Non-Cochrane · aetiology · PM42783202
Oral Structural and Functional Impairment in Relation to Depressive Outcomes in Older Adults: A Systematic Review and Meta-Analysis of Observational Studies.
Moroianu Lavinia-Alexandra, Dragus Laurentiu, Rosca Stefan, et al. · Diseases (Basel, Switzerland) · 2026 · PubMed · doi:10.3390/diseases14090309
Findings
Population Older adults
47 findings
| Poorer oral structural or functional status | Better oral status or function | Depressive outcomes Unclear ascertainment | OR 1.336 [1.122, 1.592] GRADE not reported 7 studies |
| Poorer oral structural or functional status | Better oral status or function | Depressive outcomes Meta-regression: Exposure: oral frailty versus chewing dysfunction | Ratio of ORs 2.0486 [1.4838, 2.8284] GRADE not reported 14 studies |
| Poorer oral structural or functional status | Better oral status or function | Depressive outcomes Meta-regression: Design: longitudinal versus cross-sectional | Ratio of ORs 0.7273 [0.5013, 1.0551] GRADE not reported 15 studies |
| Poorer oral structural or functional status | Better oral status or function | Depressive outcomes Trim-and-fill sensitivity; seven imputed studies, 22 observed and imputed | OR 1.29 [0.99, 1.69] GRADE not reported 15 studies |
| Poorer oral structural or functional status | Better oral status or function | Depressive outcomes Meta-regression: Ascertainment: clinical/objective or structured reference | OR 1.3632 [0.9508, 1.9544] GRADE not reported 15 studies |
| Poorer oral structural or functional status | Better oral status or function | Depressive outcomes Meta-regression: NOS score: per one-point increase | Ratio of ORs 0.905 [0.7196, 1.1383] GRADE not reported 15 studies |
| Poorer oral structural or functional status | Better oral status or function | Depressive outcomes Leave-one-out: excluding Ohi 2022 | OR 1.584 [1.298, 1.933] GRADE not reported 14 studies |
| Poorer oral structural or functional status | Better oral status or function | Depressive outcomes Likely clinical/objective or structured ascertainment | OR 1.335 [1.129, 1.58] GRADE not reported 3 studies |
| Poorer oral structural or functional status | Better oral status or function | Depressive outcomes Meta-regression: Region: non-Asia versus Asia | Ratio of ORs 0.97 [0.5494, 1.7126] GRADE not reported 15 studies |
| Poorer oral structural or functional status | Better oral status or function | Depressive outcomes Leave-one-out: excluding Lin 2022 | OR 1.554 [1.29, 1.873] GRADE not reported 14 studies |
| Poorer oral structural or functional status | Better oral status or function | Depressive outcomes Meta-regression: Exposure: tooth loss versus chewing dysfunction | Ratio of ORs 0.9043 [0.7661, 1.0673] GRADE not reported 14 studies |
| Poorer oral structural or functional status | Better oral status or function | Depressive outcomes Leave-one-out: excluding Yamamoto 2017 | OR 1.654 [1.321, 2.071] GRADE not reported 14 studies |
| Poorer oral structural or functional status | Better oral status or function | Depressive outcomes Leave-one-out: excluding Park 2023 | OR 1.671 [1.35, 2.069] GRADE not reported 14 studies |
| Poorer oral structural or functional status | Better oral status or function | Depressive outcomes Meta-regression: NOS quality: high reference | OR 1.6075 [1.277, 2.0236] GRADE not reported 15 studies |
| Poorer oral structural or functional status | Better oral status or function | Depressive outcomes Leave-one-out: excluding Rouxel 2018 | OR 1.624 [1.292, 2.042] GRADE not reported 14 studies |
| Poorer oral structural or functional status | Better oral status or function | Depressive outcomes Asia | OR 1.651 [1.257, 2.168] GRADE not reported 12 studies |
| Poorer oral structural or functional status | Better oral status or function | Depressive outcomes Leave-one-out: excluding Wang 2026 | OR 1.651 [1.316, 2.071] GRADE not reported 14 studies |
| Poorer oral structural or functional status | Better oral status or function | Depressive outcomes Meta-regression: Design: cross-sectional reference | OR 1.8261 [1.4222, 2.3448] GRADE not reported 15 studies |
| Poorer oral structural or functional status | Better oral status or function | Depressive outcomes Leave-one-out: excluding Kawamura 2026 | OR 1.59 [1.276, 1.981] GRADE not reported 14 studies |
| Poorer oral structural or functional status | Better oral status or function | Depressive outcomes Meta-regression: Exposure: chewing dysfunction reference | OR 1.4648 [1.3327, 1.61] GRADE not reported 14 studies |
| Poorer oral structural or functional status | Better oral status or function | Depressive outcomes Leave-one-out: excluding Takiguchi 2016 | OR 1.592 [1.278, 1.982] GRADE not reported 14 studies |
| Poorer oral structural or functional status | Better oral status or function | Depressive outcomes Meta-regression: Exposure: other impairment versus chewing dysfunction | Ratio of ORs 0.7663 [0.6724, 0.8732] GRADE not reported 14 studies |
| Poorer oral structural or functional status | Better oral status or function | Depressive outcomes High NOS quality | OR 1.614 [1.273, 2.046] GRADE not reported 13 studies |
| Poorer oral structural or functional status | Better oral status or function | Depressive outcomes Leave-one-out: excluding Sun 2025 | OR 1.421 [1.231, 1.64] GRADE not reported 14 studies |
| Poorer oral structural or functional status | Better oral status or function | Depressive outcomes Strict older-adult cohort/subsample | OR 1.633 [1.3, 2.052] GRADE not reported 14 studies |
| Poorer oral structural or functional status | Better oral status or function | Depressive outcomes Cross-sectional | OR 1.862 [1.385, 2.502] GRADE not reported 9 studies |
| Poorer oral structural or functional status | Better oral status or function | Depressive outcomes Leave-one-out: excluding Koh 2026 | OR 1.633 [1.3, 2.052] GRADE not reported 14 studies |
| Poorer oral structural or functional status | Better oral status or function | Depressive outcomes Meta-regression: Region: Asia reference | OR 1.6273 [1.2767, 2.0742] GRADE not reported 15 studies |
| Poorer oral structural or functional status | Better oral status or function | Depressive outcomes Leave-one-out: excluding Miyano 2025 | OR 1.656 [1.324, 2.071] GRADE not reported 14 studies |
| Poorer oral structural or functional status | Better oral status or function | Depressive outcomes Meta-regression: Ascertainment: self-report or mixed versus clinical/objective | Ratio of ORs 1.6988 [1.0479, 2.7541] GRADE not reported 15 studies |
| Poorer oral structural or functional status | Better oral status or function | Depressive outcomes Leave-one-out: excluding Kusama 2021 | OR 1.655 [1.321, 2.075] GRADE not reported 14 studies |
| Poorer oral structural or functional status | Better oral status or function | Depressive outcomes Leave-one-out: excluding Wei 2024 | OR 1.607 [1.283, 2.013] GRADE not reported 14 studies |
| Poorer oral structural or functional status | Better oral status or function | Depressive outcomes Moderate NOS quality | OR 1.692 [0.074, 38.498] GRADE not reported 2 studies |
| Poorer oral structural or functional status | Better oral status or function | Depressive outcomes Overall Unresolved: the two extractors disagree on this row. | OR 1.613 [1.311, 1.986] Very low Downgraded: inconsistency, publication bias 15 studies |
| Poorer oral structural or functional status | Better oral status or function | Depressive outcomes Likely self-report or mixed ascertainment | OR 2.588 [1.35, 4.961] GRADE not reported 5 studies |
| Poorer oral structural or functional status | Better oral status or function | Depressive outcomes Meta-regression: NOS quality: moderate versus high | Ratio of ORs 1.0485 [0.5064, 2.171] GRADE not reported 15 studies |
| Poorer oral structural or functional status | Better oral status or function | Depressive outcomes Longitudinal | OR 1.266 [1.047, 1.531] GRADE not reported 6 studies |
| Poorer oral structural or functional status | Better oral status or function | Depressive outcomes Non-Asia | OR 1.604 [1.17, 2.2] GRADE not reported 3 studies |
| Poorer oral structural or functional status | Better oral status or function | Depressive outcomes Meta-regression: Ascertainment: unclear versus clinical/objective | Ratio of ORs 1.0179 [0.6652, 1.5574] GRADE not reported 15 studies |
| Poorer oral structural or functional status | Better oral status or function | Depressive outcomes Meta-regression: Exposure: OHRQoL/oral impacts versus chewing dysfunction | Ratio of ORs 1.1491 [0.7628, 1.7311] GRADE not reported 14 studies |
| Poorer oral structural or functional status | Better oral status or function | Depressive outcomes Leave-one-out: excluding Muniz 2021 | OR 1.637 [1.311, 2.044] GRADE not reported 14 studies |
| Poorer oral structural or functional status | Better oral status or function | Depressive outcomes Leave-one-out: excluding Park 2016 | OR 1.639 [1.301, 2.065] GRADE not reported 14 studies |
| Chewing dysfunction | Better oral status or function | Depressive outcomes Chewing dysfunction | OR 1.419 [0.55, 3.659] GRADE not reported 2 studies |
| Poorer oral health-related quality of life or oral impacts | Better oral status or function | Depressive outcomes OHRQoL/oral impacts | OR 2.529 [0.001, 7225.535] GRADE not reported 2 studies |
| Oral frailty or functional decline | Better oral status or function | Depressive outcomes Oral frailty/functional decline | OR 2.967 [1.459, 6.037] GRADE not reported 3 studies |
| Other oral impairment | Better oral status or function | Depressive outcomes Other oral impairment | OR 1.349 [0.064, 28.347] GRADE not reported 2 studies |
| Tooth loss or poorer dentition | Better oral status or function | Depressive outcomes Tooth loss/dentition | OR 1.326 [1.247, 1.409] GRADE not reported 5 studies |
Included primary studies 30
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Lin 2022 Physical Frailty and Oral Frailty Associated with Late-Life Depression in Community-Dwelling Older Adults. PMID:35330459 | 2022 | 4 other reviews | Depressive outcomes | not extracted yet |
| Koh 2026 Association of Tooth Loss With Stress and Depressive Symptoms in Korean Adults: An Analysis Using Korean National Health and Nutrition… PMID:40765280 | 2026 | 1 other review | Depressive outcomes | not extracted yet |
| Skośkiewicz-Malinowska 2018 Oral health condition and occurrence of depression in the elderly. PMID:30313038 | 2018 | 1 other review | not stated | not extracted yet |
| Sun 2025 Association of social frailty, sarcopenia, and oral frailty with depressive symptoms in Chinese older adults: a cross-sectional study. PMID:39910522 | 2025 | 1 other review | Depressive outcomes | not extracted yet |
| Hajek 2023 Oral health, anxiety symptoms and depressive symptoms: findings from the survey of health, ageing and retirement in Europe. PMID:37020329 | 2023 | this review only | not stated | not extracted yet |
| Kaur 2024 Occurrence of Depression and its Association with Oral Health in Elderly People Living in Old Age Homes of Mathura. PMID:38595567 | 2024 | this review only | not stated | not extracted yet |
| Kawamura 2026 Relationship between Depressive Moods and Oral Frailty in a Frailty Outpatient Clinic: A Cross-Sectional Study. PMID:41397001 | 2026 | this review only | Depressive outcomes | not extracted yet |
| Kunrath 2021 Oral health and depressive symptoms among older adults: longitudinal study. PMID:33291966 | 2021 | this review only | not stated | not extracted yet |
| Kusama 2021 The deterioration of oral function and orofacial appearance mediated the relationship between tooth loss and depression among… PMID:33730661 | 2021 | this review only | Depressive outcomes | not extracted yet |
| Lou 2024 Association between Oral Health and Depressive Symptoms in Chinese Older Adults: The Mediating Role of Dietary Diversity. PMID:38674922 | 2024 | this review only | not stated | not extracted yet |
| Mariño 2020 Self-assessed impact of oral health on the psychological well-being and depressive symptoms of older adults living in Melbourne. PMID:32281128 | 2020 | this review only | not stated | not extracted yet |
| Matsuyama 2021 Causal effect of tooth loss on depression: evidence from a population-wide natural experiment in the USA. PMID:34030762 | 2021 | this review only | not stated | not extracted yet |
| Miyano 2025 Longitudinal Association Between Self-Reported Chewing Difficulty and Depression Among Older Japanese Adults Using Data From the Longevity… PMID:40551921 | 2025 | this review only | Depressive outcomes | not extracted yet |
| Muniz 2021 Association between depressive symptoms and oral health care in non-institutionalized elders in Northeastern Brazil DOI:10.33448/rsd-v10i4.13745 | 2021 | this review only | Depressive outcomes | not extracted yet |
| Nakazawa 2024 Dental prosthesis use moderates association between tooth loss and risk of depressive symptoms in older adults with severe tooth loss: The… PMID:38479890 | 2024 | this review only | not stated | not extracted yet |
| Ohi 2022 Oral health-related quality of life is associated with the prevalence and development of depressive symptoms in older Japanese… PMID:34009675 | 2022 | this review only | Depressive outcomes | not extracted yet |
| Park 2016 Correlation between depressive symptoms and subjective mastication ability and ability to pronunciation among Korean elderly. PMID:27457065 | 2016 | this review only | Depressive outcomes | not extracted yet |
| Park 2023 Association Between Changes in Oral Health-Related Quality of Life and Depressive Symptoms in the Korean Elderly Population. PMID:37065644 | 2023 | this review only | Depressive outcomes | not extracted yet |
| Rouxel 2018 Oral Health-A Neglected Aspect of Subjective Well-Being in Later Life. PMID:26970523 | 2018 | this review only | Depressive outcomes | not extracted yet |
| Sun 2022 Oral health and depressive symptoms among older adults in urban China: a moderated mediation model analysis. PMID:36307767 | 2022 | this review only | not stated | not extracted yet |
| Sung 2025 The Mediating Role of Formal Social Engagement in the Relationship Between Oral Health and Depressive Symptoms Among Older Adults in South… PMID:40286245 | 2025 | this review only | not stated | not extracted yet |
| Takiguchi 2016 Oral health and depression in older Japanese people. PMID:25645887 | 2016 | this review only | Depressive outcomes | not extracted yet |
| Tanaka 2026 Oral frailty and the trajectories of psychological well-being and cognitive function: findings from the 12-year community-based Kashiwa… PMID:41533683 | 2026 | this review only | not stated | not extracted yet |
| Tay 2025 Estimating the causal impact of chewing disability on depressive symptoms mediated by loneliness: a longitudinal marginal structural model… PMID:41158119 | 2025 | this review only | not stated | not extracted yet |
| Wang 2026 The Effect of Tooth Loss on Depression and Anxiety Among Older Adults in China: The Mediating Role of Dietary Diversity. PMID:41901068 | 2026 | this review only | Depressive outcomes | not extracted yet |
| Wei 2024 Association between masticatory function and depression in older adults: Results from NHANES 2009 to 2018. PMID:38987924 | 2024 | this review only | Depressive outcomes | not extracted yet |
| Wright 2020 Associations between oral health and depressive symptoms: Findings from the Concord Health and Ageing in Men Project. PMID:31943668 | 2020 | this review only | not stated | not extracted yet |
| Yamamoto 2017 Oral Health and Incident Depressive Symptoms: JAGES Project Longitudinal Study in Older Japanese. PMID:28165614 | 2017 | this review only | Depressive outcomes | not extracted yet |
| Zhang 2021 Longitudinal Association Between Oral Status and Depressive Symptoms Among Chinese Older Adults - China, 2014-2018. PMID:34659865 | 2021 | this review only | not stated | not extracted yet |
| Zhang 2025 Dietary diversity and life satisfaction as mediators in the relationship between oral health and depression among older adults in china: a… PMID:41181690 | 2025 | this review only | not stated | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Older adults (explicitly geriatric samples, typically 60 or 65 years and over) or a separable older-adult subgroup | Older adults in 30 studies (sample sizes 201 to 169,061; 21 of 30 in Asia) (n=30 studies) |
| Intervention | Oral structural or functional impairment as exposure, grouped into structural, functional, symptom-based and proxy families (tooth loss/dentition, oral frailty, chewing dysfunction, xerostomia/salivary dysfunction, OHRQoL/oral impacts, prosthetic status, self-rated oral health) | Tooth loss/dentition (n=15); oral frailty/functional decline (n=4); chewing dysfunction (n=4); other oral impairment constructs (n=4); OHRQoL/oral impacts (n=2); denture/prosthetic status (n=2); xerostomia/salivary dysfunction (n=1) |
| Comparison | Better oral status or function (no or less oral impairment) | Better oral status or function |
| Outcomes | Depressive outcomes: diagnosed depression, depressive symptoms, incident depression, depression severity (GDS, PHQ, CES-D, SDS, Euro-D, GHQ-30 and similar) | Adverse depressive outcomes pooled as OR (n=15 studies; OR 1.613, very low certainty); RR/PR stream narrative only (n=4; very low certainty); beta/coefficient stream narrative only (n=10; very low certainty); qualitative only (n=1) |
| Study designs | Observational studies (cross-sectional and longitudinal/cohort) | 18 cross-sectional and 12 longitudinal observational studies (n=30) |
| Timing | Not specified | Cross-sectional and longitudinal follow-up (up to 12 years) |