title: Nothing to smile about.
abstract: BACKGROUND
  Several studies have demonstrated the high incidence of periodontal disorders among patients suffering from mental illnesses, probably because of self-care impairment, the difficult financial conditions, and the lack of motivation. The primary aim of this study was to evaluate the impact of depression and alexithymia on periodontal status. Due to the influence of personality traits on behavior in general, the secondary aim of our study was to investigate the possible impact of personality disorders on dental status.
  
  
  METHODS
  Patients with major depression (DP) referred to our psychiatry unit and healthy individuals (controls) were consecutively enrolled during the period April 2012-September 2012. All the participants to the study underwent a psychiatric evaluation (through questionnaires investigating the presence of depression, anxiety, personality disorders, and alexithymia) and a dental examination through the following indexes: plaque index, gingival index, simplified oral hygiene index, periodontal index.
  
  
  RESULTS
  Fifty DP (aged 56.7±15.2 years) and 40 controls (aged 56.1±15.9 years) were enrolled in the study. DP showed a worse oral hygiene status. In particular, statistically significant differences were found when comparing DP and controls in terms of plaque index, simplified oral hygiene index, gingival index, periodontal index, and oral health impact profile. In addition, periodontal health was found to be negatively related to the severity of depression and the presence of alexithymia. The strength of association between depression and dental indexes was reduced after adjusting for the other psychiatric variables (alexithymia and personality disorders) and was confirmed only for oral health impact profile.
  
  
  CONCLUSIONS
  Psychiatric variables seem to affect the patients' periodontal status; due to the high frequency of dental problems, patients suffering from mental illnesses should be referred to the oral health services for evaluation.
authors.affiliation: Department of Medical and Surgery Specialties, Psychiatry Unit, University Hospital "Policlinico-Vittorio Emanuele" of Catania, Sicily, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Luca
authors.affiliation: Department "GF Ingrassia", Section of Neuroscience, University Hospital "Policlinico-Vittorio Emanuele" of Catania, Sicily, Italy.
authors.forename: Antonina
authors.initials: A
authors.lastname: Luca
authors.affiliation: Department of Medical and Surgery Specialties, Dental Unit, University Hospital "Policlinico-Vittorio Emanuele" of Catania, Sicily, Italy.
authors.forename: Carmelo Maria Augusto Vittorio
authors.initials: CM
authors.lastname: Grasso
authors.affiliation: Department of Medical and Surgery Specialties, Psychiatry Unit, University Hospital "Policlinico-Vittorio Emanuele" of Catania, Sicily, Italy.
authors.forename: Carmela
authors.initials: C
authors.lastname: Calandra
keywords: alexithymia; dental health; dental indexes; depression; oral health; oral health-related quality of life