Can dentist tell if you have depression?

Depression is a complex mental health condition that affects millions of people worldwide. It can manifest with a variety of symptoms, both psychological and physical. Interestingly, some research suggests that dentists may be able to detect signs of depression during routine dental examinations.

Table of Contents

What are the symptoms of depression?

According to the National Institute of Mental Health, common symptoms of depression include:

Persistent sad, anxious, or “empty” mood

Feelings of hopelessness, guilt, worthlessness, or helplessness
Irritability
Restlessness

Loss of interest in activities once enjoyed
Fatigue and decreased energy
Difficulty concentrating, remembering details, and making decisions

Insomnia, early-morning wakefulness, or excessive sleeping
Overeating or appetite loss
Thoughts of suicide, suicide attempts

Aches or pains, headaches, cramps, or digestive problems without a clear physical cause.

In addition to emotional and psychological symptoms, depression can also produce physical signs that healthcare providers can detect. These include issues like sluggish speech, slowed movement, poor posture, and facial expressions that betray sadness, anxiety, or lack of enjoyment.

Why would dentists be able to detect depression?

At first glance, it may seem odd that dentists would be able to spot signs of depression. After all, their main focus is on oral health. However, dentists are highly trained medical professionals who see patients on a regular basis. This gives them a unique opportunity to notice subtle physical and behavioral changes that could indicate an underlying problem like depression.

During a typical dental visit, the dentist will.

Interact with the patient in a close, intimate setting
Observe the patient’s face from just a couple feet away

Listen to the patient answer questions
Check the patient’s teeth, oral tissues, andFacial muscles for issues

In this context, a dentist may be able to pick up on facial expressions, body language, speech patterns, and physical signs consistent with depression. Factors they might notice include:

Sad expressions
Lack of excitement about dental treatment
Slumped posture

Lack of eye contact
Slowed speech
Poor motivation for oral hygiene

Irritability
Fatigue
Neck and jaw muscle tension

Strained facial muscles

What studies have found links between depression and dental health?

In recent years, a number of studies have explored connections between depression and dental health issues:

Depression and periodontitis: In a 2013 study published in the Journal of Periodontology, researchers found associations between depression and gum disease. Among the potential mechanisms, depression may cause impaired immune function and inflammation, increasing risk for periodontitis.
Depression and dry mouth: A 2016 study in the General Hospital Psychiatry journal found that depressed patients were significantly more likely to experience dry mouth symptoms than non-depressed patients.

Depression and oral health complaints: A 2017 study in Community Dentistry and Oral Epidemiology concluded that depression and anxiety were linked with more frequent oral health complaints, even when dental exam findings were similar.
Depression and tooth loss: A meta-analysis published in the Journal of Dental Research in 2018 determined that depression appears to be associated with greater tooth loss and worse periodontal health.
Depression and dental avoidance: In a 2020 study, researchers found that older adults with depressive symptoms were more likely to avoid necessary dental care due to cost.

While more research is still needed, these studies demonstrate plausible biological and behavioral links between depression and various types of dental health issues.

Studies on dentists spotting signs of depression

A handful of studies provide evidence that dentists are able to recognize possible depression in their patients.

Early study in 1999: A 1999 study published in the Journal of the American Dental Association (JADA) found that dentists were able to identify signs of depression and refer patients for further evaluation. The detection rate was higher among dentists who had experienced more training and education related to mental illnesses.
Study on facial muscle tone: A small 2007 study measured facial muscle tone among depressed patients during dental exams. Depressed patients had increased tone in muscles involved with frowning, consistent with distress.

Study on medically compromised patients: A study in the 2011 issue of the Journal of Evidence-Based Dental Practice reported that dental professionals were able to recognize signs of depression in medically compromised patients at a level consistent with diagnostic criteria.
Study on referral practices: A 2012 study in BMC Oral Health found that the majority of dentists surveyed agreed that they have a role in identifying patients with major depression. About 75% said they made referrals to physicians for suspected depressed patients.
Recent study on detection: A 2019 study in BMC Oral Health investigated whether dentists could accurately detect psychological distress and depression among their patients. The majority of participating dentists were able to correctly identify depression among actor-patients exhibiting signs and symptoms.

Together, these studies provide promising evidence that dentists are capable of spotting potential depression, especially with proper training.

How can dentists detect signs of depression?

During dental exams and consultations, dentists can look for facial expressions, body language, behaviors, and conversations that may signal depression. Possible cues include:

Minimal excitement about dental treatment

Lack of motivation for oral hygiene
Disinterest in cosmetic dentistry options
Self-deprecating remarks

Focus on discomfort over solutions
Hopelessness about treatment
Irritability

Sad expressions
Slumped posture
Lack of eye contact

Slowed speech and movement
Comments about trouble sleeping or eating
Unexplained dental health complaints

Jaw tension and strained facial muscles
Missed appointments and avoidance of care

Dentists can also look for physical signs consistent with depression, such as unhealthy weight changes, hair and skin changes, mouth sores, TMJ issues, and unhealthy oral bacteria levels.

Recommendations for dentists on detecting depression

Experts provide the following recommendations for dentists looking to identify patients who may have depression.

Get training on depression symptoms, warning signs, and high-risk groups.
Ask questions and listen carefully to patients’ concerns.

Observe patients’ facial expressions, body language, and behaviors.
Notice comments that may indicate hopelessness or lack of self-care.
Identify potential physical signs, such as unhealthy weight changes.

Be alert for complaints that cannot be explained by dental findings.
Keep dental charts up to date to spot changes over time.
Refer patients to physicians for further evaluation when warranted.

Measure facial muscular tone, where feasible.
Screen patients using validated depression scales.

Dentists should also be sure to rule out physical causes first for any observed changes. With training and awareness, they are well positioned to recognize potential depression in many patients.

Challenges and limitations

Despite their potential to detect depression, dentists face some challenges and limitations:

Dentists have limited time with each patient.
There are many possible causes for symptoms like pain.

Dentists cannot diagnose depression, only refer patients.
Patients may hide symptoms and avoid sharing concerns.
Dentists receive minimal mental health training.

Screening tools tend to be too long for routine use.
Dentists may lack referral resources in some areas.
Not all depressed patients show outward signs.

Cultural norms influence how patients talk about depression.
Stigma remains regarding mental health.

With proper resources and training, however, these challenges can be overcome to support dentists in identifying patients in need of further evaluation and care.

How patients can bring up concerns

While dentists can spot possible signs, patients should also feel empowered to proactively share concerns about depression with their dental provider. Some recommendations include:

Mentioning mood symptoms when asked about health history.
Being honest if dentist asks about stress, mood, appetite/sleep.

Sharing that depression makes it hard to care for teeth.
Asking for advice coping with oral health side effects.
Informing staff about depression medication side effects.

Talking to dentist privately if embarrassed.
Allowing extra time at appointments to discuss concerns.
Following up by email or patient portal if discussion feels rushed.

Patients should keep in mind that dentists have their best interests in mind. Being open can help dentists refer patients to appropriate doctors or resources.

Key takeaways

Here are some key conclusions:

Depression manifests with many emotional, psychological, behavioral and physical symptoms.

Dentists are trained medical professionals who see patients frequently and closely.
Studies suggest links between depression and periodontal disease, dry mouth, dental pain, tooth loss, and dental avoidance.
Research indicates dentists can successfully identify signs of depression in many patients.

Dentists can look for facial expressions, body language, behaviors and conversations signaling depression.
Dentists are limited in what they can diagnose but can refer patients to doctors.
Patients should also voice concerns of depression to their dentists.

The bottom line

In summary, depression often manifests physically in ways dentists may be able to detect in routine exams and interactions with patients. While dentists cannot diagnose depression, they can recognize concerning signs and symptoms and refer patients to physicians for further evaluation. Patients can also aid this process by openly communicating with dentists about depression concerns. With proper training and resources, dentists are in a good position to help identify patients who may have undiagnosed depression and need care.