Oral Health Status and Cardinal Symptoms of Depression in the Old Order Amish: a cross-sectional study

Abstract Background Although results have been mixed, possibly owing to high confounding heterogeneity within and across studies, multiple efforts suggest that tooth loss and periodontitis are associated with depression. Methods We analyzed questionnaires on dental health and depression obtained as a component of a Wellness study in 4,288 Old Order Amish (mean age = 43.5 ± 16.8 years; 57% women), a population with relatively high genetic and lifestyle homogeneity. Specifically, we obtained questionnaires reporting the use of removable partial/complete dentures (false teeth) and cardinal symptoms of depression (dysphoria/hopelessness and anhedonia), and we analyzed their associations using multivariable logistic regression, with adjustment for age, sex, smoking status, and occupation (farmer vs. non-farmer). Results We report statistically significant associations between dentures and current (but not “ever”) depression symptom ratings (p < 0.05). The most robust associations were between current anhedonia AND dysphoria/hopelessness and the presence of any dentures (versus no dentures) (OR 1.760 [1.131, 2.737], p = 0.012), and the presence of complete dentures (versus partial or no dentures) (OR 1.794 [1.008, 3.193], p = 0.047). Conclusions In this relatively homogeneous population, denture use—particularly complete dentures—was associated with current anhedonia and dysphoria/hopelessness. A primary strength of the study is its relatively homogeneous population, with a low prevalence of smoking—an important confounding factor—and limited access to both prophylactic dental care and fluoridated water, which collectively enhance the reliability of the findings. Limitations include the cross-sectional design and reliance on self-reported data. These findings warrant replication in future longitudinal studies incorporating dental and clinical examinations, imaging, and laboratory biomarkers.