Oral Health and Generalized Anxiety Disorder in Adolescents: The Mediating Role of Physical Activity

PURPOSE: This study explored associations between oral health, physical activity, and generalized anxiety disorder (GAD) in adolescents, focusing on the mediating role of physical activity in the relationship between oral health and GAD-7 scores.METHODS: Data from the 20th Korea Youth Risk Behavior Survey (KYRBS, 2024) included 53,166 middle and high school students. GAD symptoms were measured using the GAD-7 scale. Oral health variables covered tooth fracture, chewing discomfort, toothache, and gingival bleeding in the past 12 months. Physical activity was categorized by WHO guidelines. Chi-square tests, logistic regression, and PROCESS macro (Model 4) mediation analysis assessed direct and indirect associations.RESULTS: Adolescents with oral health issues showed higher GAD symptoms. Adjusted odds ratios (ORs) were significant for tooth fracture (OR=1.206, 95% CI: 1.120–1.298), chewing discomfort (OR=1.689, 95% CI: 1.606–1.777), tooth pain (OR=1.892, 95% CI: 1.792–1.997), gingival bleeding (OR=1.761, 95% CI: 1.664–1.862), and overall oral health status (OR=1.985, 95% CI: 1.847–2.132). Physical activity partially mediated these associations, explaining 7.3% (tooth fracture), 0.9% (chewing discomfort), 1.7% (tooth pain), 1.1% (gingival bleeding), and 0.7% (overall oral health status) of the total effect.CONCLUSIONS: Compromised oral health is linked to elevated anxiety in adolescents, with physical activity as a partial mediator. Integrated strategies promoting oral hygiene and physical activity can support adolescent mental health.