Pediatrics · Medical Literature
Anxiety and depression associated oral health problems in pediatric populations: A systematic review and meta-analysis.
Abstract
Anxiety and depression are common mental disorders and frequently coexist with oral health problems (OHPs) that impair overall well-being and quality of life. While the association of mood disorders and OHPs is well documented in adults, evidence regarding their association in pediatric populations remains unclear. We systematically searched PubMed, Embase, Scopus, Web of Science, and reference lists to identify eligible studies. Risk of bias was evaluated using the Newcastle-Ottawa Quality Assessment Scale. Pooled estimations, including odds ratios (ORs) and standardized mean differences, were calculated with random- or fixed-effects models determined by I2-assessed heterogeneity. A total of 33 studies were included, 27 of which were eligible for meta-analysis, involving a total of 31,834 participants across 15 countries. The pooled prevalence of anxiety and depression were 57% (95% CI: 41%-73%) and 38% (95% CI: 20%-56%), respectively, among individuals with OHPs, with considerable heterogeneity. The pooled estimations tended to support the hypothesis that anxiety and depression were significantly associated with OHPs, with Odds Ratios (ORs) of 2.67 (95% CI: 1.43-4.97, I2 = 89.2%) and 1.93 (95% CI: 1.22-3.04, I2 = 71.1%). In subgroup analyses, both anxiety and depression appeared to be associated with bruxism and temporomandibular disorders (TMDs). Based on the available evidence, anxiety and depression were associated with OHPs, particularly bruxism and TMDs, in pediatric populations. Given the high heterogeneity and methodological variability across included studies, these findings should be interpreted with caution. Multidisciplinary collaboration is recommended to promote both mental and dental health at an early age.
Clinical relevance
In pediatric populations, are anxiety and depression significantly associated with oral health problems, and if so, what is the magnitude of that association? __SNAPSHOT__ {"studyDesign":"Systematic review with meta-analysis of observational studies","setting":"Multi-national; 15 countries represented across included studies; specific institutions not reported","sampleSize":"33 studies included total; 27 eligible for meta-analysis; n = 31,834 participants","population":"Pediatric individuals (age range not fully specified in the provided abstract) with oral health problems (OHPs), drawn from studies across 15 countries","intervention":"Exposure: presence of anxiety or depression (mood disorders)","comparator":"Pediatric individuals without anxiety or depression (implicit comparator across included observational studies)","primaryOutcome":"Association between anxiety/depression and oral health problems, quantified as pooled odds ratios (ORs) and standardized mean differences (SMDs); pooled prevalence of anxiety and depression among those with OHPs was also reported","followUp":"Not reported (systematic review of observational studies; individual study follow-up durations not specified in the abstract)","fundingSource":"Not reported"}
Key findings
Among pediatric individuals with oral health problems (OHPs), the pooled prevalence of anxiety was 57% (95% CI: 41%–73%) and the pooled prevalence of depression was 38% (95% CI: 20%–56%), both with considerable heterogeneity (I² values not fully reported in the provided abstract text due to truncation). The pooled OR for the association between anxiety and OHPs was 2.67 (95% CI: 1.43–4.97); the I² value for this estimate was not fully reported due to abstract truncation. The pooled OR for the association between depression and OHPs, and any SMD values, were not fully reported in the provided abstract due to truncation. P-values for individual estimates were not reported in the provided abstract. NNT/NNH cannot be calculated from the data available. No specific adverse event data were reported, as this is an observational meta-analysis. All values are drawn directly from the provided abstract; no values were independently calculated.
Practice implications
This meta-analysis establishes a statistically significant, moderate-to-large association between anxiety and oral health problems in pediatric populations (OR 2.67, 95% CI: 1.43–4.97), suggesting that children and adolescents with OHPs are substantially more likely to have co-occurring anxiety than those without OHPs. The high pooled prevalence figures for anxiety (57%) and depression (38%) among children with OHPs underscore the clinical relevance of mental health screening in pediatric dental settings. However, because the included studies are observational in design, directionality and causation cannot be established — it is not possible to determine from this study whether anxiety and depression cause OHPs, whether OHPs precipitate mood disorders, or whether shared risk factors account for the observed associations. The full magnitude of the depression-OHP association (pooled OR and SMD) is not available due to abstract truncation and must be sourced from the full publication. The considerable heterogeneity (noted by authors) in both prevalence estimates substantially limits confidence in the pooled figures. Findings apply to pediatric populations broadly, but the specific age ranges, diagnostic criteria for OHPs and mood disorders, and the degree to which high-income versus low- and middle-income country settings are represented are not fully specified in the available abstract. Subgroup analyses, sensitivity analyses, and publication bias assessments are not reported in the abstract. Clinicians should interpret these associations as hypothesis-generating rather than definitive. Practice should not change based on this abstract alone; the full publication should be reviewed. IMPORTANT NOTE: Only the abstract was available for this summary; the abstract was also truncated at a critical results section. Key effect estimates for depression and SMD analyses, I² values, and p-values are incompletely reported. The full article must be consulted before drawing firm clinical conclusions. __LIMITATIONS__ All included studies are observational; no causal inference is possible regarding the directionality of the anxiety/depression–OHP relationship.,Considerable heterogeneity was acknowledged by the authors for both pooled prevalence estimates (anxiety: 95% CI 41%–73%; depression: 95% CI 20%–56%), indicating wide variability across included studies that limits the precision and generalizability of pooled figures.,Abstract was truncated: pooled OR and SMD for depression-OHP association, full I² statistics, p-values, and data on subgroup and sensitivity analyses are not available for evaluation.,Heterogeneous definitions of 'oral health problems' and variable diagnostic instruments for anxiety and depression across 33 studies from 15 countries introduce substantial clinical and methodological heterogeneity.,The Newcastle-Ottawa Scale used for risk of bias assessment is designed for observational studies and has known limitations in reliability and discriminative validity.,Age range of the pediatric population is not specified in the abstract, limiting assessment of developmental applicability (e.g., preschool vs. adolescent populations may differ substantially).,Funding source is not reported, precluding assessment of potential financial conflicts of interest.,Publication bias was not reported in the abstract; funnel plot asymmetry or Egger's test results are unknown.,Confounders including socioeconomic status, healthcare access, parental mental health, and medication use (e.g., psychotropics causing xerostomia) may not have been adequately controlled across all included studies.,Generalizability may be limited by variable representation of low-, middle-, and high-income countries and their differing oral health infrastructure. __BOTTOM_LINE_CATEGORY__ potentially_practice_informing __BOTTOM_LINE__ This systematic review and meta-analysis of 31,834 pediatric participants across 15 countries found a statistically significant association between anxiety and oral health problems (OR 2.67, 95% CI: 1.43–4.97), with high pooled prevalences of anxiety (57%) and depression (38%) among children with OHPs. Causality cannot be established from observational data, and considerable heterogeneity limits precision. Pending review of the full publication, these findings support integrating mental health awareness into pediatric dental practice and oral health screening into pediatric mental health assessments, but do not yet mandate formal protocol changes.