# Association of Chewing Difficulty and Number of Remaining Teeth with Anxiety (GAD-7) Among Korean Adults: Evidence from the 2023 KNHANES

## TL;DR

This study finds that chewing difficulty and fewer remaining teeth are linked to higher anxiety levels in Korean adults, suggesting better oral health could improve mental well-being.

## Contribution

The study provides new evidence linking specific oral health indicators to anxiety severity in a nationally representative sample of Korean adults.

## Key findings

- Chewing difficulty and fewer than 20 remaining teeth were significantly associated with greater anxiety severity.
- Overweight status, high stress, depressive symptoms, and unmet dental care needs also correlated with higher anxiety levels.
- Preserving functional dentition and timely dental care may reduce psychological burden in the general population.

## Abstract

Background: Oral health is increasingly recognized as a determinant of overall well-being, but its role in mental health remains underexplored. Chewing difficulty and tooth loss can impair nutrition, social interaction, and quality of life, thereby contributing to psychological distress. Objectives: This study examined the association between oral health indicators and anxiety among Korean adults. Methods: Data were obtained from 4746 adults aged ≥19 years who participated in the 2023 Korea National Health and Nutrition Examination Survey (KNHANES). Anxiety was assessed using the Generalized Anxiety Disorder-7 (GAD-7), a validated 7-item self-report questionnaire with responses on a 4-point Likert scale (0 = not at all to 3 = nearly every day). Anxiety severity was categorized into four levels. Severity was categorized into four levels using the GAD-7. Oral health predictors included the number of remaining teeth and self-reported chewing difficulty, along with toothache experience, toothbrushing frequency, and unmet dental care needs. Complex survey-weighted ordinal logistic regression models were applied, adjusting for sociodemographic, behavioral, and clinical covariates. Results: Overall, 15.3% of adults reported mild, 3.1% moderate, and 1.6% severe anxiety. Chewing difficulty, fewer than 20 remaining teeth, overweight status, high stress, depressive symptoms, and unmet dental care needs were significantly associated with greater anxiety severity. Conclusions: The number of remaining teeth retention and chewing function were closely related to anxiety. Preserving functional dentition and ensuring timely access to dental care may be effective public health measures to reduce the psychological burden in the general population.