Association of psychological distress with periodontal status, plaque accumulation, and salivary flow rate in psychiatric outpatients receiving chronic psychotropic therapy

BACKGROUND: Psychiatric outpatients receiving long-term psychotropic therapy are at increased risk of oral health problems because of medication-related xerostomia, impaired self-care, and reduced utilisation of dental services. This study evaluated the association between psychological distress and periodontal status, plaque accumulation, and salivary flow rate among psychiatric outpatients in Peshawar, Pakistan. METHODS: A hospital-based analytical cross-sectional study was conducted in the psychiatric outpatient departments of tertiary care hospitals in Peshawar, Khyber Pakhtunkhwa, Pakistan. A total of 168 participants receiving psychotropic medications for at least six months were recruited through consecutive sampling. Psychological distress was assessed using the validated Depression Anxiety Stress Scale-21 (DASS-21). Clinical parameters included the Silness and Löe Plaque Index (PI), mean probing pocket depth (PPD) measured using a UNC-15 periodontal probe, and unstimulated salivary flow rate (SFR). RESULTS: The mean age of participants was 34.7 ± 10.2 years, and 53.0% were male. Moderate to extremely severe psychological distress was observed in 64.9% of participants. The mean plaque index was 1.87 ± 0.61, the mean probing pocket depth was 3.42 ± 0.89 mm, and the mean salivary flow rate was 0.21 ± 0.09 mL/min. DASS-21 total score showed a significant positive correlation with plaque index (r = 0.47, p < 0.001) and probing pocket depth (r = 0.43, p < 0.001), while an inverse correlation was observed with salivary flow rate (r = - 0.52, p < 0.001). Multiple linear regression analysis identified DASS-21 score, plaque index, salivary flow rate, age, and duration of psychotropic medication use as independent predictors of probing pocket depth (R² = 0.48, p < 0.001). CONCLUSION: Psychological distress was significantly associated with poorer periodontal status and reduced salivary flow among psychiatric outpatients receiving chronic psychotropic therapy. These findings highlight the importance of integrating routine oral health assessment and preventive dental care into psychiatric outpatient services, particularly in low- and middle-income country settings.