Oral health practices and oral hygiene status as indicators of suicidal ideation among adolescents in Southwest Nigeria

BACKGROUND: Oral health is a less-recognized correlate of overall and mental wellbeing. This study aimed to assess the relationship between suicidal behavior (ideation and attempt) and oral health practices and status, and to determine the effect of sex on these associations among Nigerian adolescents. METHODS: Household survey data were collected from 10 to 19-year-old adolescents in southwestern Nigeria. Dependent variables were daily tooth brushing, daily consumption of refined carbohydrates between meals, and oral hygiene status (measured by plaque index). The independent variable was lifetime suicidal ideation/attempt, dichotomized into ‘yes’ and ‘never’. ‘Daily tooth brushing’ and ‘daily consumption of refined carbohydrates between meals’ were included in two separate logistic regression models, and ‘oral hygiene status’ was included in a linear regression model. The models were adjusted for sex, age, and socioeconomic status. The linear regression model was also adjusted for frequency of daily tooth-brushing and of consumption of refined carbohydrates between meals. Interactions between sex and suicidal ideation/suicide attempt in association with dependent variables were assessed. Significance was set at 5%. RESULTS: We recruited 1,472 participants with mean age (standard deviation) of 14.6 (2.6) years. The mean plaque index was 0.84 (0.56), and 66 (4.5%) adolescents reported ever having suicidal ideation/attempt. Suicidal ideation/attempt was associated with significantly lower likelihood of tooth brushing (OR = 0.48, 95% CI: 0.26, 0.91), higher likelihood of consuming refined carbohydrates between meals (OR = 2.30, 95% CI: 1.29, 4.10), and having poor oral hygiene (B = 0.18, 95% CI: 0.05, 0.32). Among males, suicidal ideation/attempt was associated with less likelihood of eating refined carbohydrates between meals (OR = 0.96, 95% CI: 0.35, 2.61). Conversely, it was associated with a significantly higher likelihood of this outcome (OR = 4.85, 95% CI: 2.23, 10.55) among females. CONCLUSION: The study findings suggest that poor tooth brushing habits and poor oral hygiene are indicators for risk of suicidal behavior for adolescents in Nigeria, while high sugar consumption may be an additional risk factor for adolescent females. These findings support the role of dental practitioners as members of healthcare teams responsible for screening, identifying and referring patients at risk for suicidal ideation/attempt.