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Periodontal disease, a bacterially mediated inflammatory disease of the gingival and adjacent periodontal attachment apparatus, represents, after dental caries, the leading cause of tooth loss among adults in developed countries due to the destruction of the periodontal ligament and the loss of the adjacent supporting bone, the tissues which support the teeth (Pihlstrom et al., 2005).Depressive disorders, the most commonly diagnosed conditions in psychiatry (Ustun et al., 2004; Kessler and Bromet, 2013), include, according to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5): disruptive mood dysregulation disorder, major depressive disorder (including major depressive episode) an extensive prevalent disorder ranked third among the primary causes of global illness (Mathers and Loncar, 2006), persistent depressive disorder (dysthymia), premenstrual dysphoric disorder, substance/medication-induced depressive disorder, depressive disorder due to another medical condition, other specified depressive disorder, and unspecified depressive disorder (American Psychiatric Association, 2013; Patten, 2013).The aim of this article is to summarize the current knowledge about the periodontal disease—depression relationship and to discuss the plausible mechanisms underlying this possible bidirectional association, by which each disease may contribute to the other (Figure (Figure11).Figure 1Review of reported results related to the biological and psychosocial mechanisms underlying the depression-periodontal disease bidirectional connection.The periodontal disease-depression associationu0027s studiesAn extensive body of clinical research (Monteiro da Silva et al., 1996; Moss et al., 1996; Genco et al., 1999; Ronderos and Ryder, 2004; Dosumu et al., 2005; Klages et al., 2005; Saletu et al., 2005; Johannsen et al., 2006, 2007; Rosania et al., 2009; Ababneh et al., 2010; Li et al., 2011; Lopez et al., 2012) and experimental animal models (Breivik et al., 2006) documents the causal relationships between periodontitis and depression. Moreover, it has been revealed that clinical depression may also have a negative effect on periodontal treatment outcomes (Elter et al., 2002), paralleling other research indicating that psychosocial factors are predictive not only of surgical outcome, but also play a significant role in postoperative recovery (Rosenberger et al., 2006). Furthermore, antidepressants, such as fluoxetine, a selective serotonin reuptake inhibitor, have demonstrated suppressive effects on the inflammatory response and on periodontal disease severity not only in a rat ligature-induced periodontitis model (Branco-de-Almeida et al., 2012; Aguiar et al., 2013; Galli et al., 2013), but also in patients with periodontitis with clinical depression (Bhatia et al., 2015). In contrast, several clinical studies (Anttila et al., 2001; Persson et al., 2003; Solis et al., 2004, 2014; Castro et al., 2006; Cakmak et al., 2014) and experimental animal model studies (Soletti et al., 2009) failed to demonstrate the periodontal disease—depression connection, possibly because of the lack of consideration for relevant common mediators.

Depression and Inflammatory Periodontal Disease Considerations—An Interdisciplinary Approach