Objectives: This systematic review aimed to investigate the association between depression and oral health outcomes, including periodontitis, gingivitis, dental caries, partial tooth loss, and edentulism (complete tooth loss). Methods: A comprehensive search was conducted across seven major databases and two gray literature sources, including only studies with probabilistic samples, clinical assessment of oral outcomes, validated measuring of depression, and analyses statistically controlled for confounders. Two reviewers independently performed study selection, data extraction, risk of bias assessment (Newcastle-Ottawa scale), and evaluation of evidence certainty. Results: From 5865 unique records identified, 53 studies were included (44 cross-sectional and 9 cohort studies), with low risk of bias in 45 studies. Depression was significantly associated with the outcomes of periodontitis (OR = 1.30, 95%CI 1.07–1.57, I2 = 56%), dental caries (PR = 1.32, 95%CI 1.12–1.52, I2 = 0%), and edentulism (OR = 1.26, 95%CI 1.16–1.37, I2 = 35%). Individuals with edentulism were more likely to have the outcome of depression compared to controls (OR = 1.37, 95%CI 1.15–1.64, I2 = 69%). Meta-analyses demonstrated very low to low certainty of evidence. Conclusions: This systematic review and meta-analysis found significant associations between depression and oral health outcomes, such as periodontitis, dental caries and edentulism. These findings reinforce the interconnection between oral health and psychological factors.
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