Mental Disorders, Metabolic Syndrome and Periodontal Disease: A Systematic Review

Objectives: Mental disorders, such as anxiety and depression, appear to be associated with metabolic syndrome and with periodontal disease, however, the association among these diseases, have not been explored. Thus, the aim of this systematic review was to evaluate the associations among anxiety and depression, metabolic syndrome and periodontal disease.
Methods: The Medline and PsycINFO were searched systematically, during the period of June 12-22, 2013, to identify studies evaluating the association between anxiety/depression, metabolic syndrome and PD. For this, were used combinations of descriptors related to the three disorders jointly. However, no paper was found after review of title and abstracts. A new search was performed, this time combining the descriptors ‘anxiety’ and ‘depression’ and separating ‘periodontal disease’/ ‘periodontitis’ and ‘metabolic syndrome’. A hand-search was also carried out from the reference lists of initial studies identified. Only cohort, case-control and cross-sectional studies published until June 2013 were included.
Results: A total of 46 and nine citations for anxiety/depression/metabolic syndrome and anxiety/depression/periodontal disease were found and remained, for systematic review, 10 and five articles, respectively. Most articles found an association among the conditions. Some mechanisms which explained the associations of anxiety/depression, both with metabolic syndrome and periodontal disease were similar, such as the action of pro-inflammatory cytokines. Moreover, characteristic behavioural habits of subjects with symptoms of anxiety/depression, such as excessive alcohol and food intake, unhealthy diet and smoking, for example, may interfere significantly in the aetiology and course of both, metabolic syndrome as periodontal disease.
Conclusions: Although this review suggests that anxiety/depression, metabolic syndrome and periodontal disease may be associated, further studies involving all these diseases are needed to elucidate this hypothesis.