Introduction: Depression and tooth loss are increasingly recognized as interconnected conditions linked through biological and psychosocial mechanisms. However, most research focuses on older adults, due to the cumulative nature of oral health. The purpose of this study is to examine the relationship between depression and tooth loss in working-aged adults in the United States, adults aged 18-60 years, where oral health decline may manifest differently in relation to depression. Methods: Data from the 2017-2020 National Health and Nutrition Examination Survey (NHANES) (n=4,435) were used in analysis. Stata 19.5 was used to calculate the weighted prevalence of depression severity and tooth loss severity in US populations aged 18-60. A generalized ordered logit model was used to examine the association between depression severity and tooth loss, adjusting for age, gender, race, education level, income to poverty ratio, diabetes status, smoking status, and dental care utilization. Results: The weighted prevalence of minimal depression in the sample was 74.9% (95% CI [72.43%-77.14%]), only 11.86% (95% CI [10.35%-13.56%]) of individuals had severe depression. More than half of the study population had no missing teeth (52.11%, 95% CI [48.97%-55.24%]), and severe tooth loss was experienced by 11.86% (95% CI [10.35%-13.56%]) of the study population. Depression severity was not found to be associated with tooth loss after adjustment (Mild Depression: OR=1.06, 95% CI [0.81, 1.40]; Moderate Depression: OR=1.43, 95% CI [0.88, 2.34]; Severe Depression: OR=1.06, 95% CI [1.08, 1.10]).
Conclusions: In this sample of US adults aged 18-60, depression symptoms were not found to be associated with tooth loss after accounting for sociodemographic and behavioral factors. Instead, established structural and behavioral determinants of tooth loss were the primary contributors of tooth loss in this population. These findings suggest that oral health decline in the American non-elderly is driven more by social and behavioral conditions than by depression symptoms.