Mental Disorders and Oral Diseases: Future Research Directions

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

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 middle-aged adults. Thus, there is an urgent need to intensify stomatological prophylaxis, education and treatment for middle-aged individuals.

Genetic evidence strengthens the bidirectional connection between oral health status and psychiatric disorders: A two-sample Mendelian randomization study

BACKGROUND

Observational studies cannot accurately infer the causal associations between oral health status and psychiatric disorders.

METHODS

We conducted univariate and multivariate Mendelian randomization (MR) analyses using single nucleotide polymorphisms (SNPs) associated with eight oral health statuses (periodontitis, DMFS, Nteeth, toothache, loose teeth, painful gums, bleeding gums, and mouth ulcers) and four psychiatric disorders (Schizophrenia, Major Depressive Disorder (MDD), anxiety and stress-related disorder (ASRD), and Bipolar Disorder (BIP)) as instrumental variables. Genetic data were sourced from the Gene-lifestyle interactions in dental endpoints (GLIDE), UK Biobank, Psychiatric Genomics Consortium (PGC), and Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH). The inverse variance-weighted (IVW) approach, supported by a comprehensive sensitivity analysis, was employed.

RESULTS

Genetically predicted mouth ulcers were significantly linked to higher MDD (OR = 2.17, 95 % CI: 1.33--3.54, P< 0.01) and BIP risks (OR = 2.25, 95 % CI: 1.22-4.15, P = 0.01). BIP heightened bleeding gums risk (OR = 1.01, 95 % CI: 1.00-1.01, P < 0.01). These associations were adjusted for smoking status and alcohol consumption. Painful gums were significantly associated with MDD risk (OR = 96.48, 95 % CI: 2.66-3495.28, P = 0.01), while MDD raised periodontitis risk (OR = 2.15, 95 % CI: 1.24-3.75, P = 0.01), both confounded by smoking and alcohol. Relatively small effects between several variables, while others could not withstand correction for multiple tests.

LIMITATIONS

The sample size and limitation to European populations limits the study generalizability.

CONCLUSIONS

This study provide evidence of possible causal relationships between several oral health conditions and mental illness. Focusing on oral health and valuing mental health are important for each other and overall health.

Salivary signatures of oral-brain communication in sleep bruxers

Introduction

Microbiota and their interaction with hosts have been of great interest in brain research in recent years. However, the role of oral microbiota in mental illness and the underlying mechanism of oral-brain communication remains elusive. Sleep bruxism (SB) is an oral parafunctional activity related to the nervous system and is considered a risk factor for harmful clinical consequences and severe systemic conditions. Exploring the connection between oral microbiota and sleep bruxism may deepen our understanding of the complex relationship between oral-brain axis and provide insights for treatment.

Methods

In this study, salivary samples were collected from 22 individuals with SB and 21 healthy controls, and metagenomics with metabolomics was performed. Nonparametric Wilcoxon test were applied for the statistical analysis between the two groups. Microbial dysbiosis and altered oral metabolites were found in the SB individuals.

Results

The characteristic metabolite N-acetylglucosamine (GlcNAc) (VIP=8.4823, P<0.05) was correlated to a statistically lower Streptococcus mitis level in SB individuals. Salivary IFN-g level and IFN-g/IL-4 ratio were detected with significant changes in a chip assay. Amino acid metabolism pathways were upregulated, and the pathway with the largest number of differentially expressed genes is related to amino-tRNA charging pathway, while the most significantly enriched pathway is related to arginine biosynthesis. Neurotransmitter-associated pathways with glutamatergic and GABAergic synapses and cardiovascular system-related pathways were enriched in the SB group.

Discussion

These results indicate a possible neuroimmune regulatory network of oral-brain communication in SB, which helps explain the mechanism of the oral microbiome with the host in sleep bruxers and provides a reference for early clinical and therapeutic intervention to improve the diagnosis and treatment of SB and similar diseases.

The Relationship between Oral Health and Schizophrenia in Advanced Age-A Narrative Review in the Context of the Current Literature

Schizophrenia is a psychiatric disorder that makes patients incompetent to perform day-to-day activities due to their progressing mental illness. In addition to disturbances with thoughts, behavioral changes, and impaired cognitive functions, oro-systemic health also becomes compromised. Even though the population with schizophrenia is primarily made up of older people, little is known about this group's oral health treatment. The present review explores the relationship between oral healthcare and elderly patients with schizophrenia. Our literature search included databases, like PubMed, Embase, and Google Scholar, for appropriate and evidence-based information. Preventive and management strategies outlined in the included articles and future research perspectives in this field are discussed. To the best of our knowledge, this is the first review that looked at dental care and related characteristics in older schizophrenia patients. The findings highlight the necessity for targeted dental interventions to address the dental health challenges faced by this vulnerable population. Integrating dental health into the overall medical management of elderly individuals with schizophrenia is crucial. Although specific therapies remain limited, the emphasis is on preventive dentistry to reduce the occurrence and progression of oral diseases in this group.

Importance of oral health in mental health disorders: An updated review

Background

Mental disorders are indeed an expanding threat, which requires raised awareness, education, prevention, and treatment initiatives nationally and globally. This review presents an updated review on the relationships between oral health and mental health disorders and the importance of oral health in mental health disorders.

Method

A literature search was done regarding mental disorders and oral health approaches in Google Scholar and PubMed from the year 1995 until 2023. All the English-language papers were evaluated based on the inclusion criteria. Publications included original research papers, review articles and book chapters.

Results

Common mental disorders include depression, anxiety, bipolar disorder, Schizophrenia, dementia, and alcohol and drug use disorders. The interplay of oral health and mental disorders involves dysregulated microbiome, translocated bacteria, and systemic inflammation, among others.

Conclusion

There is a complex relationship between mental disorders and oral diseases. Various oral health problems are associated with mental health problems. The interplay of oral health and mental disorders involves dysregulated microbiome, translocated bacteria, and systemic inflammation, among others. Mental health nurses including physicians and dental professionals should be involved in the oral health care of mental health disorder patients. Therefore, multidisciplinary should be involved in the care of mental health disorders, and they should consider oral health care as an essential part of their care for patients with mental health disorders. Future investigations should strive to elucidate the exact biological relationships, to develop new directions for treatment.

Association between COVID-19 stress, coping mechanisms and stress-related oral conditions among Egyptian adults: a cross-sectional study

The present study investigated the association between COVID-19 stresses and oral conditions including gingivitis, oral hygiene, oral ulcers, and dry mouth. This was a cross-sectional study that collected data from adults in community settings in Alexandria, Egypt, between October 2021, and February 2022. Gingival condition and oral hygiene were assessed using the gingival and plaque indices. Participants were asked if they experienced oral ulcers during the past week and dry mouth during the past year. COVID-19 fears and coping were assessed using the COVID Stress Scale (CSS), and the Brief Resilience Coping Scale (BRCS), respectively. Oral health behaviors were assessed using the World Health Organization questionnaire. Regression analyses were used to assess the association between the dependent variables (clinically assessed gingival and plaque indices, reported presence of oral ulcers, and dry mouth) and explanatory variables (CSS and BRCS) after adjusting for confounders (COVID-19 status, oral health behaviors, smoking, age in years, sex, and highest educational level). The response rate was 88.8% (373/420). The mean (SD) age = 39.26 (11.45) with 74.3% females and 49.3% reporting completing high school or higher education. The mean (SD) plaque and gingival indices were 1.59 (0.66) and 1.39 (0.59), respectively. Only 20.1% reported the presence of oral ulcers and 41.6% reported xerostomia. Lower plaque score was associated with higher COVID-19 contamination fears (B = - 0.03, 95% CI - 0.05, - 0.02) and higher compulsive checking and reassurance-seeking (B = - 0.02, 95% CI - 0.03, - 0.009). Lower gingival score was associated with higher COVID-19 contamination fears (B = - 0.02, 95% CI - 0.03, - 0.002). Higher odds of reporting dry mouth were associated with greater fear of COVID-19 socioeconomic consequences (AOR = 1.05, 95% CI 1.001, 1.09), and lower coping scores (AOR = 0.93, 95% CI 0.88, 0.99). The findings suggest an association between COVID-19 specific stresses and stress-related oral conditions and shed light on the possible link between mental and oral health, emphasizing the importance of integrated planning of care services.