental and physical health conditions, medical history, and current list of prescription medications, can give the dentist an overall indication of the patient’s health and well-being. As a result it can inform the dentist to possible dental issues, as well as the development of depressive symptoms, and lead them to facilitate treatment intervention with the appropriate referral.

About Your Lake Forest Dentist:

Aside from providing dependable family, general, and restorative dentistry services to our community, Dr. James Fondriest also holds respected academic appointments at the Pankey Institute in Key Biscayne, FL, and the Spear Institute in Scottsdale, AZ, and he is an adjunct Assistant Professor in the Department of Prosthodontics at the University of Florida Dental School. At Lake Forest Dental Arts, Dr. Fondriest combines his impressive array of experience with modern technology and caring, compassionate, knowledgeable staff, and we proudly serve patients from Chicago and all surrounding communities. To schedule a consultation, call our office today at (847) 234-0517.

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