Disparities in Oral Health Status and Depression Among Children in The United States




Espinoza, Luis
Kaur, Amanjot
Giesler, Laura
Kavuluri, Soumya


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Disparities In Oral Health Status And Depression Among Children In The United States Background: Poor oral health has been identified in the literature as a risk factor for other inflammatory diseases or disorders such as depression. Depression produces a chronic, low-grade inflammation that leads to increased levels of acute phase proteins and cytokines (i.e. interleukins and tumor necrosis factor). Oral health status and its association with depression has previously been examined in adults, but not in adolescents. Purpose: We seek to understand how oral health status impacts depression among adolescents (14-17 years old). Methods: We used the National Survey of Children’s Health (NSCH) 2011-2012 dataset to investigate this association. Cross sectional data for 20575 children was analyzed. Depression status is the outcome of interest, dichotomized as ever had depression (clinical diagnosis or self-report) and never had depression. The exposure, oral health status, is categorized as having oral health problems (i.e., toothache, decayed teeth, or unfilled cavities) or not having oral health problems. Statistical analyses was performed with SAS software version 9.3 (SAS Institute, Inc, Cary, NC). Survey–specific SAS procedures were used to account for weighting, clustering and stratification in the survey design. Results: Depression status was associated with the presence of oral health problems among adolescents. Controlling for all factors, the odds of depression are 1.8 (1.4-2.4 CI) times larger for adolescents with oral health problems than adolescents with no oral health problems. Conclusion: This study provides evidence that oral health problems are associated with depressive status in adolescents. Our findings strengthen evidence that there is a relationship between oral health and social/emotional health. Children with poor emotional well-being are more sensitive to the impacts of oral health and its effects on overall well-being. Preventing and treating oral health problems and improving dental health might benefit child’s cognitive and psychosocial development. So, strategies for reaching adolescents through school based programs, improving access to oral health education aids in improving the oral health status for those at higher risk. A limitation of this study is we did not focus on behavior measures (i.e. time spent watching videos) and social interaction measures (i.e. living in supportive neighborhoods) because the literature indicated these are not significant in children’s oral health status as parents made medical health services decisions for their children.