Alkan et al Vol 13, No 4, 2015 331 ORIGINAL ARTICLE Relationship Between Psychological Factors and Oral Health Status and Behaviours Arzu Alkan a /Omer Cakmak b /Savas Yilmaz c /Taylan Cebi d /Cem Gurgan e Purpose: To examine oral health related behaviours in relation to anxiety, depression and attention defcit hyperactiv- ity disorder (ADHD). Materials and Methods: This study included 364 subjects (195 female, age range 19–65 years; 169 male, age range 18–64 years). A psychological evaluation was performed using Beck’s anxiety, Beck’s depression and ADHD scales. A separate questionnaire covering oral health behaviours, including parafunctional habits, dental visits and toothbrush- ing frequency, was given to the subjects and completed before the clinical examination. The numbers of decayed, missing and flled teeth were recorded and the status of the subject’s periodontal health was determined clinically using periodontal probes and panoramic radiographs. Results: There were signifcant differences in the gender, level of education, level of income, household size, parafunc- tional habits and number of missing teeth in those with anxiety and depression (p < 0.05) vs those without. Females and subjects with parafunctional habits and lower education and income level presented higher anxiety and depression scores. ADHD was associated negatively with household size and positively with dental visits and toothbrushing fre- quency (p < 0.05). The results of structural equation modeling (SEM) revealed that anxiety, depression and ADHD were indirectly related to missing teeth and periodontal status: subjects with higher depression and anxiety scores had more missing teeth and worse periodontal health. However, there was no association between psychological factors and decayed teeth or toothbrushing frequency. Conclusions: Anxiety, depression and ADHD can result in poor oral hygiene, thereby having indirect, adverse effects on the periodontal health status of affected individuals. Although the frequency of dental visits seemed to be related to anxiety and ADHD, the frequency of toothbrushing showed no such association. Key words: anxiety, behavioural science, depression, oral health, psychosocial aspects of oral health Oral Health Prev Dent 2015;13:331-339 Submitted for publication: 15.04.13; accepted for publication: 21.08.13 doi: 10.3290/j.ohpd.32679 a Associate Professor, Department of Periodontology, Faculty of Dentistry, Erciyes University, Kayseri, Turkey. Idea, hypothesis, experimental design, wrote the manuscript. b PhD Student, Department of Periodontology, Faculty of Dentistry, Erciyes University, Kayseri, Turkey. Performed clinical examina- tion, wrote and proofread the manuscript. c Assistant Professor, Department of Child and Adolescent Mental Health, Meram Faculty of Medicine, Necmettin Erbakan Univer- sity, Konya, Turkey. Collected data using self-reported question- naires. d Private Practice, Istanbul, Turkey. Consulted on statistical evalua- tion. e Professor, Department of Periodontology, Faculty of Dentistry, Er- ciyes University, Kayseri, Turkey. Consulted on and performed statistical evaluation, contributed substantially to discussion. Correspondence: Dr. Arzu Alkan, Associate Professor, Department of Periodontology, Faculty of Dentistry, Erciyes University, 38039, Melikgazi, Kayseri, Turkey. Tel: +90-352-2076600-29152, Fax: +90- 352-4380657. Email: arzualkan@erciyes.edu.tr D ental caries and periodontal disease are the most prevalent oral health problems worldwide. The aetiology of periodontal disease is multifactorial and includes pathogenic microorganisms, uncon- trolled diabetes, smoking, genetics, psychosocial stress and certain psychosomatic conditions, such as anxiety and depression. The relationship between stress and periodontal disease has been recognised since the 1950s 29 and has received renewed atten- tion in recent years. Although a recent systematic review by Peruzzo et al 28 showed a positive relation- ship between periodontal diseases and psychologi- cal factors such as stress, anxiety, depression and loneliness, there is currently no consensus regard- ing this issue. Investigators claim that stress-in- duced increases in cortisol levels depress the im- mune system by inhibiting the secretion of IgA and IgG and the function of neutrophils, thereby poten-