|Year : 2022 | Volume
| Issue : 3 | Page : 254-259
Effect of oral function problems on depression in Korean adults: Analysis of data from the National Health and Nutrition Examination Survey
Eun Gyo Son
Department of Dental Hygiene, Catholic Kwandong University, Gangneung, Republic of Korea
|Date of Submission||14-Oct-2021|
|Date of Decision||07-Mar-2022|
|Date of Acceptance||25-Mar-2022|
|Date of Web Publication||28-Jun-2022|
Dr. Eun Gyo Son
Department of Dental Hygiene, Catholic Kwandong University, 24, Beomil-ro 579 Beon-gil, Gangneung-si, Gangwon-do 25601
Republic of Korea
Source of Support: None, Conflict of Interest: None
Aim: To identify changes in oral function problems in Korean adults by comparing and analyzing changes before and after the expansion of dental health insurance across units of a 5-year period and to identify the relationship between oral health and depression. Materials and Methods: This research study used raw data from the 4th National Health and Nutrition Survey 2009, the 6th National Health and Nutrition Survey 2014, and the 8th National Health and Nutrition Survey 2019. A total of 26,193 participants aged 19 years or older were included in the study. The data were analyzed using SPSS Statistics 24.0. Results: The results showed that the application of dental health insurance helped in solving oral function problems and oral function problems that influenced depression. Conclusion: Thus, the use of oral supplements and customized education according to gender are required. In addition, although there was a difference in oral aids by year, it had an effect on chewing and speaking problems. To solve more oral function problems, it is necessary to expand the coverage of dental health insurance.
Keywords: Dental Health Insurance, Depression, Oral Function, Oral Health, Oral Supplements
|How to cite this article:|
Gyo Son E. Effect of oral function problems on depression in Korean adults: Analysis of data from the National Health and Nutrition Examination Survey. J Int Oral Health 2022;14:254-9
|How to cite this URL:|
Gyo Son E. Effect of oral function problems on depression in Korean adults: Analysis of data from the National Health and Nutrition Examination Survey. J Int Oral Health [serial online] 2022 [cited 2023 Oct 5];14:254-9. Available from: https://www.jioh.org/text.asp?2022/14/3/254/348416
| Introduction|| |
According to the 2019 Population and Housing Census, elderly Koreans account for 15.5% of the total population of 51.78 million, an increase from 7.3% in 2000 to 11.3% in 2010, and this is increasing yearly. This increase resulted in reduced working-age population and burden of care for the elderly. Consequently, their holistic happiness, including dental health condition, should be taken into account.
The effective use of mouth functions includes chewing, swallowing, and speaking well. The double chewing function is changing from a physiological desire to sustain life by eating food to a psychological desire for individual satisfaction. The chewing function is becoming more prominent because of the short- and long-term implementation of social distancing to restrict movement between regions and countries due to the COVID-19 pandemic. Hence, as more time is spent at home and with increased exposure to online media, “Mukbang” stimulates the desire to chew through various contents.
The elderly particularly experience problems with the chewing function due to teeth loss, which increase with aging. Additionally, depression is emerging with the increase of aging. This causes a decrease in mood, loss of interest, energy loss, low self-esteem, sleep disturbance, appetite disturbance, and decreased concentration.
In Park’s study on suicide in the elderly, when depressed, suicidal thoughts were 8.94 times higher in men and 5.98 times higher in women, and suicidal ideation increased by 2.68 times in men if they did not eat regularly. Thus, eating does not only extend life, but also plays an important role in mental health.
Additionally, in a study by Lim et al. which examined the effects of chewing-related problems on depression in the elderly, the chewing function affected the quality of life and increased the depression index. Gender difference in depression has also been reported.
Many studies on oral function problems have been conducted on the elderly.,,, The contents included dry mouth and cognitive impairment, masticatory function and cognitive impairment, and oral muscle function and oral bacteria in those with systemic disease. Although the importance of oral functions among the elderly is known, it is necessary to understand oral functions of various ages. This is because the onset of oral function problems due to tooth loss does occur in the elderly and identifying these problems can serve as a basis for the treatment of depression. Previous studies have reported that the placement of removable dentures could reduce the likelihood of severe depression in patients with multiple tooth loss, and the number of remaining teeth is an important factor in depression. Gender, age, educational level, income, smoking, drinking alcohol, and the oral cavity have showed significant differences in the relationship between depression and the number of existing teeth.
This study investigated the changes in the treatment of oral function problems and depression before and after the expansion of dental health insurance through units of a 5-year period. We believed that the study would highlight the importance of expanding dental health insurance.
| Materials and Methods|| |
Selection and description of participants
This study used raw data from surveys conducted by the Korea Center for Disease Control and Prevention. These surveys were the 4th National Health and Nutrition Survey 2009, the 6th National Health and Nutrition Survey 2014, and the 8th National Health and Nutrition Survey 2019. A total of 26,193 participants aged 19 years or older were included in the study. This statutory investigation was conducted based on Article 16 of the National Health Promotion Act and is a designated statistic according to Article 17 of the Statistical Act (approval number 117002).
Data collection process and analysis
Data were extracted nationwide by proportional allocation and phylogenetic extraction. In addition, an estimate was calculated by assigning weights so that the results of the sample survey data were representative. Data were analyzed using SPSS Statistics 24.0.
| Results|| |
Demographic and sociological factors
Data from the National Nutrition Survey were used by sampling based on the most recent population and housing census data. A survey and interviews were conducted to estimate the population average (
) of the indicator of interest, and the weighted sample average was calculated by reflecting the weight (
) in the survey data (
) of n people:
Comparison of trends by year, gender, and income was calculated through direct standardization methods, and data for only adults aged 19 years or older were extracted and frequency analyzed.
A total of 26,193 participants were selected from the 2009 (10,533), 2014 (7,550), and 2019 (8,110) surveys. There were more females than males across the three categories. The age distribution was from 19 to 70 years old or older, and the age of the survey subjects for all 3 years was distributed from 40 years old or older. Regarding income, 31.5% earned below 1 million won in 2009. In 2014 and 2019, more participants earned above 3 million won compared with the other income categories [Table 1].
Differences in authoring discomfort according to age and sex
The difference in chewing discomfort according to age and gender and the rate of discomfort in chewing were designated as 19 years of age or older due to dental problems affecting teeth, dentures, and gums. Additionally, the age was the estimated population in 2005, and the frequency analysis based on age standardization was compared.
[Table 2] shows the differences in authoring discomfort by age and sex. In both males and females, there was a direct relationship between age and authoring discomfort across all three categories, except in 2019 among males aged 30–39 years (4.8%) who found writing less inconvenient than those aged 19–29 years (6.8%) and in 2014 among females aged 30–39 years (9.1%) who had less writing discomfort compared with those aged 19–29 years (10.0%). Males 70 years and older experienced the greatest discomfort in 2009, with a consistent decrease in 2014 and 2019.
|Table 2: Differences in authoring discomfort according to age and gender|
Click here to view
The overall difference in authoring discomfort decreased significantly from 2009 to 2014 and 2019. Except among males aged 19–29 years and women aged 40–49 years, where there were respective increases of 1.7% and 1.2% between 2014 and 2019, the decrease was consistent across all age groups and sex.
In terms of comparison by sex, men aged 19–29 years felt less comfortable in 2009 and 2014 when compared with women, and the reverse was the case in 2019. For those aged 30–39 years, more women reported being uncomfortable in 2014 and 2019 when compared with men, and an equal proportion of men and women reported discomfort in 2009. In the age categories of 40–49 and 50–59 years, more men compared to women reported writing inconvenience. For those aged 60–69 years, more women reported discomfort in 2009 and 2014 than men, and more men stated that they were uncomfortable in 2019. Among the participants who were 70 years and older, females felt more discomfort with authoring [Table 2].
Difference in oral function restriction rate by gender and income
The oral function restriction rate by gender and income was calculated for those who were aged 19 years or older and those who experienced mastication or pronunciation discomfort due to dental problems affecting teeth, dentures, and gums. Income level equal to monthly household income (monthly household income divided by the number of household members) was classified into quintiles by gender and age (5-year-old unit), and the frequency of each year was compared.
Regarding the difference in the oral function restriction rate according to income, in the case of men, the rate was highest among low earners, followed by medium, medium-low, medium-high, and high earners in 2009. In 2019, there was a consistent decrease in the rate by increasing income, whereas in 2014, the decrease in rate was consistent, except for the high-income category in which the rate was higher than that in the medium-high category. There were more variations among the women: In 2009, the oral function restriction rate was highest among the low-medium earners, followed by the low, medium, medium-high, and high earners. The decrease in rate in 2014 was consistent with increasing income, and in 2019, the rate was highest among low-income earners, followed by medium, medium-low, high, and medium-high [Table 3].
|Table 3: Differences in oral function restriction rates by gender and income|
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Effects of the chewing and speaking problems on the treatment of depression
The effects of the chewing and speaking problems on the treatment of depression were investigated by the multiple regression analysis. In the linear regression analysis, it was confirmed that the Durbin–Watson value was close to 2 and thus independent. This was measured on a five-point scale: 1, very uncomfortable; 2, discomfort; 3, fair enough; 4, not very uncomfortable; and 5, not at all uncomfortable.
In 2009, both chewing and speaking were significant. However, in 2014, chewing was significant while speaking was not, and in 2019, chewing was not significant but speaking was significant, indicating a difference in the effect on depression treatment according to the change of year [Table 4].
|Table 4: Effects of chewing and speaking problems on the treatment of depression|
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Effects of oral aids on chewing and speaking problems
The effects of oral aids on chewing and speaking problems were analyzed by the multiple regression analysis. In the linear regression analysis, it was confirmed that the Durbin–Watson value was close to 2 and thus independent.
In the effect of oral aids on chewing problems, in 2009, dental floss, interdental toothbrush, and electric toothbrush were significant, and in 2014, dental floss and electric toothbrush were significant. In 2019, dental floss, interdental brush, and electric toothbrush had significant effects. It was impossible to confirm the change in the perception of the use of oral products as all of them influenced chewing problems.
In the effect of oral aids on speech problems, in 2009, dental floss, interdental toothbrush, and electric toothbrush had an effect. There was a significant effect with dental floss, brushing solution, and electric toothbrush in 2014 and with dental floss and electric toothbrush in 2019 [Table 5].
| Discussion|| |
When teeth are lost because of oral disease, the range of food choices is narrowed, and problems with balancing meal quantity and quality exist. Thus, subjective and objective chewing abilities are related to the total number of functional teeth. Oral health also affects pronunciation, appearance, and interpersonal and social life, and masticatory ability is related to hypertension, dyslipidemia, and stroke. In addition, in the case of the elderly, tooth loss can lead to nutritional deficiencies.
The proper use of oral functions also affects the quality of life. Dentures and implants are used to solve problems with oral functions such as chewing and speaking problems. The government applied dental insurance to implants in 2014, starting with resin-based full denture insurance on July 1, 2012, to help elderly patients with chewing problems solve the problem of oral function, is still expanding the scope of application. Hence, compared with 2009, it was possible to confirm the decrease in mastication discomfort in all age groups. In addition, the periodontal health of the local community changed with the insurance on yearly “scaling” from July 1, 2013, but with differences in use based on demographic factors such as education, income, and work. However, in a survey conducted among dental visitors in June 2021, 29% were still unaware of the health insurance coverage. This suggests that although the dental insurance policy in Korea is well established, awareness on the policy is poor. A critical look at this policy shows that 19–64-year-olds have reduced authorship inconvenience due to scaling insurance, and those over 65 years have benefited from scaling insurance as well as denture and implant insurance. In 2009 and 2019, among 60–69-year-olds, 17% of males and 25% of females had masticatory discomfort. In other words, these policies need to be further expanded, and because women are more inconvenient, interventions among women should be promoted.
The problem with the chewing function also increases the depression index. Korea has the highest depression and suicide rates among OECD countries. Managing it is therefore crucial, and experts have emphasized the importance of a regular lifestyle and exercise diet. This study showed that solving the chewing and speaking problems had an effect on the treatment of depression, and this is consistent with previous studies., Therefore, it is necessary to integrate the treatment of oral function problems into the treatment of mental problems, not dental problems.
Efforts to expand and publicize polices thus become imperative. Beyond that, public education on a treatment course, as well as actions that should be taken to prevent oral diseases, is needed. In this study, oral products influenced chewing and speaking, and there was a significant difference over 2009, 2004, and 2019. Therefore, this finding agrees with Jang et al.’s study, which emphasized the necessity of insurance coverage for continuous oral health care. Patients are interested in oral care but lack knowledge regarding the types of products and their usage. They are also inhibited by the cost burden of accessing oral care. This essentially makes expansion of dental insurance pertinent.
This study is difficult to generalize as a secondary study using only the National Health and Nutrition Survey for 3 years in Korea, but since it was conducted based on research conducted by the state, we hope to use it as basic data for oral health development.
| Conclusion|| |
Solving oral function problems will help in the treatment of depression, and effective use of oral products will address oral function problems. In addition, gender-sensitive education and expansion of dental health insurance coverage are required.
I would like to thank the Korea Centers for Disease Control and Prevention for providing data on the National Health and Nutrition Examination Survey.
Financial support and sponsorship
Conflicts of interest
The author declares no conflict of interest.
This study was conducted solely by Eun Gyo Son.
Ethical policy and Institutional Review Board statement
The National Health and Nutrition Examination Survey is a statutory survey on health behaviors, chronic disease prevalence, food and nutrition intake conducted in accordance with Article 16 of the National Health Promotion Act.
Patient declaration of consent
Informed written consent was obtained from patients by the state, and this study used secondary data.
Data availability statement
2009: 2009-01CON-03-2C/The Fourth Korea National Health and Nutrition Examination Survey (KNHANES IV-3), 2009, Korea Centers for Disease Control and Prevention.
2014: 2013-12EXP-03-5C/The Sixth Korea National Health and Nutrition Examination Survey (KNHANES VI-2), 2014, Korea Centers for Disease Control and Prevention.
2019: 2018-01-03-C-A/The Seventh Korea National Health and Nutrition Examination Survey (KNHANES VIII-1), 2019, Korea Disease Control and Prevention Agency.
| References|| |
Statistical Office. 2019 population and housing census. 2020. Available from: https://eiec.kdi.re.kr/policy/materialView.do?num=204403&topic=
. [Last accessed on 2020 Aug 28].
Lee SH Are you looking at the aging problem correctly? KERI Col 2013;4:1-3.
Kang KH, Kim KH An integrative study on the subjective happiness by eating foods in the elderly: Focus group interview. J Korea Acad Ind Coop Soc 2018;20:75-82.
Kwon SM The relation between desire and happiness from the viewpoint of psychology. Chul Hak Sa Sang: J Philos Ideas 2010;36:121-52.
Yang SC The effects of COVID-19 pandemic on real estate market. J Appraisal Stud 2020;19:5-28.
An ST, Lim YJ, Lee HN A content analysis of eating show (Mukbang) programs on television and online program content in South Korea. Korean J Broadcast Telecommun Stud 2020;34:39-79.
Kanasi E, Ayilavarapu S, Jones J The aging population: Demographics and the biology of aging. Periodontol 2000 2016;72:13-8.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. VA: American Psychiatric Association; 2013.
Park MJ Suicidal ideation and affecting factors according to sex in elderly by using Korea Health Panel Data 2010. J Korean Data Anal Soc 2015;17:1087-99.
Im IJ, Lee HJ, Kim HH The relationship among subjective chewing function, chewing-related quality of life, and depression: A structural equation modeling approach. J Rehabil Res 2019; 23:107-23.
Ryu HS, Lee MA Eating alone and depressive symptoms of Korean older adults: Examining differential effects by gender. Surv Res 2019;20:1-27.
Heo SE, Jang KA, Kim YR, Kang HK Relationship between subjective dry mouth feeling and cognitive dysfunction assessment in elderly in some areas. Korean Soc Oral Health Sci 2021;9:17-23.
Park TJ, Heo HJ, Cho MJ, Kim HC, Youm YS, Song KB, et al
. Association between masticatory function and cognitive impairment in the elderly. J Korean Acad Oral Health 2021;45:57-63.
Kim SH A convergence study on the oral myofunction and oral bacteria in the elderly with systemic disease. J Converg Inf Technol 2021;19:315-22.
Shim JS, Lee YH, Hong SJ, Noh KT, Pae AR, Kim HS, et al
. Relationship between usage of removable denture and depression in Korean adults with loss of multiple teeth: A cross-sectional study using the Seventh Korea National Health and Nutrition Examination Survey. J Korean Acad Prosthodont 2021;59:1-10.
Cho MJ, Ma JK Relationship between the number of remaining teeth and depression in Korean adults. J Korean Soc Dent Hyg 2016;16:19-25.
Choi HS Relationship between depression and number of present teeth in Korean elderly: Data from the Sixth Korea National Health and Nutrition Examination Survey. J Korean Soc Dent Hyg 2019;19:689-98.
Choi MI, Noh HJ, Han SY, Mun SJ Effect of cognitive function and oral health status on mastication ability in elderly individuals. J Korean Soc Dent Hyg 2019;19:65-78.
Kim YS, Jun BH A study of comparative mastication capability and life quality of elderly people using dentures or implant. J Korean Soc Dent Hyg 2011;11:629-36.
Her SY, Kim JS A study on the chewing ability and subjective oral health and DMFT of over 60’s adults contracting in cardiovascular disease. J Dent Hyg Sci 2017;5:1-7.
Kwon HG Food Intake and Oral Health. New York: Korea Invention Promotion Association; 2006. p. 88-9.
Choi HS Summary of questions and answers related to implants and dentures (dentures) among dental health insurance. J Korean Dent Ins Soc2019:21-8.
Park IS A study on the change of dental scaling experience in some areas after applying scaling insurance. Soc Dig Policy Manage 2017;15:387-97.
Medical News. Seoul: 8 Years of Applying Scaling Insurance… Still 29% Don’t Know. Available from: https://www.bosa.co.kr/news/articleView.html?idxno=2152263
. [Last accessed on 2021 Jun 07].
Sisajournal. Seoul: The key to treating depression is timing. Available from: http://www.sisajournal.com/news/articleView.html?idxno=219055
. [Last accessed on 2021 Jun 24].
Jang HY, Lee SR, Lee YJ, Lee SB, Lee HN, Lee HB, et al
. Awareness and need as factors in an incremental oral health care program for Korean adults. J Korean Soc Dent Hyg 2016;16:442-8.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]