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Periodontal disease and emotional disorders: A meta-analysis.

OBJECTIVE
The objective of this study was to evaluate the relationship of periodontal disease with depression and anxiety via a systematic review and meta-analysis.


METHOD
We systematically searched the EMBASE, PubMed, Web of Science, PsycINFO, and SinoMed databases (until August 4, 2019) with language restricted to English and Chinese. Case-control, cross-sectional, and cohort studies that calculated the risk ratio (RR), odds ratio (OR)/prevalence OR (POR), and hazard ratio (HR) of depression/anxiety with periodontal disease or the OR/POR/RR/HR of periodontal disease caused by depression/anxiety were included. Observational studies that reported the depression/anxiety scale score of patients with periodontal disease and healthy periodontal subjects aged ≥14 years were also included. We used the standard format to extract the following information from each included study: author/s, survey year, study design, age of participants, periodontal disease definition, depression/anxiety measurement, and summary of results. The Newcastle-Ottawa scale was used to ascertain the quality of the included citations.


RESULTS
After screening, 40 studies were included. A meta-analysis of the case-control studies showed that periodontal disease was positively associated with depression (OR = 1.70, 95% confidence interval [CI] =1.01-2.83). A meta-analysis of 12 studies showed that periodontal disease was significantly correlated with anxiety (OR=1.36, 95% CI=1.11-1.66). A meta-analysis of 18 studies showed that subjects with periodontal disease had higher depression scale score (standardized mean difference [SMD]=1.05, 95% CI=0.68-1.41) and anxiety scale score (SMD=0.70, 95% CI=0.44-0.96).


CONCLUSION
Periodontal disease is associated with emotional disorders. However, the high degree of heterogeneity among studies should be considered. More high-quality prospective studies are required to confirm the relationship.


CLINICAL RELEVANCE
Scientific rationale for the study: To systematically investigate the association between periodontal disease and emotional disorders.


PRINCIPAL FINDINGS
A meta-analysis of the case-control studies showed a significant association between depression and periodontal disease. A meta-analysis of 12 studies showed a significant association between anxiety and periodontal disease. Subjects with periodontal disease had significantly higher depression/anxiety scale scores. There was heterogeneity among these studies.


PRACTICAL IMPLICATIONS
The presence of the relationship may be instructive for the clinical prevention and treatment of periodontal disease and emotional disorders; however, further evidence is still needed to verify the effectiveness of clinical interventions. Additionally, more high-quality prospective studies are required to confirm the association between periodontal disease and emotional disorders.