Reports & Studies

Does periodontitis cause anxiety and depression?

PD Dr. Kristina Bertl, PhD MSc MBA

Are anxiety and depression caused by periodontitis? Or is periodontitis caused by anxiety and depression? According to the literature, the connection between periodontal disease and mental illness or mood disorders is probably bi-directional; this means that each illness can influence the other.

The following suspected links have been discussed in particular:

  • A (long-term) systemic increase in inflammatory markers triggered by periodontitis could further promote the development of mood disorders such as anxiety and depression.
  • Patients with mental illnesses often have ‘bad’ habits such as smoking, consumption of alcohol and lack of motivation regarding oral hygiene, etc., all of which are risk factors for developing periodontitis.
  • The stress caused by mental illness, including its impact on cortisol level, can have a negative effect on immune response and might therefore also contribute to the development of periodontitis.

As part of a systematic review, a research group from China compiled and analyzed the data from more than 40 studies. The review revealed the following interesting results:

  • Based on the results of case–control studies, periodontitis increases the risk of depression by approximately 70%.
  • Periodontitis increases the risk of an anxiety disorder by approximately 35%.
  • Based on indices, patients with periodontitis exhibit significantly higher depression and anxiety values.

However, closer inspection of the studies also showed that the results of the individual studies are inconsistent, and that in some cases they present contradictory results. Accordingly, this remains a fascinating topic for future research. In particular, it will be exciting to see the extent to which treating one disease can influence the progression of the other.


Zheng DX, Kang XN, Wang YX, et al. Periodontal disease and emotional disorders: A meta-analysis.
J Clin Periodontol. 2021;48:180–204.