Psychosocial Factors In Oral Health: Anxiety, Depression and Dental Visit

Objective: 1. To what extent are anxiety and depression associated with oral health status and utilization. 2. To estimate the disparity of oral health (OH) status and utilization among adults with mental health (MH) problems in the US. 3. To develop a conceptual model of possible causal-link between OH utilization and MH factors.

Method: Univariate/bivariate/multivariable analysis was conducted on adult data from 2006 national BRFSS using chi-square/t-tests, ANOVA and logistic regression to study the association of mental health (MH) status and oral health (OH) attributes (dental visit, teeth lost and teeth cleaning) in context of  various psycho-social-economic factors. Based on observed associations and graphical criteria, a conceptual theoretical model explaining the possible causal links was developed, grouping domains of factors MH potentially impacting OH attributes

Result: Preliminary results suggest that 16% of the total US population had a life-time diagnosis of depression (48,959,128 persons). Those with anxiety/depression were less likely to visit a dentist compared to those with no anxiety/depression (OR:0.81; 95%CI:0.77-0.86). Those with depression only were also less likely to visit a dentist (OR:0.78; CI:0.74-0.83). Upon adjustment for various socio-economic and demographic factors in a main-effects model, those with anxiety/depression continued to be less likely to visit a dentist compared to those with no anxiety/depression (AdjOR: 0.91;CI:0.85-0.97). The crude OR was confounded away from the null by 11% compared to adjusted OR. Results were similar for anxiety and depression factors individually. Unlike a previous report, our estimates were lesser in magnitude. Interaction models are being developed. A hierarchically interacting conceptual model conceptual model explaining potential causal links between MH states and OH attributes was developed and is described.

Conclusion: Those with anxiety and/or depression have slightly poorer observed odds for visiting a dentist. The risk is confounded by socio-economic factors and careful causal-modeling can further explore this association.